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Sample records for center lansce experiment

  1. The Manuel Lujan Jr. Neutron Scattering Center (LANSCE) experiment reports 1993 run cycle. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Farrer, R.; Longshore, A. [comps.

    1995-06-01

    This year the Manuel Lujan Jr. Neutron Scattering Center (LANSCE) ran an informal user program because the US Department of Energy planned to close LANSCE in FY1994. As a result, an advisory committee recommended that LANSCE scientists and their collaborators complete work in progress. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and a associated Proton Storage Ring (PSR), which can Iter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory (LANL) may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. This year, a total of 127 proposals were submitted. The proposed experiments involved 229 scientists, 57 of whom visited LANSCE to participate in measurements. In addition, 3 (nuclear physics) participating research teams, comprising 44 scientists, carried out experiments at LANSCE. Instrument beam time was again oversubscribed, with 552 total days requested an 473 available for allocation.

  2. The Manuel Lujan, Jr. Neutron Scattering Center, LANSCE experiment reports: 1990 Run Cycle

    Energy Technology Data Exchange (ETDEWEB)

    DiStravolo, M.A. (comp.)

    1991-10-01

    This year was the third in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each six-month LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred thirty-four proposals were submitted for unclassified research and twelve proposals for research of a programmatic nature to the Laboratory. Our definition of beam availability is when the proton current from the PSR exceeds 50% of the planned value. The PSR ran at 65{mu}A current (average) at 20 Hz for most of 1990. All of the scheduled experiments were performed and experiments in support of the LANSCE research program were accomplished during the discretionary periods.

  3. The Manuel Lujan, Jr. Neutron Scattering Center (LANSCE) experiment reports 1992 run cycle. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    DiStravolo, M.A. [comp.

    1993-09-01

    This year was the fifth in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory, examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred sixty-seven proposals were submitted for unclassified research and twelve proposals for research of a programmatic interest to the Laboratory; six experiments in support of the LANSCE research program were accomplished during the discretionary periods. Oversubscription for instrument beam time by a factor of three was evident with 839 total days requested and only 371 available for allocation.

  4. The Manuel Lujan, Jr. Neutron Scattering Center LANSCE experiment reports 1989 run cycle

    Energy Technology Data Exchange (ETDEWEB)

    Hyer, D.K.; DiStravolo, M.A. (comps.)

    1990-10-01

    This report contains a listing and description of experiments carried on at the LANSCE neutron scattering facility in the following areas: High Density Powder Diffraction; Neutron Powder Diffractometer, (NPD); Single Crystal Diffractometer, (SCD); Low-Q Diffractometer, (LQD); Surface Profile Analysis Reflectometer, (SPEAR); Filter Difference Spectrometer, (FDS); and Constant-Q Spectrometer.

  5. Design of the next generation target at Lujan center, LANSCE.

    Energy Technology Data Exchange (ETDEWEB)

    Ferres, Laurent [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-07-27

    This is a presentation given at Los Alamos National Laboratory (LANL) on the design of the next generation target at Lujan center, LANSCE. The motivation for this design is to enable new nuclear physics experiments (defense program applications (DANCE)) that are currently limited by neutron intensity or energy resolution available at LANSCE. The target is being redesigned so that the Flight Paths in the upper tier provide a higher intensity in the epithermal and medium energy ranges.

  6. The NPDGamma Experiment at LANSCE

    CERN Document Server

    Gericke, M T; Chupp, T E; Coulter, K P; Dabaghyan, M; Dawkins, M; Desai, D; Freedman, S J; Gentile, T R; Gillis, R C; Greene, G L; Hersman, F W; Ino, T; Jones, G L; Kandes, M; Lauss, B; Leuschner, M B; Lozowski, W R; Mahurin, R; Masuda, Y; Mason, M; Mitchell, G S; Muto, S; Nann, H; Page, S A; Penttila, S I; Ramsay, W D; Santra, S B; Seo, P N; Sharapov, E I; Smith, T B; Snow, W M; Wilburn, W S; Yuan, V; Zhu, H

    2005-01-01

    The NPDGamma collaboration has constructed and commissioned an apparatus to determine the size of the pion-nucleon coupling constant in the parity non conserving pion exchange weak potential for N-N interactions. This coupling constant is directly proportional to the parity violating up-down asymmetry in the angular distribution of gamma rays with respect to the neutron spin direction in the capture of polarized cold neutrons on protons. The measurement of the weak pNN coupling will provide a test for the effective theory, describing the nucleon-nucleon interaction as mediated by the exchange of mesons, and provide results against which to compare models describing QCD at low energy. NPDGamma is located at the Los Alamos Neutron Science Center (LANSCE) and utilizes the special features of cold spallation neutrons to make it possible to measure very small gamma ray asymmetries. In this paper, we present the motivation for the experiment and report on experimental setup as well as the current status of the proj...

  7. LANSCE '90: The Manuel Lujan Jr. Neutron Scattering Center

    Energy Technology Data Exchange (ETDEWEB)

    Pynn, R.

    1990-01-01

    This paper describes progress that has been made at the Manuel Lujan Jr. Neutron Scattering Center (LANSCE) during the past two years. Presently, LANSCE provides a higher peak neutron flux than any other pulsed spallation neutron source. There are seven spectrometers for neutron scattering experiments that are operated for a national user program sponsored by the US Department of Energy. Two more spectrometers are under construction. Plans have been made to raise the number of beam holes available for instrumentation and to improve the efficiency of the target/moderator system. 9 refs., 4 figs.

  8. Los Alamos Neutron Science Center (LANSCE) Nuclear Science Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Ronald Owen [Los Alamos National Laboratory; Wender, Steve [Los Alamos National Laboratory

    2015-06-19

    The Los Alamos Neutron Science Center (LANSCE) facilities for Nuclear Science consist of a high-energy "white" neutron source (Target 4) with 6 flight paths, three low-energy nuclear science flight paths at the Lujan Center, and a proton reaction area. The neutron beams produced at the Target 4 complement those produced at the Lujan Center because they are of much higher energy and have shorter pulse widths. The neutron sources are driven by the 800-MeV proton beam of the LANSCE linear accelerator. With these facilities, LANSCE is able to deliver neutrons with energies ranging from a milli-electron volt to several hundreds of MeV, as well as proton beams with a wide range of energy, time and intensity characteristics. The facilities, instruments and research programs are described briefly.

  9. Operational status of the Los Alamos neutron science center (LANSCE)

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Kevin W [Los Alamos National Laboratory; Erickson, John L [Los Alamos National Laboratory; Schoenberg, Kurt F [Los Alamos National Laboratory

    2010-01-01

    The Los Alamos Neutron Science Center (LANSCE) accelerator and beam delivery complex generates the proton beams that serve three neutron production sources; the thermal and cold source for the Manuel Lujan Jr. Neutron Scattering Center, the Weapons Neutron Research (WNR) high-energy neutron source, and a pulsed Ultra-Cold Neutron Source. These three sources are the foundation of strong and productive multi-disciplinary research programs that serve a diverse and robust user community. The facility also provides multiplexed beams for the production of medical radioisotopes and proton radiography of dynamic events. The recent operating history of these sources will be reviewed and plans for performance improvement will be discussed, together with the underlying drivers for the proposed LANSCE Refurbishment project. The details of this latter project are presented in a separate contribution.

  10. Prospects for a measurement of the 237U(n,f) cross section at the LANSCE Lujan Center

    Energy Technology Data Exchange (ETDEWEB)

    Devlin, Matthew James [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Mocko, Michal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Gavron, Victor [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Jandel, Marian [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Rusev, Gencho Yordanov [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Bredeweg, Todd Allen [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-06-24

    A new measurement of the 237U(n, f) cross section from thermal to ≈ 100 keV is discussed, using one of the flightpaths at the LANSCE Lujan Center. Previous energy-resolved resonance-region measurements have been conducted using weapon test time-of-flight[1] and the LANSCE Lead Slowing Down Spectrometer[2], the former of which is limited in its energy range, and the latter in its energy resolution and range. We present here a proposal, based on simulations of the Lujan Center neutron flux and a hypothetical experiment, that is expected to adequately address both of these issues.

  11. LANSCE Activity Report

    Energy Technology Data Exchange (ETDEWEB)

    Amy Robinson; Audrey Archuleta; Barbara Maes; Dan Strottman; Earl Hoffman; Garth Tietjen; Gene Farnum; Geoff Greene; Joyce Roberts; Ken Johnson; Paul Lewis; Roger Pynn; Stan Schriber; Steve Sterbenz; Steve Wender; Sue Harper

    1999-02-01

    The Los Alamos Neutron Science Center Activity Report describes scientific and technological progress and achievements in LANSCE Division during the period of 1995 to 1998. This report includes a message from the Division Director, an overview of LANSCE, sponsor overviews, research highlights, advanced projects and facility upgrades achievements, experimental and user program accomplishments, news and events, and a list of publications. The research highlights cover the areas of condensed-matter science and engineering, accelerator science, nuclear science, and radiography. This report also contains a compact disk that includes an overview, the Activity Report itself, LANSCE operations progress reports for 1996 and 1997, experiment reports from LANSCE users, as well as a search capability.

  12. DANCE (Detector for Advanced Neutron Capture Experiments) is a 4π array of BaF2 crystals installed at LANSCE, Lujan Center. Neutron capture measurements on ^157Gd and ^89Y nuclei were conducted using this facility.

    Science.gov (United States)

    Chyzh, A.; Mitchell, G.; Vieira, D.; Bredeweg, T.; Ullmann, J.; Jandel, M.; Couture, A.; Keksis, A.; Rundberg, R.; Wilhelmy, J.; O'Donnell, J.; Baramsai, B.; Haight, R.; Wouters, J.; Krticka, M.; Parker, W.; Becker, J.; Agvaanlusan, U.

    2009-10-01

    DANCE (Detector for Advanced Neutron Capture Experiments) is a 4π array of BaF2 crystals installed at LANSCE, Lujan Center. Neutron capture measurements on ^157Gd and ^89Y nuclei were conducted using this facility. The absolute cross sections of the ^89Y(n,γ) reaction was measured for the first time ever in the neutron energy range of 10 eV -- 10 keV and improvements were made in the 10 -- 300 keV range. The error bars were significantly reduced and number of cross section points was increased since the past ^89Y(n,γ) experiments. The ^157Gd(n,γ) cross section was determined at En = 20 eV -- 300 keV by normalizing the experimental DANCE data to a well known resonance taken from the ENDF/B-VII library. Computer simulations of the ^157Gd(n,γ) cascades and DANCE pulse height function were made using DICEBOX and GEANT4 codes and simulated Esum and Eγ spectra are compared to the experimental DANCE data. Values of spin and photon strength function (PSF) of the ^157Gd(n,γ) resonances are provided in the range of En = 2 -- 300 eV using spin dependence upon a γ-ray multiplicity.

  13. Lujan at Los Alamos Neutron Science Center (LANSCE)

    Data.gov (United States)

    Federal Laboratory Consortium — The Lujan Neutron Scattering Center (Lujan Center) at Los Alamos National Laboratory is an intense pulsed neutrons source operating at a power level of 80 -100 kW....

  14. Detector for advanced neutron capture experiments at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Ullmann, J. L. (John L.); Reifarth, R. (Rene); Haight, Robert C.; Hunt, L. F. (Lloyd F.); O' Donnell, J. M.; Bredeweg, T. A. (Todd A); Wilhelmy, J. B. (Jerry B.); Fowler, Malcolm M.; Vieira, D. J. (David J.); Wouters, J. M. (Jan Marc); Strottman, D.; Kaeppeler, F. (Franz K.); Heil, M.; Chamberlin, E. P. (Edwin P.)

    2002-01-01

    The Detector for Advanced Neutron Capture Experiments (DANCE) is a 159-element 4x barium fluoride array designed to study neutron capture on small quantities, 1 mg or less, of radioactive nuclides. It is being built on a 20 m neutron flight path which views the 'upper tier' water moderator at the Manuel J. Lujan Jr. Neutron Scattering Center at the Los Alamos Neutron Science Center. The detector design is based on Monte Carlo calculations which have suggested ways to minimize backgrounds due to neutron scattering events. A data acquisition system based on fast transient digitizers is bcing implemented

  15. Design of the Next Generation Target at the Lujan Neutron Scattering Center, LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Ferres, Laurent [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); National Graduate School of Engineering and Research Center (ENSICAEN), Caen (France)

    2016-08-03

    Los Alamos National Laboratory (LANL) supports scientific research in many diverse fields such as biology, chemistry, and nuclear science. The Laboratory was established in 1943 during the Second World War to develop nuclear weapons. Today, LANL is one of the largest laboratories dedicated to nuclear defense and operates an 800 MeV proton linear accelerator for basic and applied research including: production of high- and low-energy neutrons beams, isotope production for medical applications and proton radiography. This accelerator is located at the Los Alamos Neutron Science Center (LANSCE). The work performed involved the redesign of the target for the low-energy neutron source at the Lujan Neutron Scattering Center, which is one of the facilities built around the accelerator. The redesign of the target involves modeling various arrangements of the moderator-reflector-shield for the next generation neutron production target. This is done using Monte Carlo N-Particle eXtended (MCNPX), and ROOT analysis framework, a C++ based-software, to analyze the results.

  16. Commissioning and initial operation of the Isotope Production Facility at the Los Alamos Neutron Science Center (LANSCE).

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, K. F. (Kenneth F.); Alvestad, H. W. (Henry W.); Barkley, W. C. (Walter C.); Barlow, D. B. (David B.); Barr, D. S. (Dean S.); Bennett, L. S. (Langdon S.); Bitteker, L. J. (Leo J.); Bjorklund, E. A. (Eric A.); Boedeker, W.; Borden, M. J. (Michael J.); Cardon, R.; Carr, G. (Gary); Casados, J. L. (Jeffrey L.); Cohen, Stanley; Cordova, J. F. (Justo J.; Faucett, John Allen,; Fresquez, M. (Matthew); Gallegos, F. R. (Floyd R.); Gilpatrick, J. D. (John Douglas); Gonzales, F. (Fermin); Gorman, F. W. (Frederick W.); Gulley, M. S. (Mark S.); Hall, M. J. (Michael J.); Hayden, D. J. (David J.); Heaton, R. C. (Richard C.); Henderson, D. B. (Dale B.); Ireland, D. B. (David B.); Jacobson, E. G. (Edward G.); Johns, G. D. (Glen D.); Kersteins, D. M. (Debora M.); Maestas, A. J. (Alfred J.); Martinez, A. M. (Alexandra M.); Martinez, D. G. (Derwin G.); Martinez, G.; Martinez, J.; Martinez, M. P. (Martin P.); Merl, R. B. (Robert B.); Merrill, J. B. (John B.); Meyer, B. J. (Bruce J.); Meyer, R., Sr.; Milder, M.; Morgan, E.; Nortier, M.; O' Hara, J. F. (James F.); Olivas, F. R. (Felix R.); Oothoudt, Michael; Pence, T. D. (Tim D.); Perets, Mikhaʾel ben Yosef; Peterson, E.; Pillai, C. (Chandra); Romero, F.; Rose, C.; Rybarcyk, L. J. (Lawrence J.); Sanchez, G. (Gary); Sandoval, J. B. (Jacob B.); Schaller, S. (Stuart); Shelley, F. E. (Fred E.); Shurter, R. B. (Robert B.); Sommer, Walter F.; Stettler, M. W. (Matthew W.); Stockton, J. L. (Jerry L.); Sturrock, J. C. (James C.); Tomei, T. L. (Tony L.); Valdez, F.; Vigil, V. P. (Victor P.); Walstrom, P. L. (Peter L.); Wanco, P. M. (Peter M.); Wilmarth, J.

    2004-01-01

    The recently completed 100-MeV H{sup +} Isotope Production Facility (IPF) at the LANSCE will provide radioisotopes for medical research and diagnosis, for basic research and for commercial use. A change to the LANSCE accelerator facility allowed for the installation of the IPF. Three components make up the LANSCE accelerator: an injector that accelerates the H{sup +} beam to 750-KeV, a drift-tube linac (DTL) that increases the beam energy to 100-MeV, and a side-coupled cavity linac (SCCL) that accelerates the beam to 800-MeV. The transition region, a space between the DTL and the SCCL, was modified to permit the insertion of a kicker magnet (23{sup o} kick angle) for the purpose of extracting a portion of the 100-MeV H{sup +} beam. A new beam line was installed to transport the extracted H{sup +} beam to the radioisotope production target chamber. This paper will describe the commissioning and initial operating experiences of IPF.

  17. Geanie at Lansce

    Science.gov (United States)

    Johns, G. D.; Drake, D. M.; Nelson, R. O.; Wilburn, W. S.; Archer, D. E.; Becker, J. A.; Bernstein, L. A.; Younes, W.; Garrett, P. E.; Yates, S. W.

    1998-04-01

    GEANIE (Germanium Array for Neutron-Induced Excitations) is a large-scale high-resolution Ge γ-ray spectrometer located at the Weapons Neutron Research (WNR) facility of the Los Alamos Neutron Science Center (LANSCE). Research with GEANIE includes forefront nuclear reaction and spectroscopy studies along with state-of-the-art measurements needed for the Stockpile Stewardship program. An overview of the spectrometer and ongoing research will be presented. Amparo Corporation, Santa Fe, NM

  18. LANSCE nuclear science facilities and activities

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Ronald O [Los Alamos National Laboratory

    2010-01-01

    Nuclear science activities at the Los Alamos Neutron Science Center (LANSCE) encompass measurements spanning the neutron energy range from thermal to 600 MeV. The neutron sources use spallation of the LANSCE 800 MeV pulsed proton beam with the time-of-flight technique to measure properties of neutron-induced reactions as a function of energy over this large energy range. Current experiments are conducted at the Lujan Center moderated neutron source, the unmoderated WNR target, and with a lead-slowing-down spectrometer. Instruments in use include the DANCE array of BaF{sub 2} scintillators for neutron capture studies, the FIGARO array of liquid scintillator neutron detectors, the GEANIE array of high-resolution HPGe x-ray and gamma-ray detectors, and a number of fission chambers, and other detectors. The LANL capabilities for production and handling of radioactive materials coupled with the neutron sources and detectors at LANSCE are enabling new and challenging measurements for a variety of applications including nuclear energy and nuclear astrophysics. An overview of recent research and examples of results is presented.

  19. LANSCE RF System Refurbishment

    CERN Document Server

    Rees, Daniel; Kwon, Sung-il; Lyles, John T M; Lynch, Michael; Prokop, Mark; Reass, William; Tallerico, Paul J

    2005-01-01

    The Los Alamos Neutron Science Center (LANSCE) is in the planning phase of a refurbishment project that will sustain reliable facility operations well into the next decade. The LANSCE accelerator was constructed in the late 1960s and early 1970s and is a national user facility that provides pulsed protons and spallation neutrons for defense and civilian research and applications. We will be replacing all the 201 MHz RF systems and a substantial fraction of the 805 MHz RF systems and high voltage systems. The current 44 LANSCE 805 MHz, 1.25 MW klystrons have an average in-service time in excess of 110,000 hours. All 44 must be in service to operate the accelerator. There are only 9 spares left. The klystrons receive their DC power from the power system originally installed in 1960. Although this power system has been extremely reliable, gas analysis of the insulating oil is indicating age related degradation that will need attention in the next few years. This paper will provide the design details of the new R...

  20. Status of the LANSCE refurbishment project

    Energy Technology Data Exchange (ETDEWEB)

    Erickson, John L [Los Alamos National Laboratory; Jones, Kevin W [Los Alamos National Laboratory; Prince, Peter P [Los Alamos National Laboratory

    2010-01-01

    The Los Alamos Neutron Science Center (LANSCE) accelerator is an 800-MeV proton linac that drives user facilities for isotope production, proton radiography, ultra-cold neutrons, weapons neutron research and various sciences using neutron scattering. The LANSCE Refurbishment Project (LANSCE-R) is an ambitious project to refurbish key elements of the LANSCE accelerator that are becoming obsolete or nearing end-of-life. The preliminary design phase for the project is funded and underway. The 6 year, $150M (US) project will enable future decades of reliable, high-performance operation. It will replace a substantial fraction of the radio-frequency power systems (gridded tubes and klystrons) with modern systems, completely refurbish the original accelerator control and timing systems, replace obsolete diagnostic devices, and modernize other ancillary systems. An overview of the LANSCE-R project will be presented. The project requirements will be discussed, the preliminary technical solutions presented, and the plan for successful project execution while meeting annual customer expectations for beam delivery will be reviewed.

  1. LANSCE radiation security system (RSS)

    Energy Technology Data Exchange (ETDEWEB)

    Gallegos, F.R. [Los Alamos National Lab., NM (United States). Los Alamos Neutron Science Center

    1996-12-31

    The Radiation Security System (RSS) is an engineered safety system which automatically terminates transmission of accelerated ion beams in response to pre-defined abnormal conditions. It is one of the four major mechanisms used to protect people from radiation hazards induced by accelerated pulsed ion beams at the Los Alamos Neutron Science Center (LANSCE). The others are shielding, administrative policies and procedures, and qualified, trained personnel. Prompt radiation hazards at the half-mile long LANSCE accelerator exist due to average beam intensities ranging from 1 milli-amp for H{sup +} beam to 100 micro-amps for the high intensity H{sup {minus}} beam. Experimental programs are supplied with variable energy (maximum 800 MeV), pulse-width (maximum 1 msec), and pulse frequency (maximum 120 Hz) ion beams. The RSS includes personnel access control systems, beam spill monitoring systems, and beam current level limiting systems. It is a stand-alone system with redundant logic chains. A fault of the RSS will cause the insertion of fusible beam plugs in the accelerator low energy beam transport. The design philosophy, description, and operation of the RSS are described in this paper.

  2. Neutron capture measurement on {sup 173}Lu at LANSCE with DANCE detector

    Energy Technology Data Exchange (ETDEWEB)

    Theroine, C.; Ebran, A.; Meot, V.; Roig, O. [CEA DAM DIF, F-91297 Arpajon (France); Bond, E. M.; Bredeweg, T. A.; Couture, A.; Haight, R. C.; Jandel, M.; Nortier, F. M.; O' Donnell, J. M.; Rundberg, R. S.; Taylor, W. A.; Ullmann, J. L.; Viera, D. J.; Wilhelmy, J. B.; Wouters, J. M. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States)

    2013-06-10

    The (n,{gamma}) cross section on the unstable {sup 173}Lu(t{sub 1/2} = 1.37y) has been measured from thermal energy up to 200 eV at Los Alamos Neutron Science Center (LANSCE) with The Detector for Advanced Neutron Capture Experiements (DANCE). The main aim of this study is to validate and optimize reaction models for unstable nucleus. A preliminary capture yield will be presented in this paper.

  3. Neutron capture measurement on 173Lu at LANSCE with DANCE detector

    Science.gov (United States)

    Theroine, C.; Ebran, A.; Méot, V.; Roig, O.; Bond, E. M.; Bredeweg, T. A.; Couture, A.; Haight, R. C.; Jandel, M.; Nortier, F. M.; O'Donnell, J. M.; Rundberg, R. S.; Taylor, W. A.; Ullmann, J. L.; Viera, D. J.; Wilhelmy, J. B.; Wouters, J. M.

    2013-06-01

    The (n,γ) cross section on the unstable 173Lu(t1/2 = 1.37y) has been measured from thermal energy up to 200 eV at Los Alamos Neutron Science Center (LANSCE) with The Detector for Advanced Neutron Capture Experiements (DANCE). The main aim of this study is to validate and optimize reaction models for unstable nucleus. A preliminary capture yield will be presented in this paper.

  4. Science-based stockpile stewardship at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Browne, J. [Los Alamos National Lab., NM (United States)

    1995-10-01

    Let me tell you a little about the Los Alamos Neutron Science Center (LANSCE) and how some of the examples you heard about from Sig Hecker and John Immele fit together in this view of a different world in the future where defense, basic and industrial research overlap. I am going to talk about science-based stockpile stewardship at LANSCE; the accelerator production of tritium (APT), which I think has a real bearing on the neutron road map; the world-class neutron science user facility, for which I will provide some examples so you can see the connection with defense science; and lastly, testing concepts for a high-power spallation neutron target and waste transmutation.

  5. Neutron Imaging Developments at LANSCE

    Science.gov (United States)

    Nelson, Ron; Hunter, James; Schirato, Richard; Vogel, Sven; Swift, Alicia; Ickes, Tim; Ward, Bill; Losko, Adrian; Tremsin, Anton

    2015-10-01

    Neutron imaging is complementary to x-ray imaging because of its sensitivity to light elements and greater penetration of high-Z materials. Energy-resolved neutron imaging can provide contrast enhancements for elements and isotopes due to the variations with energy in scattering cross sections due to nuclear resonances. These cross section differences exist due to compound nuclear resonances that are characteristic of each element and isotope, as well as broader resonances at higher energies. In addition, multi-probe imaging, such as combined photon and neutron imaging, is a powerful tool for discerning properties and features in materials that cannot be observed with a single probe. Recently, we have demonstrated neutron imaging, both radiography and computed tomography, using the moderated (Lujan Center) and high-energy (WNR facility) neutron sources at LANSCE. Flat panel x-ray detectors with suitable scintillator-converter screens provide good sensitivity for both low and high neutron energies. Micro-Channel-Plate detectors and iCCD scintillator camera systems that provide the fast time gating needed for energy-resolved imaging have been demonstrated as well. Examples of recent work will be shown including fluid flow in plants and imaging through dense thick objects. This work is funded by the US Department of Energy, National Nuclear Security Administration, and performed by Los Alamos National Security LLC under Contract DE-AC52-06NA25396.

  6. Overview of the Neutron experimental facilities at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Mocko, Michal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-06-30

    This presentation gives an overview of the neutron experimental facilities at LANSCE. The layout is mentioned in detail, with a map of the south-side experimental facilities, information on Target-4 and the Lujan Center. Then it goes into detail about neutron sources, specifically continuous versus pulsed. Target 4 is then discussed. In conclusion, we have introduced the south-side experimental facilities in operation at LANSCE. 1L target and Target 4 provide complementary neutron energy spectra. Two spallation neutron sources taken together cover more than 11 orders of magnitude in neutron energy.

  7. Need for an (n,α) Apparatus at the LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, Paul E. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-03-05

    There is an urgent need for a new (n,α) measurement capability at the Los Alamos Neutrons Science Center (LANSCE) for several reasons. First, it has been shown that (n,α) measurements on medium- to heavy-mass nuclides can provide some of the best constraints on some of the most important reaction rates for explosive nucleosynthesis studies. A few such measurements have been made, but many more are needed. Second, there are a few (n,p) and (n,α) cross sections on lighter nuclides of importance to nuclear astrophysics that remain unmeasured. Third, it has been shown that (n,α) measurements can constrain photon strength functions (PSFs) at very low energies. This is important because recent experiments, theory, and astrophysical calculations have demonstrated that enhanced PSFs at these energies can have large impacts on nucleosynthesis occurring in explosive environments. Also, enhanced low-energy PSFs could have significant impact on (n,γ) cross sections of interest to radiochemical diagnostics of nuclear devices. However, the shape of PSFs at low energies is a subject of considerable controversy, so new data are badly needed. Fourth, previous (n,α) data have revealed a number of puzzles and hints of exotic atomic-nuclear interactions. In addition to being interesting in their own light, these interactions could be important for understanding high-energy-density environments such as in nuclear explosion and at the National Ignition Facility. Simulations indicate that the high neutron flux at the Manuel Lujan Jr. Neutron Scattering Center (MLNSC) at the LANSCE will make many more of the needed measurements feasible. Hence, a new (n,α) instrument at the MLNSC would enable a wide range of important and interesting basic and applied science.

  8. Proceedings of the workshop on neutron-induced gamma-ray physics at LANSCE/WNR

    Energy Technology Data Exchange (ETDEWEB)

    Strottman, D.D.

    1996-07-01

    The purpose of the workshop was to present the unique capabilities of LANSCE coupled with a large scale Compton suppressed Ge detector array and to help define a future experimental research program. This document contains the vuegraphs from the unclassified session. The vuegraphs were kindly provided by the invited speakers who came from both the university and the national laboratory communities. The talks focused on planned as well as potential experiments at LANSCE/WNR and their importance to the field.

  9. BEAM POSITION AND PHASE MONITORS FOR THE LANSCE LINAC

    Energy Technology Data Exchange (ETDEWEB)

    McCrady, Rodney C. [Los Alamos National Laboratory; Gilpatrick, John D. [Los Alamos National Laboratory; Watkins, Heath A. [Los Alamos National Laboratory

    2012-04-11

    New beam-position and phase monitors are under development for the linac at the Los Alamos Neutron Science Center (LANSCE.) Transducers have been designed and are being installed. We are considering many options for the electronic instrumentation to process the signals and provide position and phase data with the necessary precision and flexibility to serve the various required functions. We'll present the various options under consideration for instrumentation along with the advantages and shortcomings of these options.

  10. Neutron Imaging Developments at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Ronald Owen [Los Alamos National Laboratory; Hunter, James F. [Los Alamos National Laboratory; Schirato, Richard C. [Los Alamos National Laboratory; Vogel, Sven C. [Los Alamos National Laboratory; Swift, Alicia L. [Los Alamos National Laboratory; Ickes, Timothy Lee [Los Alamos National Laboratory; Ward, William Carl [Los Alamos National Laboratory; Losko, Adrian Simon [University of California at Berkeley; Tremsin, Anton [University of California at Berkeley; Sevanto, Sanna Annika [Los Alamos National Laboratory; Espy, Michelle A. [Los Alamos National Laboratory; Dickman, Lee Thoresen [Los Alamos National Laboratory; Malone, Michael [Los Alamos National Laboratory

    2015-10-29

    Thermal, epithermal, and high-energy neutrons are available from two spallation sources at the 800 MeV proton accelerator. Improvements in detectors and computing have enabled new capabilities that use the pulsed beam properties at LANSCE; these include amorphous Si (aSi) detectors, intensified charge-coupled device cameras, and micro-channel plates. Applications include water flow in living specimens, inclusions and fission products in uranium oxide, and high-energy neutron imaging using an aSi flat panel with ZnS(Ag) scintillator screen. images of a metal/plastic cylinder from photons, low-energy and high-energy neutrons are compared.

  11. LANSCE beam instrumentation and the LANSCE refurbishment project

    Energy Technology Data Exchange (ETDEWEB)

    Mccrady, Rodney C [Los Alamos National Laboratory; Blind, Barbara [Los Alamos National Laboratory; Gilpatrick, John D [Los Alamos National Laboratory; Pillai, Chandra [Los Alamos National Laboratory; Power, John F [Los Alamos National Laboratory; Rybarcyk, Lawrence J [Los Alamos National Laboratory; Sedillo, James D [Los Alamos National Laboratory; Gruchalla, Michael E [Los Alamos National Laboratory

    2010-01-01

    The heart of the LANSCE accelerator complex consists of Cockroft-Walton-type injectors, a drift-tube linac (DTL) and a side-coupled linac (CCL). These systems are approaching 40 years of age and a project to re-establish high-power capability and to extend the lifetime is underway. Many of the present beam diagnostic systems are difficult to maintain, and the original beam position monitors don't provide any data at all. These deficiencies hamper beam tuning and trouble-shooting efforts. One thrust of the refurbishment project is to restore reliable operation of the diagnostic systems. This paper describes the present diagnostics systems and their limitations and the envisaged next-generation systems. The emphasis will be on the uses and requirements for the systems rather than the solutions and engineering aspects of the refurbishment.

  12. Characterizing and Controlling Beam Losses at the LANSCE Facility

    Energy Technology Data Exchange (ETDEWEB)

    Rybarcyk, Lawrence J. [Los Alamos National Laboratory

    2012-09-12

    The Los Alamos Neutron Science Center (LANSCE) currently provides 100-MeV H{sup +} and 800-MeV H{sup -} beams to several user facilities that have distinct beam requirements, e.g. intensity, micropulse pattern, duty factor, etc. Minimizing beam loss is critical to achieving good performance and reliable operation, but can be challenging in the context of simultaneous multi-beam delivery. This presentation will discuss various aspects related to the observation, characterization and minimization of beam loss associated with normal production beam operations in the linac.

  13. Lead Slowing-Down Spectrometer Research at Lansce

    Science.gov (United States)

    Haight, R. C.; Bredeweg, T. A.; Devlin, M.; Gavron, A.; Jandel, M.; O'Donnell, J. M.; Wender, S. A.; Bélier, G.; Granier, T.; Laurent, B.; Taieb, J.; Danon, Y.; Thompson, J. T.

    2013-03-01

    The lead slowing-down spectrometer (LSDS) at Los Alamos is a 20 ton cube of lead with numerous channels, one for the proton beam from the LANSCE accelerator and others for samples and detectors. A pulsed spallation neutron source at the center of the cube is produced by the 800 MeV proton beam incident on an air-cooled tungsten target. Neutrons from this source are quickly downscattered by various reactions until their energies are less than the first excited state of 207Pb (0.57 MeV). After that, the neutrons slow down by elastic scattering where they lose on the average 1% of their energy per collision. The mean energy of the neutron distribution then changes with time as ~ 1/(t + to)2, where "to" is a constant. The low neutron absorption cross section of lead and multiple scattering of the neutrons leads to a very large neutron flux, approximately 1000 times that available in beams at the intense neutron source at the Lujan Center at LANSCE. Thus nuclear cross sections can be measured with very small samples, or conversely, very small cross sections can be measured with somewhat larger samples. Present research with the LSDS at LANSCE includes measuring fission cross sections on short-lived isotopes such as 237U, developing techniques to measure (n,p) and (n, α) cross sections, testing new types of detectors for use in the extreme radiation environment, and, in an applied context, assessing the possibility of measuring the isotopic content of actinide samples with the eventual goal of characterizing fresh and used reactor fuel rods.

  14. Los Alamos Neutron Science Center

    Energy Technology Data Exchange (ETDEWEB)

    Kippen, Karen Elizabeth [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-11-08

    For more than 30 years the Los Alamos Neutron Science Center (LANSCE) has provided the scientific underpinnings in nuclear physics and material science needed to ensure the safety and surety of the nuclear stockpile into the future. In addition to national security research, the LANSCE User Facility has a vibrant research program in fundamental science, providing the scientific community with intense sources of neutrons and protons to perform experiments supporting civilian research and the production of medical and research isotopes. Five major experimental facilities operate simultaneously. These facilities contribute to the stockpile stewardship program, produce radionuclides for medical testing, and provide a venue for industrial users to irradiate and test electronics. In addition, they perform fundamental research in nuclear physics, nuclear astrophysics, materials science, and many other areas. The LANSCE User Program plays a key role in training the next generation of top scientists and in attracting the best graduate students, postdoctoral researchers, and early-career scientists. The U.S. Department of Energy (DOE), National Nuclear Security Administration (NNSA) —the principal sponsor of LANSCE—works with the Office of Science and the Office of Nuclear Energy, which have synergistic long-term needs for the linear accelerator and the neutron science that is the heart of LANSCE.

  15. Cross Section Measurements at LANSCE for Defense, Science and Applications

    Science.gov (United States)

    Nelson, Ronald O.

    2015-05-01

    The Los Alamos Neutron Science Center (LANSCE) has three neutron sources that are used for nuclear science measurements. These sources are driven by an 800 MeV proton linear accelerator and cover an energy range from sub-thermal to hundreds of MeV. Research at the facilities is performed under the auspices of a US DOE user program under which research proposals are rated for merit by a program advisory committee and are scheduled based on merit and availability of beam time. A wide variety of instruments is operated at the neutron flight paths at LANSCE including neutron detector arrays, gamma-ray detector arrays, fission fragment detectors, and charged particle detectors. These instruments provide nuclear data for multiple uses that range from increasing knowledge in fundamental science to satisfying data needs for diverse applications such as nuclear energy, global security, and industrial applications. Highlights of recent research related to cross sections measurements are presented, and future research initiatives are discussed.

  16. Cross Section Measurements at LANSCE for Defense, Science and Applications

    Directory of Open Access Journals (Sweden)

    Nelson Ronald O.

    2015-01-01

    Full Text Available The Los Alamos Neutron Science Center (LANSCE has three neutron sources that are used for nuclear science measurements. These sources are driven by an 800 MeV proton linear accelerator and cover an energy range from sub-thermal to hundreds of MeV. Research at the facilities is performed under the auspices of a US DOE user program under which research proposals are rated for merit by a program advisory committee and are scheduled based on merit and availability of beam time. A wide variety of instruments is operated at the neutron flight paths at LANSCE including neutron detector arrays, gamma-ray detector arrays, fission fragment detectors, and charged particle detectors. These instruments provide nuclear data for multiple uses that range from increasing knowledge in fundamental science to satisfying data needs for diverse applications such as nuclear energy, global security, and industrial applications. Highlights of recent research related to cross sections measurements are presented, and future research initiatives are discussed.

  17. Neutron capture measurements on unstable nuclei at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Ullmann, J.L.; Haight, R.C. [LANSCE-3, Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States); Fowler, M.M.; Miller, G.G.; Rundberg, R.S.; Wilhelmy, J.B. [CST-11, Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States)

    1999-06-01

    Although neutron capture by stable isotopes has been extensively measured, there are very few measurements on unstable isotopes. The intense neutron flux at the Manual Lujan Jr. Neutron Scattering Center at LANSCE enables us to measure capture on targets with masses of about 1 mg over the energy range from 1 eV to 100 keV. These measurements are important not only for understanding the basic physics, but also for calculations of stellar nucleosynthesis and Science-Based Stockpile Stewardship. Preliminary measurements on {sup 169}Tm and {sup 171}Tm have been made with deuterated benzene detectors. A new detector array at the Lujan center and a new radioactive isotope separator will combine to give Los Alamos a unique capability for making these measurements. {copyright} {ital 1999 American Institute of Physics.}

  18. Neutron Capture Measurements on Unstable Nuclei at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Ullmann, J.; Haight, R.; Wilhelmy, J.; Fowler, M.; Rundberg, R.; Miller, G.

    1998-11-04

    Although neutron capture by stable isotopes has been extensively measured, there are very few measurements on unstable isotopes. The intense neutron flux at the Manual Lujan Jr. Neutron Scattering Center at LANSCE enables us to measure capture on targets with masses of about 1 mg over the energy range from 1 eV to 100 keV. These measurements are important not only for understanding the basic physics, but also for calculations of stellar nucleosynthesis and Science-Based Stockpile Stewardship. Preliminary measurements on {sup 169}Tm and {sup 171}Tm have been made with deuterated benzene detectors. A new detector array at the Lujan center and a new radioactive isotope separator will combine to give Los Alamos a unique capability for making these measurements.

  19. Wire Scanner Beam Profile Measurements: LANSCE Facility Beam Development

    Energy Technology Data Exchange (ETDEWEB)

    Gilpatrick, John D. [Los Alamos National Laboratory; Batygin, Yuri K. [Los Alamos National Laboratory; Gonzales, Fermin [Los Alamos National Laboratory; Gruchalla, Michael E. [Los Alamos National Laboratory; Kutac, Vincent G. [Los Alamos National Laboratory; Martinez, Derwin [Los Alamos National Laboratory; Sedillo, James Daniel [Los Alamos National Laboratory; Pillai, Chandra [Los Alamos National Laboratory; Rodriguez Esparza, Sergio [Los Alamos National Laboratory; Smith, Brian G. [Los Alamos National Laboratory

    2012-05-15

    The Los Alamos Neutron Science Center (LANSCE) is replacing Wire Scanner (WS) beam profile measurement systems. Three beam development tests have taken place to test the new wire scanners under beam conditions. These beam development tests have integrated the WS actuator, cable plant, electronics processors and associated software and have used H{sup -} beams of different beam energy and current conditions. In addition, the WS measurement-system beam tests verified actuator control systems for minimum profile bin repeatability and speed, checked for actuator backlash and positional stability, tested the replacement of simple broadband potentiometers with narrow band resolvers, and tested resolver use with National Instruments Compact Reconfigurable Input and Output (cRIO) Virtual Instrumentation. These beam tests also have verified how trans-impedance amplifiers react with various types of beam line background noise and how noise currents were not generated. This paper will describe these beam development tests and show some resulting data.

  20. Fission neutron spectra measurements at LANSCE - status and plans

    Energy Technology Data Exchange (ETDEWEB)

    Haight, Robert C [Los Alamos National Laboratory; Noda, Shusaku [Los Alamos National Laboratory; Nelson, Ronald O [Los Alamos National Laboratory; O' Donnell, John M [Los Alamos National Laboratory; Devlin, Matt [Los Alamos National Laboratory; Chatillon, Audrey [CEA-FRANCE; Granier, Thierry [CEA-FRANCE; Taieb, Julien [CEA-FRANCE; Laurent, Benoit [CEA-FRANCE; Belier, Gilbert [CEA-FRANCE; Becker, John A [LLNL; Wu, Ching - Yen [LLNL

    2009-01-01

    A program to measure fission neutron spectra from neutron-induced fission of actinides is underway at the Los Alamos Neutron Science Center (LANSCE) in a collaboration among the CEA laboratory at Bruyeres-le-Chatel, Lawrence Livermore National Laboratory and Los Alamos National Laboratory. The spallation source of fast neutrons at LANSCE is used to provide incident neutron energies from less than 1 MeV to 100 MeV or higher. The fission events take place in a gas-ionization fission chamber, and the time of flight from the neutron source to that chamber gives the energy of the incident neutron. Outgoing neutrons are detected by an array of organic liquid scintillator neutron detectors, and their energies are deduced from the time of flight from the fission chamber to the neutron detector. Measurements have been made of the fission neutrons from fission of {sup 235}U, {sup 238}U, {sup 237}Np and {sup 239}Pu. The range of outgoing energies measured so far is from 1 MeV to approximately 8 MeV. These partial spectra and average fission neutron energies are compared with evaluated data and with models of fission neutron emission. Results to date will be presented and a discussion of uncertainties will be given in this presentation. Future plans are to make significant improvements in the fission chambers, neutron detectors, signal processing, data acquisition and the experimental environment to provide high fidelity data including mea urements of fission neutrons below 1 MeV and improvements in the data above 8 MeV.

  1. Different approaches to modeling the LANSCE H- ion source filament performance

    Science.gov (United States)

    Draganic, I. N.; O'Hara, J. F.; Rybarcyk, L. J.

    2016-02-01

    An overview of different approaches to modeling of hot tungsten filament performance in the Los Alamos Neutron Science Center (LANSCE) H- surface converter ion source is presented. The most critical components in this negative ion source are two specially shaped wire filaments heated up to the working temperature range of 2600 K-2700 K during normal beam production. In order to prevent catastrophic filament failures (creation of hot spots, wire breaking, excessive filament deflection towards source body, etc.) and to improve understanding of the material erosion processes, we have simulated the filament performance using three different models: a semi-empirical model, a thermal finite-element analysis model, and an analytical model. Results of all three models were compared with data taken during LANSCE beam production. The models were used to support the recent successful transition from the beam pulse repetition rate of 60 Hz-120 Hz.

  2. A New Approach to Measuring the Neutron Decay Correlations with Cold Neutrons at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Wilburn, W.S.; Bowman, J.D.; Greene, G.L.; Jones, G.L.; Kapustinsky, J.S.; Penttila, S.I.

    1999-06-08

    Precision measurements of the neutron beta-decay correlations A, B, a, and b provide important tests of the standard model of electroweak interactions: a test of the unitarity of the first row of the CKM matrix, a search for new weak interactions, a test of the theory of nuclear beta decays, and a test of the conserved-vector-current hypothesis. The authors are designing an experiment at the LANSCE short-pulse spallation source to measure all four correlations to an order of magnitude better accuracy than the existing measurements. The accuracy of the previous measurements was limited by systematics. The design of the proposed experiment makes use of the pulsed nature of the LANSCE source to reduce systematic errors associated with the measurement of the neutron polarization as well as other systematic errors. In addition, the authors are developing silicon strip detectors for detecting both the proton and electron from the neutron decay.

  3. Design of a new VHF RF power amplifier system for LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Lyles, John T M [Los Alamos National Laboratory

    2010-01-01

    A major upgrade is replacing much of the 40 year-old proton drift tube linac RF system with new components at the Los Alamos Neutron Science Center (LANSCE). When installed, the new system will reduce the total number of electron power tubes from twenty-four to eight in the RF powerplant. A new 200 MHz high power cavity amplifier has being developed at LANSCE. This 3.2 MW final power amplifier (FPA) uses a Thales TH628 Diacrode{reg_sign}, a state-of-the-art tetrode that eliminates the large anode modulator of the triode-based FPA that has been in use for four decades. Drive power for the FPA is provided by a new tetrode intermediate power amplifier (and a solid-state driver stage). The new system has sufficient duty-factor capability to allow LANSCE to return to 1 MW beam operation. Prototype RF power amplifiers have been designed, fabricated, and assembled, and are being tested. High voltage DC power became available through innovative re-engineering of an installed system. Details of the electrical and mechanical design of the FPA and ancillary systems are discussed.

  4. Precision Measurement of Parity Violation in Polarized Cold Neutron Capture on the Proton the NPD $\\gamma$ Experiment

    CERN Document Server

    Lauss, Bernhard; Carlini, R D; Chupp, T E; Chen, W; Corvig, S; Dabaghyan, M; Desai, D; Freedman, S J; Gentile, T R; Gericke, M T; Gillis, R C; Greene, G L; Hersman, F W; Ino, T; Ito, T; Jones, G L; Kandes, M; Leuschner, M; Lozowski, B; Mahurin, R; Mason, M; Masuda, Y; Mei, J; Mitchell, G S; Muto, S; Nann, H; Page, S A; Penttila, S I; Ramsay, W D; Santra, S; Seo, P -N; Sharapov, E I; Smith, T B; Snow, W M; Wilburn, W S; Yuan, V; Zhu, H; Bernhard, Lauss

    2006-01-01

    The NPDGamma experiment at the Los Alamos Neutron Science Center (LANSCE) is dedicated to measure with high precision the parity violating asymmetry in the $\\gamma$ emission after capture of spin polarized cold neutrons in para-hydrogen. The measurement will determine unambiguously the weak pion-nucleon-nucleon ($\\pi NN$) coupling constant {\\it f$^1_{\\pi}$}

  5. The LANSCE 805 MHZ RF System History and Status

    CERN Document Server

    Lynch, Michael; Tallerico, Paul J

    2005-01-01

    The Los Alamos Neutron Science Center (LANSCE) linear accelerator runs at 201.25 MHz for acceleration to 100 MeV. The remainder of the acceleration to 800 MeV is at 805 MHz. This is done with 44 accelerator cavity stages driven by 805 MHz klystrons. Each klystron has a peak power capability of 1.25 MeV. Originally, 97 klystrons were purchased, which was 70 from Varian/CPI and 27 from Litton. The 44 RF systems are laid out in sectors with either 6 or 7 klystrons per sector. The klystrons in each sector are powered from a common HV sytem. The current arrangement uses the Varian/CPI klystrons in 6 of the 7 sectors and Litton klystrons in the remaining sector. With that arrangement there are 38 CPI klystrons installed and 1 spare klystron per sector and 6 Litton klystrons installed in the final sector with 2 spares. The current average life of all of the operating and spare klystrons (52 total) is >112,000 filament hours and >93,000 HV hours. That is three times the typical klystron lifetime today f...

  6. Monte Carlo simulation of the spear reflectometer at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Smith, G.S. [Los Alamos National Laboratory, NM (United States)

    1995-12-31

    The Monte Carlo instrument simulation code, MCLIB, contains elements to represent several components found in neutron spectrometers including slits, choppers, detectors, sources and various samples. Using these elements to represent the components of a neutron scattering instrument, one can simulate, for example, an inelastic spectrometer, a small angle scattering machine, or a reflectometer. In order to benchmark the code, we chose to compare simulated data from the MCLIB code with an actual experiment performed on the SPEAR reflectometer at LANSCE. This was done by first fitting an actual SPEAR data set to obtain the model scattering-length-density profile, {Beta}(z), for the sample and the substrate. Then these parameters were used as input values for the sample scattering function. A simplified model of SPEAR was chosen which contained all of the essential components of the instrument. A code containing the MCLIB subroutines was then written to simulate this simplified instrument. The resulting data was then fit and compared to the actual data set in terms of the statistics, resolution and accuracy.

  7. Fission neutron output measurements at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Ronald Owen [Los Alamos National Laboratory; Haight, Robert C [Los Alamos National Laboratory; Devlin, Matthew J [Los Alamos National Laboratory; Fotiadis, Nikolaos [Los Alamos National Laboratory; Laptev, Alexander [Los Alamos National Laboratory; O' Donnell, John M [Los Alamos National Laboratory; Taddeucci, Terry N [Los Alamos National Laboratory; Tovesson, Fredrik [Los Alamos National Laboratory; Ullmann, J L [Los Alamos National Laboratory; Wender, Stephen A [Los Alamos National Laboratory; Bredeweg, T A [Los Alamos National Laboratory; Jandel, M [Los Alamos National Laboratory; Vieira, D J [Los Alamos National Laboratory; Wu, Ching - Yen [LLNL; Becker, J A [LLNL; Stoyer, M A [LLNL; Henderson, R [LLNL; Sutton, M [LLNL; Belier, Gilbert [BRUYERES-LE-CHATEL, FRANCE; Chatillon, A [BRUYERES-LE-CHATEL, FRANCE; Granier, Thierry [CEA, BRUYERES-LE-CHATEL, FRANCE; Laurent, Benoit [CEA, BRUYERES-LE-CHATEL, FRANCE; Taieb, Julien [CEA, BRUYERES-LE-CHATEL, FRANCE

    2010-01-01

    Accurate data for both physical properties and fission properties of materials are necessary to properly model dynamic fissioning systems. To address the need for accurate data on fission neutron energy spectra, especially at outgoing neutron energies below about 200 keV and at energies above 8 MeV, ongoing work at LANSCE involving collaborators from LANL, LLNL and CEA Bruyeres-le-Chatel is extending the energy range, efficiency and accuracy beyond previous measurements. Initial work in the outgoing neutron energy range from 1 to 7 MeV is consistent with current evaluations and provides a foundation for extended measurements. As part of these efforts, a new fission fragment detector that reduces backgrounds and improves timing has been designed fabricated and tested, and new neutron detectors are being assessed for optimal characteristics. Simulations of experimental designs are in progress to ensure that accuracy goals are met. Results of these measurements will be incorporated into evaluations and data libraries as they become available.

  8. The Deep Impact Network Experiment Operations Center

    Science.gov (United States)

    Torgerson, J. Leigh; Clare, Loren; Wang, Shin-Ywan

    2009-01-01

    Delay/Disruption Tolerant Networking (DTN) promises solutions in solving space communications challenges arising from disconnections as orbiters lose line-of-sight with landers, long propagation delays over interplanetary links, and other phenomena. DTN has been identified as the basis for the future NASA space communications network backbone, and international standardization is progressing through both the Consultative Committee for Space Data Systems (CCSDS) and the Internet Engineering Task Force (IETF). JPL has developed an implementation of the DTN architecture, called the Interplanetary Overlay Network (ION). ION is specifically implemented for space use, including design for use in a real-time operating system environment and high processing efficiency. In order to raise the Technology Readiness Level of ION, the first deep space flight demonstration of DTN is underway, using the Deep Impact (DI) spacecraft. Called the Deep Impact Network (DINET), operations are planned for Fall 2008. An essential component of the DINET project is the Experiment Operations Center (EOC), which will generate and receive the test communications traffic as well as "out-of-DTN band" command and control of the DTN experiment, store DTN flight test information in a database, provide display systems for monitoring DTN operations status and statistics (e.g., bundle throughput), and support query and analyses of the data collected. This paper describes the DINET EOC and its value in the DTN flight experiment and potential for further DTN testing.

  9. Pediatric renal transplantation: a single center experience

    Directory of Open Access Journals (Sweden)

    João Nascimento

    2015-12-01

    Full Text Available Introduction: End-stage renal disease in children is associated with numerous comorbidities and with age-specific mortality rates approximately 30 times higher than in healthy children. The first kidney transplantation in children was performed successfully in 1954. Surgical advances and new immunosuppressive medications have greatly improved patient’s and graft’s survival in the last years. Aim: Report Centro Hospitalar do Porto experience in pediatric renal transplantation in the last 30 years. Methods: Epidemiological and clinical data of all patients younger than 18 years, transplanted between January 1984 and August 2013, were collected from our database. In order to analyze the transplantation outcome in our center we compare graft survival between decades (1984-89 / 1990-99 / 2000-09 / 2010-13. We also compare graft survival between two age groups of patients (0-10 years ; 11-17 years at the time of surgery. Results: One hundred thirty-nine patients (58.3% male underwent 147 renal transplants (6.8% live donors. Congenital anomalies of the kidney and urinary tract (56.5% and glomerulonephritis (18.4% were the major causes of renal disease. Uncensored graft survivals rates at 5, 10, 15 and 20 years were 84.7%, 71.1%, 60.0% and 51.0%, while patient survivals were 97.9%, 95.9%, 94.7% and 94.7% respectively. Graft survival improved over time and the difference between the decades was statistically significant (p=0.004. Despite the better survival in the group of patients older than 11 years, graft’s survival difference between the two age groups was not statistically significant (p=0.697. Conclusion: The results of our hospital are comparable to other international centers. Significant improvement in survival was observed over the time. It seems that an accurate follow-up of our patients helps to minimize the negative impact of adolescence on graft survival rates.

  10. 16O(n,α cross section investigation using LENZ instrument at LANSCE

    Directory of Open Access Journals (Sweden)

    Lee H.Y.

    2016-01-01

    Full Text Available Importance of studying the 16O(n,α reaction is motivated by multiple nuclear applications. The Los Alamos Neutron Science Center (LANSCE produces a white neutron spectrum ranging from thermal to several hundreds of MeV energies. We have recently developed the LENZ (Low Energy NZ-neutron induced charged particle detection capability to measure high-precision (n,α cross sections. In order to provide more reliable data, we have enhanced solid angle coverage, and improved signal-to-noise ratios and time-of-flight resolution by implementing digitizer waveform analysis. The LENZ was commissioned by studying the 59Co(n,α reaction with neutron beams in early 2015. For the 16O(n,α reaction, we investigate solid oxygen targets and make a relative measurement to a better known cross section, such as the 6Li(n,α reaction in order to further reduce systematic uncertainty. We will discuss the progress of the 16O(n,α study at LANSCE and the outlook for improving Hauser-Feshbah prediction on (n,p reaction cross sections.

  11. 16O(n,α) cross section investigation using LENZ instrument at LANSCE

    Science.gov (United States)

    Lee, H. Y.; Mosby, S.; Haight, R. C.; White, M. C.

    2016-06-01

    Importance of studying the 16O(n,α) reaction is motivated by multiple nuclear applications. The Los Alamos Neutron Science Center (LANSCE) produces a white neutron spectrum ranging from thermal to several hundreds of MeV energies. We have recently developed the LENZ (Low Energy NZ-neutron induced charged particle detection) capability to measure high-precision (n,α) cross sections. In order to provide more reliable data, we have enhanced solid angle coverage, and improved signal-to-noise ratios and time-of-flight resolution by implementing digitizer waveform analysis. The LENZ was commissioned by studying the 59Co(n,α) reaction with neutron beams in early 2015. For the 16O(n,α) reaction, we investigate solid oxygen targets and make a relative measurement to a better known cross section, such as the 6Li(n,α) reaction in order to further reduce systematic uncertainty. We will discuss the progress of the 16O(n,α) study at LANSCE and the outlook for improving Hauser-Feshbah prediction on (n,p) reaction cross sections.

  12. Single Center Experience With Hyperthermic Intraperitoneal Chemotherapy

    Science.gov (United States)

    Kim, Woo Ram; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young

    2017-01-01

    Purpose Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. Methods Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. Results Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. Conclusion Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.

  13. Experience-Centered Design Designers, Users, and Communities in Dialogue

    CERN Document Server

    Wright, Peter

    2010-01-01

    Experience-centered design, experience-based design, experience design, designing for experience, user experience design. All of these terms have emerged and gained acceptance in the Human-Computer Interaction (HCI) and Interaction Design relatively recently. In this book, we set out our understanding of experience-centered design as a humanistic approach to designing digital technologies and media that enhance lived experience. The book is divided into three sections. In Section 1, we outline the historical origins and basic concepts that led into and flow out from our understanding of experi

  14. Surface-loss power calculations for the LANSCE DTL

    Energy Technology Data Exchange (ETDEWEB)

    Kurennoy, Surgey S [Los Alamos National Laboratory

    2008-01-01

    The surface losses in the drift-tube linac (DTL) tanks 3 and 4 of the LANSCE linear accelerator are calculated using 3-D electromagnetic modeling with the CST MicroWave Studio (MWS). The results are used to provide more realistic power estimates for the 201.25MHz RF upgrade design within the LANSCE-R project. We compared 3-D MWS results with those from traditional 2-D Superfish computations for DTL cells and their simplified models and found differences on the level of a few percent. The differences are traced to a 3-D effect consisting in a redistribution of the surface currents on the drift tubes (DT) produced by the DT stem. The dependence of MWS results on the mesh size used in computations is also discussed.

  15. The Renewal Center Time, Experience, Memory

    OpenAIRE

    Tennant, Mark

    2005-01-01

    Time, Experience, Memory Through experience we are conscious of time. Through time, our experiences become memories, influencing both conscious and unconscious thought. It is through our five senses; touch, sight, hearing, smell and taste, that these experiences are gathered. Humans are also born with inherent knowledge that our species has collected from generation to generation. This inherent knowledge, also called the collective unconscious, has a direct effect on the way we perce...

  16. Increasing Counseling Center Utilization: Yeshiva University's Experience

    Science.gov (United States)

    Schwartz, Victor; Nissel, Chaim; Eisenberg, Daniel; Kay, Jerald; Brown, Joshua T.

    2012-01-01

    Yeshiva University established a counseling center during the 2004-2005 academic year. As a religiously based institution, the administration recognized that there would likely be significant impediments to utilization of on-campus mental health services as a result of negative attitudes about mental illness and its treatment--stigma. To combat…

  17. Characteristics of a lead slowing-down spectrometer coupled to the LANSCE accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Rochman, D. [LANSCE-3, Los Alamos National Laboratory, MS H855, Los Alamos, NM 87545 (United States)]. E-mail: drochman@bnl.gov; Haight, R.C. [LANSCE-3, Los Alamos National Laboratory, MS H855, Los Alamos, NM 87545 (United States)]. E-mail: haight@lanl.gov; O' Donnell, J.M. [LANSCE-3, Los Alamos National Laboratory, MS H855, Los Alamos, NM 87545 (United States)]. E-mail: odonnell@lanl.gov; Michaudon, A. [LANSCE-3, Los Alamos National Laboratory, MS H855, Los Alamos, NM 87545 (United States)]. E-mail: michaudon@lanl.gov; Wender, S.A. [LANSCE-3, Los Alamos National Laboratory, MS H855, Los Alamos, NM 87545 (United States)]. E-mail: wender@lanl.gov; Vieira, D.J. [C-INC, Los Alamos National Laboratory, MS J514, Los Alamos, NM 87545 (United States)]. E-mail: vieira@lanl.gov; Bond, E.M. [C-INC, Los Alamos National Laboratory, MS J514, Los Alamos, NM 87545 (United States)]. E-mail: bond@lanl.gov; Bredeweg, T.A. [C-INC, Los Alamos National Laboratory, MS J514, Los Alamos, NM 87545 (United States)]. E-mail: toddb@lanl.gov; Kronenberg, A. [C-INC, Los Alamos National Laboratory, MS J514, Los Alamos, NM 87545 (United States)]. E-mail: kronenberga@mail.phy.ornl.gov; Wilhelmy, J.B. [C-INC, Los Alamos National Laboratory, MS J514, Los Alamos, NM 87545 (United States)]. E-mail: j_wilhelmy@lanl.gov; Ethvignot, T. [Commissariat a l' Energie Atomique, DIF/DPTA/Service de Physique Nucleaire, BP 12, 91680 Bruyeres-le-Cha-hat tel (France)]. E-mail: thierry.ethvignot@cea.fr; Granier, T. [Commissariat a l' Energie Atomique, DIF/DPTA/Service de Physique Nucleaire, BP 12, 91680 Bruyeres-le-Cha-hat tel (France)]. E-mail: thierry.granier@cea.fr; Petit, M. [Commissariat a l' Energie Atomique, DIF/DPTA/Service de Physique Nucleaire, BP 12, 91680 Bruyeres-le-Chatel (France)]. E-mail: michael.petit@cea.fr; Danon, Y. [Rensselaer Polytechnic Institute, Troy, New York, NY 12180 (United States)]. E-mail: danony@rpi.edu

    2005-09-11

    A description is given of a lead slowing-down spectrometer (LSDS) installed at the 800-MeV proton accelerator of the Los Alamos Neutron Science Center (LANSCE). The LSDS is designed to study neutron-induced fission on actinides that can only be obtained or used in small quantities. The characteristics of this LSDS (energy-time relation, energy resolution, neutron flux) are presented through simulations with MCNPX and measurements with several different methods. Results on neutron-induced fission of {sup 235}U and {sup 239}Pu with tens of micrograms and tens of nanograms, respectively, are presented. Finally, additional MCNPX calculations have been performed to simulate the measurement of the cross-section for U235m(n,f) using different target quantities and different initial isomer-to-ground state compositions.

  18. GEANIE at WNR/LANSCE -- A new instrument for neutron science

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, R.O.; Becker, J.A.; Archer, D.E. [and others

    1997-09-01

    GEANIE, an array of escape-suppressed high-resolution Ge detectors now installed at the white-neutron source at the Los Alamos Neutron Science Center, is the first large Ge detector array to be used at a high-energy spallation neutron source. GEANIE consists of 20 Ge detectors including both coaxial Ge detectors and planar Ge detectors to enhance capabilities for low-energy {gamma}-ray spectroscopy. The array is located on a 20 m flight path with a neutron flux spanning the energy range from 1 to over 200 MeV. Installation of the first phase of GEANIE was recently completed and data were acquired on a number of samples, including actinides. The unique combination of GEANIE with the neutron source at LANSCE provides new capabilities for neutron science. The status of the array and recent results are presented, and new opportunities for physics and nuclear data are discussed.

  19. Transplant nephrectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    Arun Ariyarathenam

    2015-01-01

    Full Text Available Transplant nephrectomy (TN is associated with significant morbidity and mortality and influences the outcome of subsequent renal transplantation. The aim of this study was to identify the reasons for TN in a single transplant center in the United Kingdom and to determine the complication rate, effect on relisting and re-transplantation. We studied all the TNs in our center from January 2000 to December 2011. Detailed information including cause of allograft failure and reason for TN were analyzed. Of 602 renal transplants performed at our center during the period of the study, 42 TNs were performed on 38 (6% patients (24 men and 14 women. The median age of the patients at the time of transplantation who subsequently underwent TN was 56 years (range: 28-73 years and 71% of the allografts were donated after circulatory death. The mean human leucocyte antigen mismatch for these patients was 2.3. The most commonly used immunosuppression was a combination of prednisolone, mycophenolate and tacrolimus, which was used in 50% of the patients. Twenty-five (60% of the TNs in this series were for allografts failing during the first month of transplantation. The most common indication for the TN was graft thrombosis (50%, with an overall in-hospital mortality rate of 9.5% and a morbidity rate of 31%. Seven of 19 patients listed underwent successful re-transplantation. Although TN is associated with a risk of significant morbidity and mortality, it does not preclude from listing for re-transplantation. The difficulty of access to complete information about transplant failures and TN highlights the need for a national registry.

  20. Pregnancy during Hemodialysis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Bahadi Abdelali

    2010-01-01

    Full Text Available Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose.

  1. Stripping of H- beams by residual gas in the linac at the Los Alamos neutron science center

    Energy Technology Data Exchange (ETDEWEB)

    Mccrady, Rodney C [Los Alamos National Laboratory; Ito, Takeyasu [Los Alamos National Laboratory; Cooper, Martin D [Los Alamos National Laboratory; Alexander, Saunders [Los Alamos National Laboratory

    2010-09-07

    The linear accelerator at the Los Alamos Neutron Science Center (LANSCE) accelerates both protons and H{sup -} ions using Cockroft-Walton-type injectors, a drift-tube linac and a coupled-cavity linac. The vacuum is maintained in the range of 10{sup -6} to 10{sup -7} Torr; the residual gas in the vacuum system results in some stripping of the electrons from the H{sup -} ions resulting in beam spill and the potential for unwanted proton beams delivered to experiments. We have measured the amount of fully-stripped H{sup -} beam (protons) that end up at approximately 800 MeV in the beam switchyard at LANSCE using image plates as very sensitive detectors. We present here the motivation for the measurement, the measurement technique and results.

  2. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  3. Prior Experiences Shaping Family Science Conversations at a Nature Center

    Science.gov (United States)

    McClain, Lucy R.; Zimmerman, Heather Toomey

    2014-01-01

    Using families as the analytical focus, this study informs the field of informal science education with a focus on the role of prior experiences in family science conversations during nature walks at an outdoor-based nature center. Through video-based research, the team analyzed 16 families during walks at a nature center. Each family's prior…

  4. Neutron Imaging Developments at LANSCE [PowerPoint

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Ronald Owen [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hunter, James F. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Schirato, Richard C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vogel, Sven C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Swift, Alicia L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Ickes, Timothy Lee [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Ward, William Carl [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Losko, Adrian Simon [Univ. of California, Berkeley, CA (United States); Tremsin, Anton [Univ. of California, Berkeley, CA (United States); Sevanto, Sanna Annika [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Espy, Michelle A. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Dickman, Lee Thoresen [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Malone, Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-10-29

    Thermal, epithermal, and high-energy neutrons are available from two spallation sources at the 800-MeV proton accelerator. Improvements in detectors and computing have enabled new capabilities that use the pulsed beam properties at LANSCE; these include amorphous Si (aSi) detectors, intensified charge-coupled device cameras, and micro-channel plates. Applications include water flow in living specimens, inclusions and fission products in uranium oxide, and high-energy neutron imaging using an aSi flat panel with ZnS(Ag) scintillator screen. images of a metal/plastic cylinder from photons, low-energy and high-energy neutrons are compared.

  5. Ultraviolet A1 phototherapy: One center's experience

    Directory of Open Access Journals (Sweden)

    Sasi Kiran Attili

    2017-01-01

    Full Text Available Background: Ultraviolet A1(UVA1 phototherapy is increasingly being used in the treatment of morphea, atopic dermatitis, lupus and some other recalcitrant dermatoses. We present a retrospective review of our experience with this modality. Aim: To evaluate the treatment response rates for various dermatoses and adverse effects of UVA1 phototherapy. Methods: We reviewed phototherapy notes along with electronic and/or paper case records for all patients treated with UVA1 phototherapy from October 1996 to December 2008. Results: A total of 269 patients (outcomes available for 247 had 361 treatment courses (treatment data available for 317 courses over this period. We found phototherapy to be beneficial in 28 (53% of 53 patients with atopic dermatitis and 19 (51% of 37 patients with morphea. A beneficial outcome was recorded in all six (100% cases of urticaria and six (85.7% of seven patients treated for a polymorphic light eruption. Benefit was also recorded in systemic lupus erythematosus (8 (44.4% of 18, lichen sclerosus (6 (42.9% of 14, mastocytosis (2 (33.3% of 6, necrobiosis lipoidica (4 (30.8% of 13, granuloma annulare (2 (25% of 8, scleroderma (2 (22.2% of 9 and keloids (1 (7.7% of 13. Overall, treatment was well tolerated with no patients having to stop treatment due to adverse effects. Limitations: This is a retrospective study with no control group. Subjective/recall bias is quite possible as a number of patients were followed up over the phone. Conclusions: Our data suggest that ultraviolet A1 can be considered for the treatment of selected dermatoses. However, long-term malignancy risk is as yet unknown.

  6. Development of a high speed crowbar for LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Friedrichs, C. Jr.; Lyles, J.T.M.; Doub, J.M.

    1997-08-01

    Each of the four 200 MHz Final Power Amplifiers (FPAs) in the LANSCE proton linac has its own capacitor bank and crowbar. The dissipation in the 10{Omega} crowbar limiting resistor is as high as 67 kW, and oil cooling is used. The authors stated upgrade goal was to substantially reduce the limiting resistor dissipation and eliminate the oil cooling. Early tests showed that the fault energy quickly rose to unacceptable levels as the current limiting resistance was reduced. FPA arcs are normally quenched by interrupting the FPA modulator current, and the crowbar waits 10 {mu}s for this to occur. The successful upgrade strategy was to replace the 10{Omega} resistor with a 3{Omega} air cooled resistor and to add a high speed crowbar circuit which operates only if there are simultaneous arcs in the FPA and its modulator. This paper describes the high speed circuit and its interface with the existing crowbar. Test results are also given.

  7. Los Alamos neutron science center nuclear weapons stewardship and unique national scientific capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Schoenberg, Kurt F [Los Alamos National Laboratory

    2010-12-15

    This presentation gives an overview of the Los Alamos Neutron Science Center (LANSCE) and its contributions to science and the nuclear weapons program. LANSCE is made of multiple experimental facilities (the Lujan Center, the Weapons Neutron Research facility (WNR), the Ultra-Cold Neutron facility (UCN), the proton Radiography facility (pRad) and the Isotope Production Facility (IPF)) served by the its kilometer long linear accelerator. Several research areas are supported, including materials and bioscience, nuclear science, materials dynamics, irradiation response and medical isotope production. LANSCE is a national user facility that supports researchers worldwide. The LANSCE Risk Mitigation program is currently in progress to update critical accelerator equipment to help extend the lifetime of LANSCE as a key user facility. The Associate Directorate of Business Sciences (ADBS) plays an important role in the continued success of LANSCE. This includes key procurement support, human resource support, technical writing support, and training support. LANSCE is also the foundation of the future signature facility MARIE (Matter-Radiation Interactions in Extremes).

  8. AMS experiment takes off for Kennedy Space Center August 2010

    CERN Multimedia

    CERN Video Productions

    2010-01-01

    Geneva, 18 August 2010. The Alpha Magnetic Spectrometer (AMS), an experiment that will search for antimatter and dark matter in space, leaves CERN next Tuesday on the next leg of its journey to the International Space Station. The AMS detector is being transported from CERN to Geneva International Airport in preparation for its planned departure from Switzerland on 26 August, when it will be flown to the Kennedy Space Center in Florida on board a US Air Force Galaxy transport aircraft.

  9. The LANL/LLNL Prompt Fission Neutron Spectrum Program at LANSCE and Approach to Uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Haight, R.C., E-mail: haight@lanl.gov [Los Alamos National Laboratory, Los Alamos, NM 87545,USA (United States); Wu, C.Y. [Lawrence Livermore National Laboratory, Livermore, CA 94551 (United States); Lee, H.Y.; Taddeucci, T.N.; Perdue, B.A.; O' Donnell, J.M.; Fotiades, N.; Devlin, M.; Ullmann, J.L.; Bredeweg, T.A.; Jandel, M.; Nelson, R.O.; Wender, S.A.; Neudecker, D.; Rising, M.E.; Mosby, S.; Sjue, S.; White, M.C. [Los Alamos National Laboratory, Los Alamos, NM 87545,USA (United States); Bucher, B.; Henderson, R. [Lawrence Livermore National Laboratory, Livermore, CA 94551 (United States)

    2015-01-15

    New data on the prompt fission neutron spectra (PFNS) from neutron-induced fission with higher accuracies are needed to resolve discrepancies in the literature and to address gaps in the experimental data. The Chi-Nu project, conducted jointly by LANL and LLNL, aims to measure the shape of the PFNS for fission of {sup 239}Pu induced by neutrons from 0.5 to 20 MeV with accuracies of 3–5% in the outgoing energy from 0.1 to 9 MeV and 15% from 9 to 12 MeV and to provide detailed experimental uncertainties. Neutrons from the WNR/LANSCE neutron source are being used to induce fission in a Parallel-Plate Avalanche Counter (PPAC). Two arrays of neutron detectors are used to cover the energy range of neutrons emitted promptly in the fission process. Challenges for the present experiment include background reduction, use of {sup 239}Pu in a PPAC, and understanding neutron detector response. Achieving the target accuracies requires the understanding of many systematic uncertainties. The status and plans for the future will be presented.

  10. Experience with Server Self Service Center (S3C)

    CERN Document Server

    Sucik, J; CERN. Geneva. IT Department

    2010-01-01

    CERN has a successful experience with running Server Self Service Center (S3C) for virtual server provisioning which is based on Microsoft® Virtual Server 2005. With the introduction of Windows Server 2008 and its built-in hypervisor based virtualization (Hyper-V) there are new possibilities for the expansion of the current service. This paper describes the architecture of the redesigned virtual Server Self Service based on Hyper-V which provides dynamically scalable virtualized resources on demand as needed and outlines the possible implications on the future use of virtual machines at CERN.

  11. Experience with Server Self Service Center (S3C)

    CERN Multimedia

    Sucik, J

    2009-01-01

    CERN has a successful experience with running Server Self Service Center (S3C) for virtual server provisioning which is based on Microsoft® Virtual Server 2005. With the introduction of Windows Server 2008 and its built-in hypervisor based virtualization (Hyper-V) there are new possibilities for the expansion of the current service. This paper describes the architecture of the redesigned virtual Server Self Service based on Hyper-V which provides dynamically scalable virtualized resources on demand as needed and outlines the possible implications on the future use of virtual machines at CERN.

  12. Joint Langley Research Center/Jet Propulsion Laboratory CSI experiment

    Science.gov (United States)

    Neat, Gregory W.; O'Brien, John F.; Lurie, Boris J.; Garnica, Angel; Belvin, W. K.; Sulla, Jeff; Won, John

    1992-01-01

    This paper describes a joint Control Structure Interaction (CSI) experiment in which Jet Propulsion Laboratory (JPL) damping devices were incorporated into the Langley Research Center (LaRC) Phase 0 Testbed. The goals of the effort were twofold: (1) test the effectiveness of the JPL structural damping methods in a new structure and (2) assess the feasibility of combining JPL local control methods with the LaRC multiple input multiple output global control methods. Six dampers (2 piezoelectric active members, 4 viscous dampers), placed in three different regions of the structure, produced up to 26 dB attenuation in target modes. The combined control strategy in which the JPL damping methods contributed local control action and the LaRC control scheme provided global control action, produced and overall control scheme with increased stability margins and improved performance. This paper presents an overview of the technologies contributed from the two centers, the strategies used to combine them, and results demonstrating the success of the damping and cooperative control efforts.

  13. CCSDS telemetry systems experience at the Goddard Space Flight Center

    Science.gov (United States)

    Carper, Richard D.; Stallings, William H., III

    1990-09-01

    NASA Goddard Space Flight Center (GSFC) designs, builds, manages, and operates science and applications spacecraft in near-earth orbit, and provides data capture, data processing, and flight control services for these spacecraft. In addition, GSFC has the responsibility of providing space-ground and ground-ground communications for near-earth orbiting spacecraft, including those of the manned spaceflight programs. The goal of reducing both the developmental and operating costs of the end-to-end information system has led the GSFC to support and participate in the standardization activities of the Consultative Committee for Space Data Systems (CCSDS), including those for packet telemetry. The environment in which such systems function is described, and the GSFC experience with CCSDS packet telemetry in the context of the Gamma-Ray Observatory project is discussed.

  14. SINGLE-CENTER EXPERIENCE OF ABO-INCOMPATIBLE LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2011-01-01

    Full Text Available Since 2008 up to 2010 eight ABO-incompatible liver transplantations have been performed in our center: one of them was urgent liver transplantation to adult patient from deceased donor, other seven were transplantations of left lateral segment to children from living relative donors. Own experience, as well as world one, proves, that barrier of ABO-incompatibility can be overcome more successfully in liver transplantation, particularly in pediatric population, that in other solid organs transplantation. Good results can be achieved even with less ag- gressive immunosuppressive therapy. Recipient conditioning before operation can significantly improve results of ABO-incompatible liver transplantation, but as own experience has shown, often there’s no need to hold some special preparation of children, because their anti-ABO antibodies are very low or absent before transplantation and do not increase after it. Thereby ABO-incompatible liver transplantation is reasonable in urgent cases and in pediatric population because of the limited pull of living relative donors for children. 

  15. Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-01

    Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  16. LIVER TRANSPLANTATION. A SINGLE CENTER EXPERIENCE OF 100 CASES

    Directory of Open Access Journals (Sweden)

    A. M. Granov

    2012-01-01

    Full Text Available A single center experience of first 100 liver transplantations (LTs is summarized. Analysis of trends in cadaver donor population and waiting list status changes, and also of early and late postoperative complications are presented. 100 LTs were performed for 95 patients (pts, retransplantation – 4 pts; one patient received 3 liver transplants (female – 55 pts, male – 40 pts, mean age – 39.9 ± 12.1 years. Cumulative 1-year survival rate of pts by Kaplan–Meyer was 91%, 3-year – 83%. Biliary complications were revealed in 9% of pts during 2–9 months after LT. 77 pts have been regularly observed in outpatient clinic, mean age – 44 ± 9.2 years, male – 35, fema- le – 42, follow-up period – 1 months up to 13 years after LT. 3.9% remained invalid with limitation of ability to work, 61.8% have been working, 22.3% were capable to work, retirees were 10.5%. Development of preoperati- ve planning, adequate organ selection will allow to improve the results of LT. Study of hematopoietic stem cells role will expand tools of prognosis of posttransplant complications. 

  17. Penile lichen sclerosus: An urologist's nightmare! - A single center experience

    Science.gov (United States)

    Singh, Jitendra Pratap; Priyadarshi, Vinod; Goel, Hemant Kumar; Vijay, Mukesh Kumar; Pal, Dilip Kumar; Chakraborty, Sudip; Kundu, Anup Kumar

    2015-01-01

    Purpose: Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This study has been carried out to present our experience about this disease with simultaneous review of the available literature. Materials and Methods: This retrospective study has been done at a tertiary care center of eastern India. The data of 306 patients affected with LS were analyzed for clinical presentation, physical examination, investigations, and treatment offered. Results: Presenting symptoms were non-specific. The prepuce was most commonly involved location followed by glans and meatus. Urethral involvement was not isolated as the primary site. Circumcision was done in 237 patients, while 63 patients underwent meatotomy. Thirty-six of 39 cases of LS induced stricture were treated with buccal mucosal graft (BMG) either in one stage or in two stages. Conclusion: LS varies from being a highly aggressive disease of the penis and anterior urethra to a burnt out condition affecting just the meatus and surrounding glans. Early diagnosis and treatment are required to prevent its complication and associated morbidity. Management depends on the anatomical location of lesion, extent of involvement, rapidity of progression and its severity. Use of BMG in LS induced urethral stricture has shown encouraging results. PMID:26229314

  18. Scientific Advancements and Technological Developments of High P-T Neutron Diffraction at LANSCE, Los Alamos

    Science.gov (United States)

    Zhao, Y.; Daemen, L. L.; Zhang, J.

    2003-12-01

    In-situ high P-T neutron diffraction experiments provide unique opportunities to study the crystal structure, hydrogen bonding, magnetism, and thermal parameters of light elements (eg. H, Li, B) and heavy elements (eg. Ta, U, Pu,), that are virtually impossible to determine with x-ray diffraction techniques. For example, thermoelasticity and Debye-Waller factor as function of pressure and temperature can be derived using in-situ high P-T neutron diffraction techniques. These applications can also be extended to a much broader spectrum of scientific problems. For instance, puzzles in Earth science such as the carbon cycle and the role of hydrous minerals for water exchange between lithosphere and biosphere can be directly addressed. Moreover, by introducing in-situ shear, texture of metals and minerals accompanied with phase transitions at high P-T conditions can also be studied by high P-T neutron diffraction. We have successfully conducted high P-T neutron diffraction experiments at LANSCE and achieved simultaneous high pressures and temperatures of 10 GPa and 1500 K. With an average 3-6 hours of data collection, the diffraction data are of sufficiently high quality for the determination of structural parameters and thermal vibrations. We have studied hydrous mineral (MgOD), perovskite (K.15,Na.85)MgF3, clathrate hydrates (CH4-, CO2-, and H2-), metals (Mo, Al, Zr), and amorphous materials (carbon black, BMG). The aim of our research is to accurately map bond lengths, bond angles, neighboring atomic environments, and phase stability in P-T-X space. Studies based on high-pressure neutron diffraction are important for multi-disciplinary science and we welcome researchers from all fields to use this advanced technique. We have developed a 500-ton toroidal press, TAP-98, to conduct simultaneous high P-T neutron diffraction experiments inside of HIPPO (High-Pressure and Preferred-Orientation diffractometer). We have also developed a large gem-crystal anvil cell, ZAP-01

  19. Upgrades to the ultracold neutron source at the Los Alamos Neutron Science Center

    Science.gov (United States)

    Pattie, Robert; LANL-nEDM Collaboration

    2015-10-01

    The spallation-driven solid deutrium-based ultracold neutron (UCN) source at the Los Alamos Neutron Science Center (LANSCE) has provided a facility for precision measurements of fundamental symmetries via the decay observables from neutron beta decay for nearly a decade. In preparation for a new room temperature neutron electric dipole moment (nEDM) experiment and to increase the statistical sensitivity of all experiments using the source an effort to increase the UCN output is underway. The ultimate goal is to provide a density of 100 UCN/cc or greater in the nEDM storage cell. This upgrade includes redesign of the cold neutron moderator and UCN converter geometries, improved coupling and coating of the UCN transport system through the biological shielding, optimization of beam timing structure, and increase of the proton beam current. We will present the results of the MCNP and UCN transport simulations that led to the new design, which will be installed spring 2016, and UCN guide tests performed at LANSCE and the Institut Laue-Langevin to study the UCN transport properties of a new nickel-based guide coating.

  20. Encapsulating peritoneal sclerosis: experience of a tertiary referral center.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-05-01

    Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.

  1. User-Centered Design in Practice: The Brown University Experience

    Science.gov (United States)

    Bordac, Sarah; Rainwater, Jean

    2008-01-01

    This article presents a case study in user-centered design that explores the needs and preferences of undergraduate users. An analysis of LibQual+ and other user surveys, interviews with public service staff, and a formal American with Disabilities Act accessibility review served as the basis for planning a redesign of the Brown University…

  2. Early experiences with big data at an academic medical center.

    Science.gov (United States)

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  3. Clinical spectrum of hypopituitarism in India: A single center experience

    Directory of Open Access Journals (Sweden)

    Abhay Gundgurthi

    2012-01-01

    Full Text Available Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years. There were 78 (69% males and 35 females (31%. There were 22 subjects aged ≤18 years (childhood and adolescence and 91 adults (>18 years. Visual disturbances were the most common presenting complaint (33%, though headache was the most common symptom (81%. Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97% was the most common abnormality seen followed by hypothyroidism (83.2%, hypoadrenalism (79.6%, growth hormone deficiency (88.1% of the 42 patients tested, and diabetes insipidus (13.3%. Panhypopituitarism was seen in 104 (92% patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

  4. Docker experience at INFN-Pisa Grid Data Center

    Science.gov (United States)

    Mazzoni, E.; Arezzini, S.; Boccali, T.; Ciampa, A.; Coscetti, S.; Bonacorsi, D.

    2015-12-01

    Clouds and virtualization offer typical answers to the needs of large-scale computing centers to satisfy diverse sets of user communities in terms of architecture, OS, etc. On the other hand, solutions like Docker seems to emerge as a way to rely on Linux kernel capabilities to package only the applications and the development environment needed by the users, thus solving several resource management issues related to cloud-like solutions. In this paper, we present an exploratory (though well advanced) test done at a major Italian Tier2, at INFN-Pisa, where a considerable fraction of the resources and services has been moved to Docker. The results obtained are definitely encouraging, and Pisa is transitioning all of its Worker Nodes and services to Docker containers. Work is currently being expanded into the preparation of suitable images for a completely virtualized Tier2, with no dependency on local configurations.

  5. Commissioning of the upgraded ultracold neutron source at Los Alamos Neutron Science Center

    Science.gov (United States)

    Pattie, Robert; LANL-UCN Team Team

    2016-09-01

    The spallation-driven solid-deuterium ultracold neutron (UCN) source at Los Alamos Neutron Science Center (LANSCE) has provided a facility for precision measurements of fundamental symmetries via the decay observables from neutron beta decay for nearly a decade. In preparation for a new room temperature neutron electric dipole moment (nEDM) experiment and to increase the statistical sensitivity of all experiments using the source an effort to upgrade the existing source has been carried out during 2016. This upgrade includes installing a redesigned cold neutron moderator and with optimized UCN converter geometries, improved coupling and nickel-phosphorus coating of the UCN transport system through the biological shielding, optimization of beam timing structure, and increase of the proton beam current. We will present the result of the commissioning run of the new source.

  6. DISTRIBUTION OF CONGENITAL HEART DISEASES AT TERTIARY CARE CENTER: SINGLE CENTER EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Vaishali

    2016-02-01

    Full Text Available BACKGROUND The current study was undertaken at a tertiary care center, Bhopal, MP, India, with the objective of establishing frequency of occurrence of congenital heart diseases by echocardiography. MATERIALS AND METHOD 10,000 consecutive cases undergoing Echo Color Doppler in the Cardiology Department Hamidia Hospital, Bhopal, between 1st Jan 2009 and July 2011 were analysed. Echo CD was performed by consultant cardiologist using Acuson Aspen Color Doppler machine following the ASE guidelines. RESULTS AND CONCLUSIONS In the present study out of 10,000consecutive cases undergoing echo 648 were identified to having congenital heart diseases. Isolated VSD (30.5%, isolated ASD (23.6% PDA (9% and TOF (8.3% were commonest defect observed. Most common congenital heart disease found in the present study is VSD and is most prevalent in males and is highest among 0-5 yrs.

  7. Postpercutaneous Nephrolithotomy Nephrostogram: Is It Mandatory? A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Abdul Rouf Khawaja

    2014-01-01

    Full Text Available Aims and Objective. “Postpercutaneous nephrolithotomy nephrostogram” (PPNN is routinely performed in most of the centers. No published series could be found in the literature without post percutaneous nephrolithotomy nephrostogram. Hence, the aim of our study is to highlight that post percutaneous nephrolithotomy nephrostogram is not mandatory and it only adds to cost and morbidity without adding any information in the management of such patients. Methods. It was a prospective study from 2005 to 2012, conducted in our institute. It included 119 patients of renal stones who underwent percutaneous nephrolithotomy performed under the guidance of a single surgeon. Postoperative nephrostogram was not done in any of the patients. Results. Complete stone clearance was achieved in 97.5% of patients and 2.5% of patients needed two to three sessions of ESWL later on. None of the patients needed second look percutaneous nephrolithotomy or nephrostogram. Conclusion. Postpercutaneous nephrolithotomy nephrostogram increases chances of infection, inconvenience, contrast related complications, and cost, with no added advantage over plain X-ray KUB, and it should not be done as a routine investigation prior to the removal of PCN tube in patients with complete stone clearance.

  8. Location-based solutions in the experience center

    DEFF Research Database (Denmark)

    Witzner Hansen, Dan; Alapetite, Alexandre; Holdgaard, Nanna

    2009-01-01

    In this paper we present a prototype system for location-based guiding. A user survey has been conducted and the observations are used to support design choices. The prototype allows for both indoor and outdoor navigation at and in the vicinity of the NaturBornholm [1] experience centre in Denmar...... using a combination of Bluetooth, Near field communication (NFC), GPS and QR-codes. Bluetooth, NFC, and GPS are used for location-based information and QR-codes are used to convey user preferences. [1] http://naturbornholm.dk...

  9. A Qualitative Examination of Connections between Learner-Centered Teaching and Past Significant Learning Experiences

    Science.gov (United States)

    Brackenbury, Tim

    2012-01-01

    Learner-centered teaching is a collection of instructional practices that shift the emphasis of courses from the instructors' goals and methods of delivery to the knowledge and skills that the students develop. This study examined potential commonalities between features of learner-centered teaching and the past significant learning experiences of…

  10. Neutron Capture Experiments Using the DANCE Array at Los Alamos

    Science.gov (United States)

    Dashdorj, D.; Mitchell, G. E.; Baramsai, B.; Chyzh, A.; Walker, C.; Agvaanluvsan, U.; Becker, J. A.; Parker, W.; Sleaford, B.; Wu, C. Y.; Bredeweg, T. A.; Couture, A.; Haight, R. C.; Jandel, M.; Rundberg, R. S.; Ullmann, J. L.; Vieira, D. J.; Wouters, J. M.; Krtička, M.; Bečvář, F.

    2009-03-01

    The Detector for Advanced Neutron Capture Experiments (DANCE) is designed for neutron capture measurements on very small and/or radioactive targets. The DANCE array of 160 BaF2 scintillation detectors is located at the Lujan Center at the Los Alamos Neutron Science Center (LANSCE). Accurate measurements of neutron capture data are important for many current applications as well as for basic understanding of neutron capture. The gamma rays following neutron capture reactions have been studied by the time-of-flight technique using the DANCE array. The high granularity of the array allows measurements of the gamma-ray multiplicity. The gamma-ray multiplicities and energy spectra for different multiplicities can be measured and analyzed for spin and parity determination of the resolved resonances.

  11. Managing disorder of sexual development surgically: A single center experience

    Directory of Open Access Journals (Sweden)

    Jatinder Kumar

    2012-01-01

    Full Text Available Introduction: Ambiguous genitalia are a major cause of parental anxiety and create psychological and social problems to patient, if not managed properly. Here we present our experience in managing patients with ambiguous genitalia. Material and Methods: We retrospectively reviewed clinical records of all patients with ambiguous genitalia managed surgically at out institute between December 1989 and January 2011. Relevant history, clinical examination , investigations and surgical procedures performed were analyzed and results were evaluated in terms of anatomical, functional and psychosexual outcomes. Results: Female pseudohermaphroditism was the most common cause of genital ambiguity in our patients. Male and female genitoplasty was done according to gender of rearing, genital anatomy and parental choice. Twenty six patients (86.6% reported satisfactory cosmetic outcome and 22 (73.3% satisfactory functional outcome on long term follow-up. Among the 24 patients diagnosed as male pseudohermaphroditism 14 (82.3% patient have reported satisfactory cosmetic outcome and 13 (76.4% have reported satisfactory functional outcome. In patients with mixed gonadal dysgenesis and true hermaphroditism satisfactory cosmetic and functional outcome was seen in 70% patient. Conclusion: Managing patients of genital ambiguity according to gender of rearing, genital anatomy and parental choice carries good prognosis in terms of anatomical, functional and psychosexual outcome.

  12. Five years' experience with capsule endoscopy in a single Center

    Institute of Scientific and Technical Information of China (English)

    Taylan Kav; Yusuf Bayraktar

    2009-01-01

    Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases.Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.

  13. Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Shpend Idrizi

    2015-08-01

    Full Text Available BACKGROUND: Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis. AIM: The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate. MATERIAL AND METHODS: The study included 43 patients, where 33 (74% of them were children between the age of 1 month and 15 years. RESULTS: The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg to 39.1 mmHg (20-80 mmHg. Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9% required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55% patients, and four (9% patients developed moderate regurgitation, without affecting the function of the right ventricle. CONCLUSIONS: Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.

  14. Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2012-02-01

    We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  15. Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

    Science.gov (United States)

    Milev, Ivan; Zafirovska, Planinka; Zimbakov, Zan; Idrizi, Shpend; Ampova-Sokolov, Vilma; Gorgieva, Emilija; Ilievska, Liljana; Tosheski, Goce; Hristov, Nikola; Georgievska-Ismail, Ljubica; Anguseva, Tanja; Mitrev, Zan

    2016-01-01

    BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. RESULTS: During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). CONCLUSIONS: Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms. PMID:28028400

  16. Experience with Evans syndrome in an academic referral center

    Directory of Open Access Journals (Sweden)

    José Carlos Jaime-Pérez

    2015-08-01

    Full Text Available OBJECTIVE: To document the experience of one referral service with patients diagnosed with Evans syndrome, the treatment and response and to briefly review current treatment strategies and results.METHODS: Patients enrolled in this study fulfilled criteria for Evans syndrome. Data were retrieved from the clinical files and electronic databases of the Department of Hematology, Hospital Universitario "Dr. José Eleuterio González". Treatment modalities and response and the use of additional therapies were evaluated. The literature was reviewed in the context of the clinical course of the studied patients.RESULTS: Six patients were diagnosed with Evans syndrome in the study period. Patient 1 was treated with steroids, relapsed twice and was again treated with steroids. Patient 2 treated initially with steroids plus intravenous immunoglobulin was subsequently lost to follow-up. A good response was achieved in Patients 3 and 4, who were treated with steroids plus rituximab; patient 4 also received danazol as a second-line therapy. However both relapsed and subsequently underwent splenectomy at ten and nine months, respectively. One patient, number 5, treated with steroids, danazol and rituximab did not relapse within four years of follow-up and Patient 6, who received steroids plus danazol did not relapse within three years of follow-up.CONCLUSION: Evans syndrome is an uncommon hematologic condition rarely diagnosed and not widely studied. Clinicians must have it in mind when evaluating a patient with a positive direct antiglobulin test, anemia and thrombocytopenia, since prognosis depends on its early recognition and opportune therapy, but even this leads to variable results.

  17. Valve replacement in pediatric patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    YU Jian-hua; GUO Hong-wei; ZHANG Gong; WU Shu-ming; SONG Guang-min; SUN Wen-yu

    2011-01-01

    Background Reconstructive surgery is the primary goal in pediatric patients with valve disease.However,in cases with irreparable valve lesions,valve replacement is the only option.This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.Methods Between January 1990 and July 2009,35 pediatric patients (16 boys,19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital.The ages ranged from 2.5 to 14 years (mean,(8.8±3.8) years) and body weight varied from 11 to 37 kg (mean,(22.1±5.2) kg).Mechanical valve replacement was performed because of congenital heart disease in 23 patients,rheumatic disease in ten patients and infective endocarditis in two patients.St.Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18,aortic valve replacement (AVR) in 12,tricuspid valve replacement (TVR) in two,AVR and MVR in two and MVR and TVR in one.The size of the prostheses ranged between 19 and 27 mm.All patients received long-term anticoagulation treatment with sodium warfarin,aiming to maintain an international normalized ratio between 1.5 to 2.0.Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.Results The operative mortality was 8.57% (3/35).One patient,who underwent cardiac debridement and AVR,died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation.Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation.One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later.Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class Ⅰ to class Ⅱ when discharged.Late events included hemorrhage and endocarditis.Two patients required

  18. Parents' Experiences with Childhood Deafness: Implications for Family-Centered Services

    Science.gov (United States)

    Jackson, Carla Wood; Traub, Randi J.; Turnbull, Ann P.

    2008-01-01

    In response to the need for family-centered follow-up, this study examined parents' experiences with deafness after early identification. Qualitative inquiry methods were used to explore and describe the perceptions and experiences of nine parents of children identified with severe to profound deafness. Parents participated in face-to-face…

  19. Learner-Centered Blogging: A Preliminary Investigation of EFL Student Writers' Experience

    Science.gov (United States)

    Lin, Ming Huei

    2015-01-01

    This study aims to investigate the effectiveness of integrating a learner-centered blogging approach into the EFL writing classroom in Taiwan. For this purpose, a 16-week experiment was conducted, involving an intact class of 18 university-level Taiwanese EFL student writers. During the experiment, the participants first created their own blogs on…

  20. Ecology-Centered Experiences among Children and Adolescents: A Qualitative and Quantitative Analysis

    Science.gov (United States)

    Orton, Judy

    2013-01-01

    The present research involved two studies that considered "ecology-centered experiences" (i.e., experiences with living things) as a factor in children's environmental attitudes and behaviors and adolescents' ecological understanding. The first study (Study 1) examined how a community garden provides children in an urban setting the…

  1. Fabrication of a tantalum-clad tungsten target for LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, A.T., E-mail: atnelson@lanl.gov [Materials Science and Technology Division, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); O' Toole, J.A.; Valicenti, R.A. [Accelerator Operations and Technology Division, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Maloy, S.A. [Civilian Nuclear Program Office, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States)

    2012-12-15

    Development of a solid state bonding technique suitable to clad tungsten targets with tantalum was completed to improve operation of the Los Alamos Neutron Science Centers spallation target. Significant deterioration of conventional bare tungsten targets has historically resulted in transfer of tungsten into the cooling system through corrosion resulting in increased radioactivity outside the target and reduction of delivered neutron flux. The fabrication method chosen to join the tantalum cladding to the tungsten was hot isostatic pressing (HIP) given the geometry constraints of a cylindrical assembly and previous success demonstrated at KENS. Nominal HIP parameters of 1500 Degree-Sign C, 200 MPa, and 3 h were selected based upon previous work. Development of the process included significant surface engineering controls and characterization given tantalums propensity for oxide and carbide formation at high temperatures. In addition to rigorous acid cleaning implemented at each step of the fabrication process, a three layer tantalum foil gettering system was devised such that any free oxygen and carbon impurities contained in the argon gas within the HIP vessel was mitigated to the extent possible before coming into contact with the tantalum cladding. The result of the numerous controls and refined techniques was negligible coarsening of the native Ta{sub 2}O{sub 5} surface oxide, no measureable oxygen diffusion into the tantalum bulk, and no detectable carburization despite use of argon containing up to 5 ppm oxygen and up to 40 ppm total CO, CO{sub 2}, or organic contaminants. Post bond characterization of the interface revealed continuous bonding with a few microns of species interdiffusion.

  2. Fabrication of a tantalum-clad tungsten target for LANSCE

    Science.gov (United States)

    Nelson, A. T.; O'Toole, J. A.; Valicenti, R. A.; Maloy, S. A.

    2012-12-01

    Development of a solid state bonding technique suitable to clad tungsten targets with tantalum was completed to improve operation of the Los Alamos Neutron Science Centers spallation target. Significant deterioration of conventional bare tungsten targets has historically resulted in transfer of tungsten into the cooling system through corrosion resulting in increased radioactivity outside the target and reduction of delivered neutron flux. The fabrication method chosen to join the tantalum cladding to the tungsten was hot isostatic pressing (HIP) given the geometry constraints of a cylindrical assembly and previous success demonstrated at KENS. Nominal HIP parameters of 1500 °C, 200 MPa, and 3 h were selected based upon previous work. Development of the process included significant surface engineering controls and characterization given tantalums propensity for oxide and carbide formation at high temperatures. In addition to rigorous acid cleaning implemented at each step of the fabrication process, a three layer tantalum foil gettering system was devised such that any free oxygen and carbon impurities contained in the argon gas within the HIP vessel was mitigated to the extent possible before coming into contact with the tantalum cladding. The result of the numerous controls and refined techniques was negligible coarsening of the native Ta2O5 surface oxide, no measureable oxygen diffusion into the tantalum bulk, and no detectable carburization despite use of argon containing up to 5 ppm oxygen and up to 40 ppm total CO, CO2, or organic contaminants. Post bond characterization of the interface revealed continuous bonding with a few microns of species interdiffusion.

  3. LOS ALAMOS NEUTRON SCIENCE CENTER CONTRIBUTIONS TO THE DEVELOPMENT OF FUTURE POWER REACTORS

    Energy Technology Data Exchange (ETDEWEB)

    GAVRON, VICTOR I. [Los Alamos National Laboratory; HILL, TONY S. [Los Alamos National Laboratory; PITCHER, ERIC J. [Los Alamos National Laboratory; TOVESSON, FREDERIK K. [Los Alamos National Laboratory

    2007-01-09

    The Los Alamos Neutron Science Center (LANSCE) is a large spallation neutron complex centered around an 800 MeV high-currently proton accelerator. Existing facilities include a highly-moderated neutron facility (Lujan Center) where neutrons between thermal and keV energies are produced, and the Weapons Neutron Research Center (WNR), where a bare spallation target produces neutrons between 0.1 and several hundred MeV.The LANSCE facility offers a unique capability to provide high precision nuclear data over a large energy region, including that for fast reactor systems. In an ongoing experimental program the fission and capture cross sections are being measured for a number of minor actinides relevant for Generation-IV reactors and transmutation technology. Fission experiments makes use of both the highly moderated spallation neutron spectrum at the Lujan Center, and the unmoderated high energy spectrum at WNR. By combininb measurements at these two facilities the differential fission cross section is measured relative to the {sup 235}U(n,f) standard from subthermal energies up to about 200 MeV. An elaborate data acquisition system is designed to deal with all the different types of background present when spanning 10 energy decades. The first isotope to be measured was {sup 237}Np, and the results were used to improve the current ENDF/B-VII evaluation. Partial results have also been obtained for {sup 240}Pu and {sup 242}Pu, and the final results are expected shortly. Capture cross sections are measured at LANSCE using the Detector for Advanced Neutron Capture Experiments (DANCE). This unique instrument is highly efficient in detecting radiative capture events, and can thus handle radioactive samples of half-lives as low as 100 years. A number of capture cross sections important to fast reaction applications have been measured with DANCE. The first measurement was on {sup 237}Np(n,{gamma}), and the results have been submitted for publication. Other capture

  4. Design of low energy beam transport for new LANSCE H+ injector

    Science.gov (United States)

    Batygin, Y. K.; Draganic, I. N.; Fortgang, C. M.; Garnett, R. W.; Kurennoy, S. S.; McCrady, R. C.; O'Hara, J. F.; Rybarcyk, L. J.

    2014-07-01

    The present LANSCE injector utilizes two 750-keV Cockcroft-Walton (CW) based injectors for simultaneous injection of H+ and H- beams into 800-MeV accelerator. To reduce long-term operational risks, the new project to replace the existing H+ CW injector with a Radio-Frequency Quadrupole (RFQ) accelerator is underway [1]. The new injector requires a Low-Energy Beam Transport (LEBT). An ion source and 2-solenoid magnetic LEBT have been designed and optimized to transport beams over a wide range of space-charge neutralization and transverse emittance, while allowing sufficient space for diagnostics and a beam deflector. The design layout minimizes the beam size in the LEBT and potential emittance growth due to solenoid aberrations and nonlinear space-charge forces. This paper describes the details of the LEBT design activity.

  5. Design of low energy beam transport for new LANSCE H{sup +} injector

    Energy Technology Data Exchange (ETDEWEB)

    Batygin, Y.K., E-mail: batygin@lanl.gov; Draganic, I.N.; Fortgang, C.M.; Garnett, R.W.; Kurennoy, S.S.; McCrady, R.C.; O’Hara, J.F.; Rybarcyk, L.J.

    2014-07-01

    The present LANSCE injector utilizes two 750-keV Cockcroft–Walton (CW) based injectors for simultaneous injection of H{sup +} and H{sup −} beams into 800-MeV accelerator. To reduce long-term operational risks, the new project to replace the existing H{sup +} CW injector with a Radio-Frequency Quadrupole (RFQ) accelerator is underway [1]. The new injector requires a Low-Energy Beam Transport (LEBT). An ion source and 2-solenoid magnetic LEBT have been designed and optimized to transport beams over a wide range of space-charge neutralization and transverse emittance, while allowing sufficient space for diagnostics and a beam deflector. The design layout minimizes the beam size in the LEBT and potential emittance growth due to solenoid aberrations and nonlinear space-charge forces. This paper describes the details of the LEBT design activity.

  6. Multi-objective particle swarm and genetic algorithm for the optimization of the LANSCE linac operation

    Energy Technology Data Exchange (ETDEWEB)

    Pang, X., E-mail: xpang@lanl.gov; Rybarcyk, L.J.

    2014-03-21

    Particle swarm optimization (PSO) and genetic algorithm (GA) are both nature-inspired population based optimization methods. Compared to GA, whose long history can trace back to 1975, PSO is a relatively new heuristic search method first proposed in 1995. Due to its fast convergence rate in single objective optimization domain, the PSO method has been extended to optimize multi-objective problems. In this paper, we will introduce the PSO method and its multi-objective extension, the MOPSO, apply it along with the MOGA (mainly the NSGA-II) to simulations of the LANSCE linac and operational set point optimizations. Our tests show that both methods can provide very similar Pareto fronts but the MOPSO converges faster.

  7. Multi-objective particle swarm and genetic algorithm for the optimization of the LANSCE linac operation

    Science.gov (United States)

    Pang, X.; Rybarcyk, L. J.

    2014-03-01

    Particle swarm optimization (PSO) and genetic algorithm (GA) are both nature-inspired population based optimization methods. Compared to GA, whose long history can trace back to 1975, PSO is a relatively new heuristic search method first proposed in 1995. Due to its fast convergence rate in single objective optimization domain, the PSO method has been extended to optimize multi-objective problems. In this paper, we will introduce the PSO method and its multi-objective extension, the MOPSO, apply it along with the MOGA (mainly the NSGA-II) to simulations of the LANSCE linac and operational set point optimizations. Our tests show that both methods can provide very similar Pareto fronts but the MOPSO converges faster.

  8. A Qualitative Study of Information Technology Managers' Experiences and Perceptions Regarding Outsourced Data Centers

    Science.gov (United States)

    Reid, Eric Justin

    2015-01-01

    This qualitative study explored the perceptions and experiences of IT Managers in publicly traded companies within the San Antonio, Texas area about outsourced data centers. Narrative data was collected using open-ended questions and face-to-face interviews within semi-structured environments. The research questions guided the study: (1)…

  9. Individual Differences and the Conundrums of User-Centered Design: Two Experiments.

    Science.gov (United States)

    Allen, Bryce

    2000-01-01

    Discusses individual differences between users of information systems that can influence search performance, and describes two experiments that addressed user-centered design of information systems. Highlights include interaction between cognitive abilities and design features; compensation and capitalization perspectives; recall and precision;…

  10. Single center experience and technical nuances in the treatment of distal anterior cerebral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Gherasim Dorin Nicolae

    2017-03-01

    Full Text Available Objective: This study presents the experience of one neurosurgical center in the treatment of 18 consecutive patients with distal anterior cerebral artery (DACA aneurysms during a 10 years period. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general, and to present technical nuances in surgical treatment.

  11. An Exploration of Student Experiences with Learner-Centered Instructional Strategies

    Science.gov (United States)

    Stefaniak, Jill E.; Tracey, Monica W.

    2015-01-01

    In this exploratory study, we examined how undergraduate students experience learning in a learner-centered teaching environment and their perceptions of motivation towards learning material in an introductory public speaking communications course. Six faculty members participated in a semester-long study where their teaching strategies were…

  12. Design experience of a base-isolation system applied to a computer center building

    Energy Technology Data Exchange (ETDEWEB)

    Hasebe, Akiyoshi; Kojima, Hideo; Tamura, Kazuo (Tohoku Electric Power Co., Sendai (Japan))

    1991-06-01

    Design experience of the base-isolated new computer center of the Tohoku Electric Power Co. is described. This building after completion will be the largest isolated building in Japan with a total floor space of {proportional to} 10,000 m{sup 2}. High-damping laminated rubber bearings are used as base-isolation devices. (orig.).

  13. Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience

    OpenAIRE

    Bazzi, Wassim M.; Kopp, Ryan P.; Donahue, Timothy F.; Bernstein, Melanie; Russo, Paul; Bochner, Bernard H.; Donat, Sherri M.; Dalbagni, Guido; Herr, Harry W.

    2014-01-01

    Objective. To report our contemporary experience with partial cystectomy after neoadjuvant chemotherapy. Patients and Methods. Retrospective review of patients who underwent neoadjuvant chemotherapy and partial cystectomy for urothelial cell carcinoma of the bladder at Memorial Sloan Kettering Cancer Center from 1995 to 2013. Log-rank test and Cox regression models were used to analyze variables possibly associated with recurrence-free, advanced recurrence-free (free from recurrence beyond sa...

  14. Causes and outcomes of revisional bariatric surgery: initial experience at a single center

    OpenAIRE

    2014-01-01

    Purpose Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center. Methods A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surge...

  15. NASA Glenn Research Center's Materials International Space Station Experiments (MISSE 1-7)

    Science.gov (United States)

    deGroh, Kim K.; Banks, Bruce a.; Dever, Joyce A.; Jaworske, Donald A.; Miller, Sharon K.; Sechkar, Edward A.; Panko, Scott R.

    2008-01-01

    NASA Glenn Research Center (Glenn) has 39 individual materials flight experiments (>540 samples) flown as part of the Materials International Space Station Experiment (MISSE) to address long duration environmental durability of spacecraft materials in low Earth orbit (LEO). MISSE is a series of materials flight experiments consisting of trays, called Passive Experiment Carriers (PECs) that are exposed to the space environment on the exterior of the International Space Station (ISS). MISSE 1-5 have been successfully flown and retrieved and were exposed to the space environment from one to four years. MISSE 6A & 6B were deployed during the STS-123 shuttle mission in March 2008, and MISSE 7A & 7B are being prepared for launch in 2009. The Glenn MISSE experiments address atomic oxygen (AO) effects such as erosion and undercutting of polymers, AO scattering, stress effects on AO erosion, and in-situ AO fluence monitoring. Experiments also address solar radiation effects such as radiation induced polymer shrinkage, stress effects on radiation degradation of polymers, and radiation degradation of indium tin oxide (ITO) coatings and spacesuit fabrics. Additional experiments address combined AO and solar radiation effects on thermal control films, paints and cermet coatings. Experiments with Orion Crew Exploration Vehicle (CEV) seals and UltraFlex solar array materials are also being flown. Several experiments were designed to provide ground-facility to in-space calibration data thus enabling more accurate in-space performance predictions based on ground-laboratory testing. This paper provides an overview of Glenn s MISSE 1-7 flight experiments along with a summary of results from Glenn s MISSE 1 & 2 experiments.

  16. Review of the Lujan neutron scattering center: basic energy sciences prereport February 2009

    Energy Technology Data Exchange (ETDEWEB)

    Hurd, Alan J [Los Alamos National Laboratory; Rhyne, James J [Los Alamos National Laboratory; Lewis, Paul S [Los Alamos National Laboratory

    2009-01-01

    The Lujan Neutron Scattering Center (Lujan Center) at LANSCE is a designated National User Facility for neutron scattering and nuclear physics studies with pulsed beams of moderated neutrons (cold, thermal, and epithermal). As one of five experimental areas at the Los Alamos Neutron Science Center (LANSCE), the Lujan Center hosts engineers, scientists, and students from around the world. The Lujan Center consists of Experimental Room (ER) 1 (ERl) built by the Laboratory in 1977, ER2 built by the Office of Basic Energy Sciences (BES) in 1989, and the Office Building (622) also built by BES in 1989, along with a chem-bio lab, a shop, and other out-buildings. According to a 1996 Memorandum of Agreement (MOA) between the Defense Programs (DP) Office of the National Nuclear Security Agency (NNSA) and the Office of Science (SC, then the Office of Energy Research), the Lujan Center flight paths were transferred from DP to SC, including those in ERI. That MOA was updated in 2001. Under the MOA, NNSA-DP delivers neutron beam to the windows of the target crypt, outside of which BES becomes the 'landlord.' The leveraging nature of the Lujan Center on the LANSCE accelerator is a substantial annual leverage to the $11 M BES operating fund worth approximately $56 M operating cost of the linear accelerator (LINAC)-in beam delivery.

  17. Health professionals’ experiences of person-centered collaboration in mental health care

    Directory of Open Access Journals (Sweden)

    Rita Sommerseth

    2008-10-01

    Full Text Available Rita Sommerseth, Elin DysvikUniversity of Stavanger, Faculty of Social Sciences, Department of Health Studies, Stavanger, NorwayObjective: The basic aim in this paper is to discuss health care professionals’ experiences of person-centered collaboration and involvement in mental health rehabilitation and suggest ways of improving this perspective. Furthermore, the paper explains the supportive systems that are at work throughout the process of rehabilitation.Method: The study design is a qualitative approach using three focus group interviews with a total of 17 informants with different professional backgrounds such as nurses, social workers, and social pedagogies. In addition, one nurse and one social worker participated in a semistructured in-depth interview to judge validity.Results: Our results may demonstrate deficits concerning mental health care on several levels. This understanding suggests firstly, that a person-centered perspective and involvement still are uncommon. Secondly, multidisciplinary work seems uncommon and only sporadically follows recommendations. Thirdly, family support is seldom involved. Lastly, firm leadership and knowledge about laws and regulations seems not to be systematically integrated in daily care.Conclusion: Taking these matters together, the improvement of a person-centered perspective implies cooperation between different services and levels in mental health care. In order to bring about improvement the health care workers must critically consider their own culture, coordination of competence must be increased, and leadership at an institutional and organizational level must be improved so that scarce rehabilitation resources are used to the optimal benefit of people with a mental illness.Keywords: multidisciplinary teams, person-centered collaboration, supportive systems, rehabilitation

  18. Gamma Emission Spectra from Neutron Resonances in 234,236,238U Measured Using the Dance Detector at Lansce

    Science.gov (United States)

    Ullmann, J. L.; Bredeweg, T. A.; Couture, A. J.; Haight, R. C.; Jandel, M.; Kawano, T.; Keksis, A. L.; O'Donnell, J. M.; Rundberg, R. S.; Vieira, D. J.; Wouters, J. M.; Wilhelmy, J. B.; Wu, C. Y.; Becker, J. A.; Chyzh, A.; Baramsai, B.; Mitchell, G. E.; Krticka, M.

    2013-03-01

    An accurate knowledge of the radiative strength function and level density is needed to calculate of neutron-capture cross sections. An additional constraint on these quantities is provided by measurements of γ-ray emission spectra following capture. We present γ-emission spectra from several neutron resonances in 234,236,238U, measured using the DANCE detector at LANSCE. The measurements are compared to preliminary calculations of the cascade. It is observed that the generalized Lorentzian form of the E1 strength function cannot reproduce the shape of the emission spectra, but a better description is made by adding low-lying M1 Lorentzian strength.

  19. Group Violence and Migration Experience among Latin American Youths in Justice Enforcement Centers (Madrid, Spain).

    Science.gov (United States)

    Martínez García, José Manuel; Martín López, María Jesús

    2015-10-30

    Group violence among Latin American immigrant youth has led to ongoing debates in political, legal, and media circles, yet none of those many perspectives has arrived at a solid, empirically supported definition for the phenomenon. This study aims to explore the relationship between the immigrant experience and violent group behavior in youths from Latin America serving prison sentences in Justice Enforcement Centers in the Community of Madrid. Semi-structured interviews were conducted with 19 juveniles, and content analysis was applied to the resulting transcripts, employing Grounded Theory to create an axial codification of intra- and inter-categorical contents, and Delphi panels for quality control. The research team delved into 62 topics, addressing participants' perceptions of the immigrant experience and its effects on five socialization settings (neighborhood, school, family, peer group, and significant other), and each one's relationship to violent behavior. The results led us to believe the young people's immigration experiences had been systematically examined. Their personal and social development was influenced by negative socioeconomic conditions, ineffective parental supervision, maladjustment and conflict at school, and experiences of marginalization and xenophobia. All those conditions favored affiliation with violent groups that provided them instrumental (economic and material), expressive, or affective support.

  20. Atmospheric monitoring of a perfluorocarbon tracer at the 2009 ZERT Center experiment

    Science.gov (United States)

    Pekney, Natalie; Wells, Arthur; Rodney Diehl, J.; McNeil, Matthew; Lesko, Natalie; Armstrong, James; Ference, Robert

    2012-02-01

    Field experiments at Montana State University are conducted for the U.S. Department of Energy as part of the Zero Emissions Research and Technology Center (ZERT) to test and verify monitoring techniques for carbon capture and storage (CCS). A controlled release of CO 2 with an added perfluorocarbon tracer was conducted in July 2009 in a multi-laboratory study of atmospheric transport and detection technologies. Tracer plume dispersion was measured with various meteorological conditions using a tethered balloon system with Multi-Tube Remote Samplers (MTRS) at elevations of 10 m, 20 m, and 40 m above ground level (AGL), as well as a ground-based portable tower with monitors containing sorbent material to collect the tracer at 1 m, 2 m, 3 m, and 4 m AGL. Researchers designed a horizontal grid of sampling locations centered at the tracer plume source, with the tower positioned at 10 m and 30 m in both upwind and downwind directions, and the MTRS spaced at 50 m and 90 m downwind and 90 m upwind. Tracer was consistently detected at elevated concentrations at downwind sampling locations. With very few exceptions, higher tracer concentrations correlated with lower elevations. Researchers observed no statistical difference between sampling at 50 m and 90 m downwind at the same elevation. The US EPA AERMOD model applied using site-specific information predicted transport and dispersion of the tracer. Model results are compared to experimental data from the 2009 ZERT experiment. Successful characterization of the tracer plume simulated by the ZERT experiment is considered a step toward demonstrating the feasibility of remote sampling with unmanned aerial systems (UAS's) at future sequestration sites.

  1. Training for life science experiments in space at the NASA Ames Research Center

    Science.gov (United States)

    Rodrigues, Annette T.; Maese, A. Christopher

    1993-01-01

    As this country prepares for exploration to other planets, the need to understand the affects of long duration exposure to microgravity is evident. The National Aeronautics and Space Administration (NASA) Ames Research Center's Space Life Sciences Payloads Office is responsible for a number of non-human life sciences payloads on NASA's Space Shuttle's Spacelab. Included in this responsibility is the training of those individuals who will be conducting the experiments during flight, the astronauts. Preparing a crew to conduct such experiments requires training protocols that build on simple tasks. Once a defined degree of performance proficiency is met for each task, these tasks are combined to increase the complexity of the activities. As tasks are combined into in-flight operations, they are subjected to time constraints and the crew enhances their skills through repetition. The science objectives must be completely understood by the crew and are critical to the overall training program. Completion of the in-flight activities is proof of success. Because the crew is exposed to the background of early research and plans for post-flight analyses, they have a vested interest in the flight activities. The salient features of this training approach is that it allows for flexibility in implementation, consideration of individual differences, and a greater ability to retain experiment information. This training approach offers another effective alternative training tool to existing methodologies.

  2. A high-rate detection system to study parity violation with polarized epithermal neutrons at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Knudson, J.N.; Bowman, J.D. [Los Alamos National Lab., NM (United States); Crawford, B.E. [Duke Univ., Durham, NC (United States)]|[Triangle Universities Nuclear Laboratory, Durham, NC (United States)

    1995-07-01

    We describe an apparatus for studies of parity violation in neutron-nucleus scattering. This experiment requires longitudinally polarized neutrons from the Los Alamos Neutron Scattering Center over the energy-range from 1 to 1000 eV, the ability to reverse the neutron spin without otherwise affecting the apparatus, the ability to detect neutrons at rates up to 500 MHz, and an appropriate data acquisition system. We will discuss the neutron polarizer, fast neutron spin reverser, detector for transmitted neutrons, and high rate data acquisition system.

  3. Computed tomography-guided core-needle biopsy of lung lesions: an oncology center experience

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Marcos Duarte; Fonte, Alexandre Calabria da; Chojniak, Rubens, E-mail: marcosduarte@yahoo.com.b [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Radiology and Imaging Diagnosis; Andrade, Marcony Queiroz de [Hospital Alianca, Salvador, BA (Brazil); Gross, Jefferson Luiz [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Chest Surgery

    2011-03-15

    Objective: The present study is aimed at describing the experience of an oncology center with computed tomography guided core-needle biopsy of pulmonary lesions. Materials and Methods: Retrospective analysis of 97 computed tomography-guided core-needle biopsy of pulmonary lesions performed in the period between 1996 and 2004 in a Brazilian reference oncology center (Hospital do Cancer - A.C. Camargo). Information regarding material appropriateness and the specific diagnoses were collected and analyzed. Results: Among 97 lung biopsies, 94 (96.9%) supplied appropriate specimens for histological analyses, with 71 (73.2%) cases being diagnosed as malignant lesions and 23 (23.7%) diagnosed as benign lesions. Specimens were inappropriate for analysis in three cases. The frequency of specific diagnosis was 83 (85.6%) cases, with high rates for both malignant lesions with 63 (88.7%) cases and benign lesions with 20 (86.7%). As regards complications, a total of 12 cases were observed as follows: 7 (7.2%) cases of hematoma, 3 (3.1%) cases of pneumothorax and 2 (2.1%) cases of hemoptysis. Conclusion: Computed tomography-guided core needle biopsy of lung lesions demonstrated high rates of material appropriateness and diagnostic specificity, and low rates of complications in the present study. (author)

  4. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  5. Experiments and contexts in the interactive exhibitions of centers and museums of science

    Directory of Open Access Journals (Sweden)

    Maura Ventura Chinelli

    2009-12-01

    Full Text Available Here is described a research that meant to indentify, through analysis of experiments and contexts in interactive expositions held by centers and museums of science, the necessary conditions for grasping the scientific culture in the post-positivist conception. The project was developed with the participation of students in training courses for teachers on a proposal based on the principles and methods of action research, in order to form skills that lead to interferences in the professional future. The results show that the samples of interactive exhibits are organized according to the classic paradigm: they offer opportunities for experimentation that produce observational data supposedly neutral and maintain separate nature and human being. In conclusion, we have those exhibits contribute to bringing the visitors closer to the positivistic science, not contributing to bring them closer to the concept of science based on the contemporary paradigm of complexity.

  6. Technology Transfer from University-Based Research Centers: The University of New Mexico Experience.

    Science.gov (United States)

    Rogers, Everett M.; Hall, Brad; Hashimoto, Michio; Steffensen, Morten; Speakman, Kristen L.; Timko, Molly K.

    1999-01-01

    A study of 55 research centers at the University of New Mexico investigated the nature of the typical center, why funding has risen during the 1990s, reasons for founding the centers, the director's role, how university-based research centers transfer technology to private companies and other organizations, and what determines program…

  7. Crack-Detection Experiments on Simulated Turbine Engine Disks in NASA Glenn Research Center's Rotordynamics Laboratory

    Science.gov (United States)

    Woike, Mark R.; Abdul-Aziz, Ali

    2010-01-01

    The development of new health-monitoring techniques requires the use of theoretical and experimental tools to allow new concepts to be demonstrated and validated prior to use on more complicated and expensive engine hardware. In order to meet this need, significant upgrades were made to NASA Glenn Research Center s Rotordynamics Laboratory and a series of tests were conducted on simulated turbine engine disks as a means of demonstrating potential crack-detection techniques. The Rotordynamics Laboratory consists of a high-precision spin rig that can rotate subscale engine disks at speeds up to 12,000 rpm. The crack-detection experiment involved introducing a notch on a subscale engine disk and measuring its vibration response using externally mounted blade-tip-clearance sensors as the disk was operated at speeds up to 12 000 rpm. Testing was accomplished on both a clean baseline disk and a disk with an artificial crack: a 50.8-mm- (2-in.-) long introduced notch. The disk s vibration responses were compared and evaluated against theoretical models to investigate how successful the technique was in detecting cracks. This paper presents the capabilities of the Rotordynamics Laboratory, the baseline theory and experimental setup for the crack-detection experiments, and the associated results from the latest test campaign.

  8. Experience with multimodality telepathology at the University of Pittsburgh Medical Center

    Directory of Open Access Journals (Sweden)

    Liron Pantanowitz

    2012-01-01

    Full Text Available Several modes of telepathology exist including static (store-and-forward, dynamic (live video streaming or robotic microscopy, and hybrid technology involving whole slide imaging (WSI. Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision® system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections. Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal (https://pathconsult.upmc.com/ was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience

  9. Experience with multimodality telepathology at the University of Pittsburgh Medical Center.

    Science.gov (United States)

    Pantanowitz, Liron; Wiley, Clayton A; Demetris, Anthony; Lesniak, Andrew; Ahmed, Ishtiaque; Cable, William; Contis, Lydia; Parwani, Anil V

    2012-01-01

    Several modes of telepathology exist including static (store-and-forward), dynamic (live video streaming or robotic microscopy), and hybrid technology involving whole slide imaging (WSI). Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC) for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision(®) system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections). Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal (https://pathconsult.upmc.com/) was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience. Early and

  10. Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

    Directory of Open Access Journals (Sweden)

    Bjelović Miloš

    2015-01-01

    Full Text Available Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36% middle thoracic esophagus tumors and 28 (64% tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes. The average blood loss was 173.6 ml. A total of 12 (27% of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE, better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

  11. Congenital duodenal obstruction in neonates:a decade's experience from one center

    Institute of Scientific and Technical Information of China (English)

    Qing-Jiang Chen; Zhi-Gang Gao; Jin-Fa Tou; Yun-Zhong Qian; Min-Ju Li; Qi-Xing Xiong; Qiang Shu

    2014-01-01

    Background: Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. Methods: We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and fi nal outcomes. Results: The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical doublebubble sign or air-fl uid levels in 68.64% of patients, and confi rmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. Conclusions: Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and

  12. Toward quality assurance for metaphase FISH: A multi-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Dewald, G. [Mayo Clinic, Rochester, NY (United States); Higgins, R. [Abbott Northwestern Hospital, Minneapolis, MN (United States); Hirsch, B. [Univ. Minnesota Hospitals and Clinics, Minneapolis, MN (United States)] [and others

    1996-09-06

    Although fluorescent in situ hybridization (FISH) is rapidly becoming a part of clinical cytogenetics, no organization sponsors multi-center determinations of the efficacy of probes. We report on 23 laboratories that volunteered to provide slides and to use a probe for SNRPN and a control locus. Experiences with FISH for these laboratories during 1994 ranged from 0 to 645 utilizations (median = 84) involving blood, amniotic fluid and bone marrow. In an initial study of hybridization efficiency, the median percentage of metaphases from normal individuals showing two SNRPN and 2 control signals for slides prepared at each site was 97.0 (range = 74-100); for slides prepared by a central laboratory, it was 97.8 (range = 81.6-100). In a subsequent blind study, each laboratory attempted to score 5 metaphases from each of 23 specimens [8 with del(15)(q11.2{r_arrow}q12) and 15 with normal 15 chromosomes]. Of 529 challenges, the correct SNRPN pattern was found in 5 of 5 metaphases in 457 (86%) and in 4 of 5 in 33 (6%). Ambiguous, incomplete or no results were reported for 32 (6%) challenges. Seven (1%) diagnostic errors were made including 6 false positives and 1 false negative: 1 laboratory made 3 errors, 1 made 2, and 2 made 1 each. Most errors and inconsistencies seemed due to inexperience with FISH. The working time to process and analyze slides singly averaged 49.5 minutes; slides processed in batches of 4 and analyzed singly required 36.9 minutes. We conclude that proficiency testing for FISH using an extensive array of challenges is possible and that multiple centers can collaborate to test probes and to evaluate costs. 10 refs., 1 fig., 4 tabs.

  13. The Fetus with Ectopia Cordis: Experience and Expectations from Two Centers.

    Science.gov (United States)

    Escobar-Diaz, Maria C; Sunderji, Sherzana; Tworetzky, Wayne; Moon-Grady, Anita J

    2016-12-19

    Ectopia cordis (EC) is a rare congenital anomaly often associated with congenital heart disease (CHD). There is a lack of contemporary information on EC diagnosed prenatally. We sought to combine the experiences of two regional referral centers in order to evaluate current outcomes for EC. Clinical, echocardiographic features and perinatal outcomes of fetuses with EC managed at two large cardiac centers from 1995 to 2014 were retrospectively reviewed. Seventeen fetuses with EC were diagnosed at a median gestational age of 23 weeks (range 17-36). There were 6 thoracic EC and 11 thoracoabdominal. Fifteen had associated CHD: 10 conotruncal defects, 2 tricuspid atresia, 1 aortic stenosis, 1 atrial septal defect, and 1 atrioventricular septal defect. There were 2 terminations of pregnancy, 2 fetal deaths, 2 lost to follow-up, and 11 live born. Mean gestational age at birth was 36.4 weeks (range 26-39). Three patients died shortly after birth with comfort care, and 8 were actively managed. Six patients underwent postnatal cardiac intervention and are currently alive with a mean follow-up of 7.3 years (range 1.4-11.4), 2 of them with chronic dependency on ventilatory support. Two patients without CHD died after attempted chest closure. When diagnosed in utero, a high proportion of pregnancy termination or fetal demise is expected. In our cohort, conotruncal anomalies were the most common associated CHD. Though mortality in actively managed patients was not as high as previously reported, and cardiac surgical intervention may be achieved, EC is still associated with high mortality and significant long-term morbidity.

  14. Outcomes of adult-to-adult living donor liver transplantation:a single center experience

    Institute of Scientific and Technical Information of China (English)

    FENG Xi; YUAN Ding; WEI Yong-gang; LI Fu-qiang; WEN Tian-fu; ZENG Yong; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing; YANG Jia-yin; MA Yu-kui; CHEN Zhe-yu; YE Hui; YAN Lü-nan; LI Bo

    2009-01-01

    Background Since January 2002,adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers.This study presents a detailed analysis of the outcomes of AALDLT in a single center.Methods A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007.Among these,67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts.Three-dimensional volumetric computed tomography,magnetic resonance imaging with angiography and cholangiography were performed preoperatively.Recipient operation time,intraoperative transfusion requirement,length of intensive care unit stay,length of hospital stay,liver function tests,coagulation tests and surgical outcomes were routinely investigated throughout this study.Results All donors survived the procedure with an overall complication rate of 15.3%.Overall recipient 1-year survival and complication rates were 87.1% and 34.2%,respectively.Among the 70 cases,average graft recipient weight ratio was 0.94% (0.72%-1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74%-71.68%).All residual liver volumes exceeded 35%.Liver function and coagulation recovered rapidly within the first 7 days after transplantation.Conclusions AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease.Patient selection and timely decision-making for transplantation are essential in achieving good outcomes.With accumulation of experience in surgery and clinical management,timely feedback and proper modification,we foresee better outcomes in the future.

  15. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E. (Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)), E-mail: Stephanie.Combs@med.uni-heidelberg.de; Ellerbrock, Malte; Haberer, Thomas (Heidelberger Ionenstrahl Therapiezentrum (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg (Germany)) (and others)

    2010-10-15

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  16. Nuclear Energy Experiments to the Center for Global Security and Cooperation.

    Energy Technology Data Exchange (ETDEWEB)

    Osborn, Douglas M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-06-01

    This is to serve as verification that the Center 6200 experimental pieces supplied to the Technology Training and Demonstration Area within the Center of Global Security and Cooperation are indeed unclassified unlimited released for viewing.

  17. Mental health and solidarity economy: the experience of users and workers of a Psychosocial Care Center

    Directory of Open Access Journals (Sweden)

    Ioneide de Oliveira Campos

    2015-07-01

    Full Text Available This work is within the context of discussions on mental health and solidarity economy. It is an account of the experience lived at the Tabatinga II Psychosocial Care Center (CAPS in the Federal District, Brazil, where projects designed to generate employment and income in the mental health area reaffirm their ability, as tools for social inclusion, to incorporate the principles and values of solidarity economy aiming at the empowerment and autonomy of citizens in mental distress. This work intended to support and encourage reflections on the possibilities for social inclusion arising from the generation of jobs and income through collective and cooperative actions developed and elaborated with the participation of users, family members, and workers of this service. Emphasis on participatory methodology guided the development of the experience, and the proposition of triggering actions on mental health and solidarity economy at different times, under the coordination of the performing team, afforded, concurrently, the realization of two actions/interventions: a group activity designed to service users and their relatives who gathered to learn and reflect on collective work and supportive venture; and three monthly training sessions, from August to December 2013, on cooperativism, solidarity economy, and mental health addressed to the professionals of that CAPS. At the end of these interventions, it was possible to observe that the involvement of people under mental distress in these projects contributes to overcome their current state of subordination and weakness. It is worth mentioning that, in general, the development of these actions favored reflections on the world of collective work and aggregated methodological knowledge on solidarity ventures.

  18. An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study.

    Science.gov (United States)

    Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

    2016-06-16

    Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients' time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries.

  19. Hepatobilio-pancreatic robotic surgery: initial experience from a single center institute.

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    Quijano, Yolanda; Vicente, Emilio; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Malave, Luis; Ferri, Valentina; Plaza, Carlos; Lindemann, Jan Lammel; D'Andrea, Vito; Caruso, Riccardo

    2016-12-30

    The use of robotic surgery in the hepatobilio-pancreatic (HBP) field is still limited. Our aim is to present our early experience of robotic liver resection. A retrospective review of robotic pancreatic and liver resection was performed at Sanchinarro University hospital from October 2010 to April 2016. Since the beginning of the robotic program in our center, 22 hepatic procedures and 45 pancreatic robotic procedures have been performed. Of the 21 patients subjected to liver resection, 13 (65%) were for malignancy. There were two left hepatectomies, one right hepatectomy, one associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), three bisegmentectomies and three segmentectomies, eight wedge resections, and three pericystectomies. The mean operating time was 282 min. The overall conversion rate and postoperative complication rate were 4.7 and 19%, respectively. The mean length of hospital stay was 13.4 days (range 4-64 days). Of the 45 patients subjected to pancreatic resection, 22 were male and 23 female. The average age of all patients was 62 years (range 31-82 years). The mean operating room (OR) time was 370 min (120-780 min). Among the procedures performed were 15 pancreatico-duodenectomies, 19 distal pancreatectomies, and 11 enucleations. All procedures in the HBP area were R0. Our early experience shows that robotic surgery is a safe and feasible procedure in the HBP area. The complication and mortality rates are comparable to those of open surgery, but with the advantages of minimally invasive surgery.

  20. Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

    Science.gov (United States)

    Liu, Wei-Cheng; Wan, Song-Lin; Yaseen, SM; Ren, Xiang-Hai; Tian, Cui-Ping; Ding, Zhao; Zheng, Ken-Yan; Wu, Yun-Hua; Jiang, Cong-Qing; Qian, Qun

    2016-01-01

    Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented. PMID:27672293

  1. Hyperhemolysis in Patients With Hemoglobinopathies: A Single-Center Experience and Review of the Literature.

    Science.gov (United States)

    Danaee, Anicee; Inusa, Baba; Howard, Jo; Robinson, Susan

    2015-10-01

    Hyperhemolysis is a severe and potentially life-threatening complication of transfusion described in numerous case reports and gaining recognition since 2009 via the UK Serious Hazards of Transfusion scheme. Although it is predominantly seen in patients with sickle cell disease, there are several reports of this complication in patients with other hemoglobinopathies as well as patients with a range of other hematologic diagnoses who have blood transfusions as part of their management. Our understanding of the underlying pathophysiology of this subtype of delayed transfusion reaction has increased over the last few years; however, there are still questions, which remain unanswered. In our center alone, we have encountered 9 cases in the last 5 years both in the adult and pediatric population. Here we discuss our experience in the diagnosis and management of this complication, and review other cases reported in the literature and the various existing theories behind the pathophysiology of this process. We also discuss the role of genotyping and using DNA technology to aid selection of the most appropriate blood for this patient group. With an increased awareness of hyperhemolysis, it would be advantageous to finally develop international registries to determine the true incidence of hyperhemolysis, better understand the pathophysiology, identify markers to predict which patients are at risk, and inform management guidelines.

  2. Turner syndrome: review of clinical, neuropsychiatric, and EEG status: an experience of tertiary center.

    Science.gov (United States)

    Saad, Khaled; Abdelrahman, Ahmed A; Abdel-Raheem, Yasser F; Othman, Essam R; Badry, Reda; Othman, Hisham A K; Sobhy, Karema M

    2014-03-01

    We reviewed the clinical, neuropsychiatric, and EEG status of 53 turner syndrome (TS) females, aged 3-16 years, in Assiut university hospitals, Upper Egypt. The diagnosis and care of patients with TS in Egypt is still in the developing stage. Hence this study was undertaken to review the details of patients with TS with respect to the pattern of cognitive, psychiatric, and motor dysfunction. We aimed to provide a comprehensive data about the experience of our center comparable to previous studies, which have been published in this field. This will contribute to a better definition of the neuropsychiatric features that may be specific to TS that allows early and better detection and management of these cases. We found FSIQ and verbal IQ that seem to be at a nearly normal level and a decreased performance IQ. ADHD and autistic symptoms were found in 20.70 and 3.77 % of our cohort, respectively. The motor performance in TS was disturbed, with some neurological deficits present in 17 % (reduced muscle tone and reduced muscle power). In addition, females with TS in our study exhibit social and emotional problems, including anxiety (5.66 %) and depression (11.30 %). The EEG results revealed abnormalities in seven patients (13.20 %). One patient presenting with generalized tonic-clonic seizures showed generalized epileptiform activity, and six patients presenting with intellectual disabilities showed abnormal EEG background activity.

  3. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  4. Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

    Directory of Open Access Journals (Sweden)

    Xiquan Tian

    2015-04-01

    Full Text Available Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes and the mean estimated blood loss was 134 mL (80-650 mL.The mean postoperative hospital stay was 3.6 days (3-5days and the mean return to normal activity was 11.6 days (10-14days. Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.

  5. Early liver retransplantation versus late liver retransplantation:analysis of a single-center experience

    Institute of Scientific and Technical Information of China (English)

    CHEN Gui-hua; ZHANG Jun-feng; ZHANG Tong; WANG Guo-ying; FU Bin-sheng; YANG Yang; CAI Chang-jie; LU Min-qiang; LI Hua; WANG Gen-shu; YI Shu-hong; XU Chi

    2008-01-01

    Background Orthotopic liver retransplantation (re-OLT) is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.Results Biliary tract complications were the main indications for early re-OLT (57.1%) and late re-OLT (52.9%). Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease (MELD) score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma (HCC) in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the

  6. Advancing user experience research to facilitate and enable patient-centered research: current state and future directions.

    Science.gov (United States)

    Payne, Philip R O

    2013-01-01

    Human-computer interaction and related areas of user experience (UX) research, such as human factors, workflow evaluation, and data visualization, are thus essential to presenting data in ways that can further the analysis of complex data sets such as those used in patient-centered research. However, a review of available data on the state of UX research as it relates to patient-centered research demonstrates a significant underinvestment and consequently a large gap in knowledge generation. In response, this report explores trends in funding and research productivity focused on UX and patient-centered research and then presents a set of recommendations to advance innovation at this important intersection point. Ultimately, the aim is to catalyze a community-wide dialogue concerning future directions for research and innovation in UX as it applies to patient-centered research.

  7. Parent Perspectives on How a Child-Centered Preschool Experience Shapes Children's Navigation of Kindergarten

    Science.gov (United States)

    Recchia, Susan; Bentley, Dana Frantz

    2013-01-01

    The authors used qualitative case study methodology to explore parents' perceptions of their children's readiness for kindergarten. The authors interviewed parents, focusing on their children's experiences during their transition from a child-centered, play-based preschool setting guided by an emergent curriculum into a range of…

  8. Living Related Donor Kidney Transplantation in Libya: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Elusta Ahmed

    2008-01-01

    Full Text Available The aim of this study is to report the experience from a single center in Libya, on the prevailing live-related kidney transplantation program. The results of three years work on kidney transplantation at the Tripoli Central Hospital (National Organ Transplant Program in Libya were evaluated. The transplant program was launched on 17 th August, 2004 and 135 patients have been transplanted since then till 17 th August, 2007. All donors and recipients were screened thoroughly prior to transplant and monitored closely in the post-transplant period. Our immuno-suppressive protocol was cyclosporine-based. Among the 135 accepted pairs, donors and reci-pients were genetically-related in 133 cases (98.5% and emotionally-related in two others. The mean donor age was 37 ± 9.5 years (range 18-56 years and recipient age 37 ± 13.6 years (range 7-67 years. There were 95 males (70.4% and 40 females (29.6% among the recipients while among the donors, there were 102 males (75.6% and 33 females (24.4%. Delayed graft function was seen in three patients (2.2%, acute rejection in six (4.4%, post-transplant urinary tract infection in six (4.4%, pneumonia in three (2.2%, ureteric kink in two (1.5% and urine leak in four (3.0%. Graft survival at 36 months was 93.3% while patient survival at the same period was 96.3%. This report indicates that the results of our transplant program are good and comparable with other international programs.

  9. Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

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    Ali Hikmet Kırdök

    2012-03-01

    Full Text Available Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous closure of secundum atrial septal defects (ASD in our clinic.Results: We retrospectively included 70 patients (19 male, 51 female undergoing percutaneous ASD closure procedure with mean age of 36±14.8 (17-75 in our clinic between March 2008 and January 2010. Defect diameter measured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm. Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36. Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%, Cardiofix (26.7% and biodegredable BioStar (8.6%. The percutaneous closure procedure was successful at 68 of 70 (97% patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2% supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44 and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed.Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last decades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

  10. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach.

    Science.gov (United States)

    Marte, Gianpaolo; Scuderi, Vincenzo; Rocca, Aldo; Surfaro, Giuseppe; Migliaccio, Carla; Ceriello, Antonio

    2013-06-01

    Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers.

  11. Congenital bronchopulmonary malformations: A single-center experience and a review of literature

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    Kumar Basant

    2008-01-01

    Full Text Available Purpose: To present a single-center experience with 25 cases of bronchopulmonary malformations and the review the literature. Materials and Methods: We conducted a retrospective analysis of the medical records of patients with congenital bronchopulmonary malformations who were operated between July 1997 and July 2007 in our institute; we examined the modes of presentations, management, and outcome. Outcome of all patients was assessed over a short follow-up period (average 1.8 months. Results: Out of 25 patients, 18 (72% were male and 7 (28% were female. Age of patients ranged from 1 day to 11 years. The histopathological diagnosis was congenital cystic adenomatoid malformations [CCAM; n = 14 (56%], congenital lobar emphysema [CLE; n = 5 (20%], pulmonary sequestrations [PS; n = 3 (12%], and bronchogenic cysts [BC; n = 3 (12%]. Antenatal diagnosis was available in only 2 (8% patients. The common presenting symptoms were respiratory distress and chest infections. Lobectomy was the procedure of choice . Mortality was 16% (n = 4; M: F = 3: 1. Two patients died because of overwhelming sepsis, one from compromised cardiac function, and one from aspiration which might possibly have been prevented. Conclusion: Patients with progressive respiratory distress due to these anomalies may require urgent surgical intervention regardless of age. The surgical outcome is favorable, with manageable complications. Plain x-ray chest and CT of thorax are usually sufficient for diagnosis and planning of treatment. Pathological diagnosis may differ from the imaging diagnosis. Mortality is found to be more in neonates. Apart from initial stabilization, resection of lesion and careful postoperative care is necessary to reduce mortality and morbidity.

  12. Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience

    Institute of Scientific and Technical Information of China (English)

    JIAO Li-qun; SONG Gang; LI Shen-mao; MIAO Zhong-rong; ZHU Feng-shui; JI Xun-ming; YIN Guo-yang

    2013-01-01

    Background Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies.This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population.Methods Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed.Postoperative 30-day complication rates were analyzed and compared with those of other studies.Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI),stroke,and death.Results The overall 30-day rate of MI,stroke,and death after CAS was 2.53%.In univariate analysis,patients who were symptomatic,had a neurological deficit (modified Rankin score (mRS) ≥3; P=0.001),and who were not taking statins experienced a significantly increased rate of MI,stroke,and death (P=-0.017).In multivariate Logistic regression analysis,the presence of symptoms (odds ratio (OR)=2.485; 95% confidence interval (CI)=1.267-4.876; P=0.008) and a neurological deficit (mRS ≥3) (OR=3.025; 95% CI=1.353-6.763; P=0.007) were independent risk factors for perioperative MI,stroke,and death.Conclusions According to this single-center experience,CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke.Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI,stroke,and death.

  13. 47. A cardiac center experience with Brugada syndrome who survived sudden cardiac death

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    I. Suliman

    2016-07-01

    Full Text Available Brugada syndrome is a heritable arrhythmia syndrome that is characterized by an electrocardiographic pattern consisting of coved-type ST-segment elevation (2 mm followed by a negative T wave in the right precordial leads, V1 through V3 (often referred to as type 1 Brugada electrocardiographic pattern, here we describe 3 cases of Brugada who survived sudden cardiac death (SCD cardiac center experience with survived Brugada syndrome patients – case series. First Case: The Father 45 years old male, presented in 2005 after involvement in unprovoked motor vehicle accident, the patient was the driver who lost consciousness and rushed to the hospital. On arrival to our ER and putting the patient on the bed, the ER doctor observed a brief episode of VF on the monitor. The patient was taken to the catheterization Lab , his coronaries were normal. The diagnosis of Brugada was established and the patient received a defibrillator. At That Time all family members were screened and were negative. Second Case: The Son of the first patient 5 years later his 23 years old male rushed to our ER after he lost consciousness, he was passenger in the car of his friend. Third Case: The pilot A military pilot aged a male 35 years old was in very good health when he lost consciousness and brought to the hospital after resuscitation in 2005. He had full invasive cardiac evaluation, subsequently he received a defibrillator in the same admission period, till 2015 he is doing fine. Brugada syndrome is associated with high tendency for sudden cardiac death. In our three cases the first clinical presentation was survived sudden cardiac death (SCD and all three male patients survived. We did not encounter a female patient who survived sudden cardiac death.

  14. Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

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    Saurabh Kamal

    2016-01-01

    Full Text Available Aim: The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR. Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75 years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD obstruction in 72% (39/54, acute dacryocystitis in 15% (8/54, failed DCR in 7% (4/54, and persistent congenital NLD obstruction in 5% (3/54. The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05. Anatomical and functional success rate was 94% (48/51 at 6 months follow-up period. Conclusions: Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn

  15. Outcome of deceased donor renal transplantation - A single-center experience from developing country

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    Himanshu V Patel

    2013-01-01

    Full Text Available Renal transplantation (RTx is considered as the best therapeutic modality for patient suffering from end-stage renal disease (ESRD. Dearth of donor kidneys is a major problem everywhere, and deceased donor renal transplantation (DDRTx is seen as at least a partial solution. Even so, DDRTx accounts for only less than 4% of RTx in India. We report our 6-year single-center experience on DDRTx vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr, rejection episodes, and delayed graft function (DGF. Between January 2005 and March 2011, 236 DDRTx were performed. Majority of the donors were those with brain death due to road traffic/cerebrovascular accidents. The commonest recipient diseases leading to ESRD were chronic glomerulonephritis (42.8%, diabetes (12.7%, and hypertension (10.6%. Mean recipient age was 36.2 ± 14.2 years; 162 were males and 74 were females. Mean donor age was 45.3 ± 17.13 years; 144 were males and 92 were females. Mean dialysis duration pre-transplantation was 18.5 ± 2.5 months. All recipients received single-dose rabbit-anti-thymocyte globulin induction and steroids, calcinueurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Delayed graft function was observed in 29.6% patients and 22% had biopsy-proven acute rejection. Over the mean follow-up of 2.18 ± 1.75 years, patient and graft survival rates were 74.57% and 86.8%, respectively, with mean SCr of 1.42 ± 0.66 mg%. DDRTx achieves acceptable graft function with patient/graft survival, encouraging the use of this approach in view of organ shortage.

  16. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

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    Yazmin Yaacob

    2013-01-01

    Full Text Available Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%, followed by catheter-related infection (9/161; 5.6%. Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8% chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  17. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

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    Chhavi Sawhney

    2014-01-01

    Full Text Available Background and Aim: Solid organ (spleen and liver injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70% were admitted in intensive care unit (ICU. Their ages ranged from 6 to 74 years (median 24 years. Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury.

  18. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

    Science.gov (United States)

    Sawhney, Chhavi; Kaur, Manpreet; Gupta, Babita; Singh, P. M.; Gupta, Amit; Kumar, Subodh; Misra, M. C.

    2014-01-01

    Background and Aim: Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury. PMID:25538517

  19. CryoPlasty therapy of the superficial femoral and popliteal arteries: a single center experience.

    Science.gov (United States)

    Samson, Russell H; Showalter, David P; Lepore, Michael R; Ames, Scott

    Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.

  20. Fertility preservation in female cancer patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    Cristina Sigismondi; Enrico Papaleo; Paola Viganò; Simona Vailati; Massimo Candiani; Jessica Ottolina; Valentina E. Di Mattei; Giorgia Mangili

    2015-01-01

    Advances in cancer treatment allow women to be cured and live longer. However, the necessary chemotherapy and radiotherapy regimens have a negative impact on future fertility. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer treatment and to facilitate fertility preservation, including oocyte and ovarian tissue cryopreservation. These fertility issues are often inadequately addressed, and referral rates to oncofertility centers are low. The aim of this study was to report the 3-year experience of the San Raffaele Oncofertility Unit. A total of 96 patients were referred to the Oncofertility Unit for evaluation after the diagnosis of cancer and before gonadotoxic treatment between April 2011 and June 2014. Of the 96 patients, 30 (31.2%) were affected by breast cancers, 20 (20.8%) by sarcomas, 28 (29.2%) by hematologic malignancies, 13 (13.5%) by central nervous system cancers, 3 (3.1%) by bowel tumors, 1 (1.0%) by Wilms’ tumor, and 1 (1.0%) by a thyroid tumor; 47 (49.0%) were referred for oocyte cryopreservation before starting chemotherapy, 20 (20.8%) were referred for ovarian tissue cryopreservation, and 29 (30.2%) were not recruited. The mean time between the patients’ counseling and oocyte retrieval was 15 days (range, 2–37 days). The mean time between the laparoscopic surgery and the beginning of treatment was 4 days (range, 2–10 days). The number of patients who were referred increased over time, whereas the rate of patients who were not recruited decreased, showing an improvement in referrals to the Oncofertility Unit and in the patients’ counseling and understanding. Our results indicate that an effective multidisciplinary oncofertility team is necessary for prompt referrals and treatment.

  1. Second-Line Immunosuppressive Treatment of Childhood Nephrotic Syndrome: A Single-Center Experience

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    J. Kim

    2014-01-01

    Full Text Available Objective: Most cases of idiopathic nephrotic syndrome in childhood are responsive to corticosteroids. However, there is a small group of children that demonstrate steroid resistance (steroid-resistant nephrotic syndrome; SRNS, steroid dependence, or that frequently relapse (frequent-relapse steroid-sensitive nephrotic syndrome; FR-SSNS which are more clinically difficult to treat. Therefore, second-line immunosuppressants, such as alkylating agents, calcineurin inhibitors, antimetabolites and, more recently, rituximab, have been used with varying success. The objective was to evaluate the response rates of various second-line therapies in the treatment of childhood nephrotic syndrome. Study Design: A retrospective chart review of pediatric subjects with idiopathic nephrotic syndrome was conducted at a single tertiary care center (2007-2012. Drug responses were classified as complete response, partial response, and no response. Results: Of the 188 charts reviewed, 121 children were classified as SSNS and 67 children as SRNS; 58% were classified as FR-SSNS. Sixty-five subjects were diagnosed with focal segmental glomerulosclerosis via biopsy. Follow-up ranged from 6 months to 21 years. The combined rate of complete and partial response for mycophenolate mofetil (MMF was 65% (33/51 in SSNS and 67% (6/9 in SRNS. For tacrolimus, the response rate was 96% (22/23 for SSNS and 77% (17/22 for SRNS. Eighty-three percent (5/6 of SSNS subjects treated with rituximab went into complete remission; 60% relapsed after B-cell repletion. Eight refractory subjects were treated with combined MMF/tacrolimus/corticosteroid therapy with a 75% response rate. Conclusion: Our experience demonstrates that older medications can be replaced with newer ones such as MMF, tacrolimus, and rituximab with good outcomes and better side effect profiles. The treatment of refractory cases with combination therapy is promising.

  2. Endovascular treatment of ruptured proximal pica aneurysms: A single-center 5-years experience

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    Vivek Gupta

    2014-01-01

    Full Text Available Background and Purpose: Posterior inferior cerebellar artery (PICA like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA - PICA junction and the proximal segment of the PICA. The use of endovascular treatment as an alternative treatment to surgery has been increasing. We present our last 5 years experience in treating the ruptured proximal PICA aneurysms. Materials and Methods: Retrospective analysis of records of all patients with ruptured VA-PICA junction aneurysms treated at our referral center between July 2008 and July 2013 was performed. Over the last 5 years, we came across 17 patients who had aneurysms of proximal PICA or VA-PICA junction out of which 13 patients underwent endovascular treatment for ruptured saccular VA-PICA junction aneurysms and were the focus of this research. Follow-up studies ranged from 6 months to 3 years. Results: All the patients presented with an acute intracranial hemorrhage on NCCT. All the aneurysms were at VA-PICA junction with partial or complete incorporation of PICA origin in the sac. Endovascular treatment of all the 13 aneurysm was successful in the first attempt. Aneurysms were treated with balloon assisted coiling either by placing the balloon across the VA-PICA junction (n = 3 or in the vertebral artery proper (n = 9. Stent assisted coiling VA-PICA was performed in one aneurysm (n = 1. There was no intra-procedural rupture of the aneurysms. Conclusion: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first line treatment.

  3. The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

    Science.gov (United States)

    Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

  4. Staff's experiences of a person-centered health education group intervention for people with a persistent mental illness.

    Science.gov (United States)

    Jormfeldt, Henrika; Brunt, David Arthur; Rask, Mikael; Bengtsson, Agneta; Svedberg, Petra

    2013-07-01

    Patient education in mental health care is a conventional intervention to increase patients' knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large.

  5. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

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    Lynne Moore

    2013-01-01

    Full Text Available Background: Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. Materials and Methods: Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005. Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic, discrimination between centers (coefficient of variation, content validity (correlation with accreditation decision, designation level, and patient volume and forecasting (correlation between visits performed in 1994-1999 and 1998-2005. Results: Kappa statistics were >0.8 for 66 of the 73 (90% grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1. Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%, showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively. No correlation was observed over time (r = 0.03. Conclusion: This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of

  6. Retinoblastoma: experience of a referral center in the North Region of Portugal

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    Rocha-Bastos R

    2014-05-01

    Full Text Available RA da Rocha-Bastos,1 JR Araújo,1 RS Silva,2 MJ Gil-da-Costa,2 E Brandão,1 NJ Farinha,2,3 F Falcão-Reis,1,4 T Dinah-Bragança1 1Department of Ophthalmology, Hospital São João, 2Hematology and Oncology Unit, Pediatric Hospital, Hospital São João, 3Pediatrics Department, Faculty of Medicine, University of Porto, 4Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal Purpose: To describe the experience of the Ophthalmology Department of Hospital São João (HSJ, a tertiary health care center in North Region, Portugal, in terms of the diagnosis, treatment, and follow-up of retinoblastoma. Methods: This was a retrospective study of patients diagnosed with retinoblastoma in Hospital São João, between 1978 and 2012. Results: Fifty patients with retinoblastoma were evaluated in our institution between 1978 and 2012. Four patients were excluded due to loss of follow-up. Among the 46 retinoblastoma cases, 33 (71.7% were unilateral and 13 (28.3% bilateral, with a mean age at diagnosis of 22.19 months and 6.92 months, respectively (P<0.001. Leukocoria was the most common presenting sign (36.9%, followed by strabismus (19.6%, a combination of leukocoria and strabismus (8.7%, and buphthalmia (2.2%. Between 1978 and 1992, nine retinoblastoma cases were referred to our hospital, all of them unilateral, and, in each case, enucleation was performed, with or without salvage therapy. Between 1993 and 2012, 18 eyes with retinoblastoma were successfully managed with conservative treatment. Conclusion: Demographic results were generally coincident with previous reports. It is crucial to screen leukocoria in pediatric practice, even in asymptomatic children. The outcome of retinoblastoma treatment in our hospital is similar to other series in developed countries. Keywords: retinoblastoma, leukocoria, strabismus, enucleation, pediatric cancer

  7. Axial lumbar interbody fusion: a 6-year single-center experience

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    Zeilstra DJ

    2013-08-01

    Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF. Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months. Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001. Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ≥30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001. Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0% patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10, total disc replacement of an uninvolved level (n = 3, facet screw fixation (n = 3, facet screw removal (n = 1, and interbody fusion at L4–L5 (n = 1. Eight (6.1% reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: Axia

  8. Alternative funding for academic medicine: experience at a Canadian Health Sciences Center.

    Science.gov (United States)

    Rosenbaum, Paul; Shortt, S E D; Walker, D M C

    2004-03-01

    In 1994 the School of Medicine of Queen's University in Kingston, Ontario, its clinical teachers, and the three principal teaching hospitals initiated a new approach to funding, the Alternative Funding Plan, a pragmatic response to the inability of fee-for-service billing by clinical faculty to subsidize the academic mission of the health sciences center. The center was funded to provide a package of service and academic deliverables (outputs), rather than on the basis of payment for physician clinical activity (inputs). The new plan required a new governance structure representing stakeholders and raised a number of important issues: how to reconcile the preservation of physician professional autonomy with corporate responsibilities; how to gather requisite information so as to equitably allocate resources; and how to report to the Ontario Ministry of Health and Long-term Care in order to demonstrate accountability. In subsequent iterations of the agreement it was necessary to address issues of flexibility resulting from locked-in funding levels and to devise meaningful performance measures for departments and the center as a whole. The authors conclude that the Alternative Funding Plan represents a successful innovation in funding for an academic health sciences center in that it has created financial stability, as well as modest positive effects for education and research. The Ontario government hopes to replicate the model at the province's other four health sciences centers, and it may have applicability in any jurisdiction in which the costs of medical education outstrip the capacity of faculty clinical earnings.

  9. Measuring User Experience of the Student-Centered e-Learning Environment

    Science.gov (United States)

    Santoso, Harry B.; Schrepp, Martin; Isal, R. Yugo Kartono; Utomo, Andika Yudha; Priyogi, Bilih

    2016-01-01

    The aim of the current study is to develop an adapted version of User Experience Questionnaire (UEQ) and evaluate a learning management system. Although there is a growing interest on User Experience, there are still limited resources (i.e. measurement tools or questionnaires) available to measure user experience of any products, especially…

  10. Report on Ten Years' Experience of Premarital Hemoglobinopathy Screening at a Center in Antalya, Southern Turkey.

    Science.gov (United States)

    Canatan, Duran; Delibas, Serpil

    2016-08-01

    Thalassemia and hemoglobinopathies are a major public health problem in Turkey. Hemoglobinopathy prevention programs (HPPs) were started in 33 provinces situated in Thrace, Marmara, Aegean, Mediterranean and South Eastern regions of Turkey in 2003. A premarital hemoglobinopathy test is mandatory and free of charge in this program. According to the Ministry of Health reports, 46 first level hemoglobinopathy diagnostic centers were established for premarital tests. Within the last 10 years, approximately 79.0% of married individuals per year were screened by the centers. While the percentage of premarital screening tests was 30.0% of all couples in 2003, it reached 86.0% in 2013. The number of newborn with thalassemia and hemoglobinopathies were 272 in 2002 and dropped to 25 in 2013. There has been a 90.0% reduction in affected births. Our hemoglobinopathy diagnostic center was established in 2003 and licensed by the Ministry of Health in 2004. We studied a total of 89,981 blood samples from premarital tests for 10 years and the incidence of β- and α-thalassemia (β- and α-thal) trait was found to be 6.57 and 3.56%, respectively. The distribution of the most common abnormal hemoglobins (Hbs) was: Hb S (HBB: c.20A > T) (0.31%), Hb D-Los Angeles (HBB: c.364G > C) (0.15%), Hb G-Coushatta (HBB: c.68A > C) (0.06%) and Hb E (HBB: c.79G > A) (0.02%). A total of 60 couples, both carrying β-thal trait, were directed to the prenatal diagnosis (PND) center in 10 years. The premarital hemoglobinopathy screening program is running successfully at our center and other centers in Turkey.

  11. Experiences of CFD simulations at Foster Wheeler Energia Oy`s Karhula R and D center

    Energy Technology Data Exchange (ETDEWEB)

    Hyppaenen, T. [Foster Wheeler Energia Oy, Karhula (Finland). Karhula R and D Center

    1996-12-31

    Karhula R and D Center is specialized in the research of solid fuel combustion based on circulating fluidized bed technology. Since the 1970`s, numerical models have been utilized in process development to enhance fundamental understanding of the technology. Both own and commercial computer models have been used. Until now, a special problem in circulating fluidized beds has been the modeling of dense phase multiphase flow, especially for industrial solid-fuel boilers. This has prevented the Karhula R and D Center from using commercial codes, and as a consequence, own modeling approaches have been necessary. This presentation describes some main points of the modeling activities in circulating fluidized bed boilers. (author)

  12. Further Analyses of the NASA Glenn Research Center Solar Cell and Photovoltaic Materials Experiment Onboard the International Space Station

    Science.gov (United States)

    Myers, Matthew G.; Prokop, Norman F.; Krasowski, Michael J.; Piszczor, Michael F.; McNatt, Jeremiah S.

    2016-01-01

    Accurate air mass zero (AM0) measurement is essential for the evaluation of new photovoltaic (PV) technology for space solar cells. The NASA Glenn Research Center (GRC) has flown an experiment designed to measure the electrical performance of several solar cells onboard NASA Goddard Space Flight Center's (GSFC) Robotic Refueling Mission's (RRM) Task Board 4 (TB4) on the exterior of the International Space Station (ISS). Four industry and government partners provided advanced PV devices for measurement and orbital environment testing. The experiment was positioned on the exterior of the station for approximately eight months, and was completely self-contained, providing its own power and internal data storage. Several new cell technologies including four-junction (4J) Inverted Metamorphic Multi-Junction (IMM) cells were evaluated and the results will be compared to ground-based measurement methods.

  13. [Management of motor disability in rural Sahelian environment. Experience of the center for rehabilitation and devices in Bogande, Burkina Faso].

    Science.gov (United States)

    Condamine, J L; Artigues, S; Catherine, V; Diagnougou, N; Ouoba, T

    1998-01-01

    The center for rehabilitation and fitting of the disabled in Bogande, Burkina Faso has been in operation since 1992. It was created by a non-governmental organization named Actions de Solidarité Internationale (ASI). The primary goal of the center is to provide support devices to restore upright position and mobility and allow social reinsertion especially for disabled persons between the ages of 0 and 20 years. Approximately one hundred people are treated annually. Treatment is delivered either directly in villages or in dispensaries if the disabled person can be brought in with the assistance of family members or health care workers. This policy has enhanced the quality of information, training, and prevention. Patients with severe disabilities beyond the scope of treatment at the center are contraindicated. The activities of the center have been organized with a view to covering costs. A welding shop has been set up to produce aid devices and provide revenues to pay for some services. The major lessons of this experience involve the need for active recruitment in villages, for contraindicating patients with severe untreatable disability, for developing economically sustainable programs, for training management staff, and for good financial planning. In 4 years of operation, the rehabilitation and fitting center has demonstrated its ability to meet the needs of the disabled in Bogande.

  14. Earth resources programs at the Langley Research Center. Part 1: Advanced Applications Flight Experiments (AAFE) and microwave remote sensing program

    Science.gov (United States)

    Parker, R. N.

    1972-01-01

    The earth resources activity is comprised of two basic programs as follows: advanced applications flight experiments, and microwave remote sensing. The two programs are in various stages of implementation, extending from experimental investigations within both the AAFE program and the microwave remote sensing program, to multidisciplinary studies and planning. The purpose of this paper is simply to identify the main thrust of the Langley Research Center activity in earth resources.

  15. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    OpenAIRE

    Silviu Grisaru; Morgunov, Melissa A.; Samuel, Susan M.; Julian P Midgley; Wade, Andrew W; Tee, James B.; Hamiwka, Lorraine A.

    2011-01-01

    Acute kidney injury (AKI) is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT) and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 5...

  16. Intergenerational Learning at a Nature Center: Families Using Prior Experiences and Participation Frameworks to Understand Raptors

    Science.gov (United States)

    Zimmerman, Heather Toomey; McClain, Lucy Richardson

    2014-01-01

    Using a sociocultural framework to approach intergenerational learning, this inquiry examines learning processes used by families during visits to one nature center. Data were collected from videotaped observations of families participating in an environmental education program and a follow-up task to draw the habitat of raptors. Based on a…

  17. Social and Architectural Aspects of Revitalization of Historic Urban Centers: Foreign Experience

    Directory of Open Access Journals (Sweden)

    Indrė Gražulevičiutė-Vileniškė

    2011-03-01

    Full Text Available The structure and architecture of many European cities has started their development during the Middle Ages or even earlier. The historic cores gradually had become centers of contemporary cities and are constantly evolving. They are affected by the tendencies of destruction, initiatives and movements of preservation are also taking place there. The comprehensive works of rehabilitation of Lithuanian historic urban centers were carried out during the period of soviet occupation. The insularity of the Soviet empire, ideological reasons and the absence of the private property has determined certain architectural expressions and solutions for the social problems. After the restoration of the country‘s independence the problems and tendencies typical to Western city centers, such as commercialization and gentrification, started to appear in Lithuanian historic urban cores. This justifies the aim of the article which is to analyze the tendencies of revitalization of historic city centers in Western countries with the main attention to the social and architectural aspects.Article in Lithuanian

  18. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    Science.gov (United States)

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of English. (MES)

  19. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    Science.gov (United States)

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of…

  20. Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience

    NARCIS (Netherlands)

    Den Toom, I.J.; Heuveling, D.A.; Flach, G.B.; van Weert, S.; Karagozoglu, K.H.; van Schie, A.; Bloemena, E.; Leemans, C.R.; de Bree, R.

    2015-01-01

    Background Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. Methods A

  1. Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology

    Directory of Open Access Journals (Sweden)

    Piotr Maciej Kabata

    2015-10-01

    Full Text Available Background: In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdańsk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. Material and Methods: Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. Results: The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%. Most of the calls came from emergency rooms (N = 1495; 58.63%. In the case of 1396 (54.7% patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8% or suicidal (N = 814; 31.9% and the most of them took place in the patient’s home. Conclusions: Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers. Med Pr 2015;66(5:635–644

  2. Researching children's health experiences: The place for participatory, child-centered, arts-based approaches.

    Science.gov (United States)

    Carter, Bernie; Ford, Karen

    2013-02-01

    A central concern when conducting qualitative health research with children is eliciting data that genuinely reflect their perspectives. Invariably, this involves being child-centered and participatory. Drawing and photography increasingly accompany dialogic methods to facilitate children's communication through arts-based and verbal modes of expression. However, little literature is available on how arts-based tools shape data. We suggest that researchers need to be attentive to how such tools can liberate, constrain and frame data generated by children, drawing attention to the promises of such approaches as well as the conundrums that can arise from their use. We explore the place for participatory, child-centered, arts-based approaches using examples of the use of drawing and photography in our own studies.

  3. A Proposed Experiment to Study Relaxation Formation of a Spherical Tokamak with a Plasma Center Column

    CERN Document Server

    Hsu, S C

    2006-01-01

    A spherical tokamak (ST) with a plasma center column (PCC) can be formed via driven magnetic relaxation of a screw pinch plasma. An ST-PCC could in principle eliminate many problems associated with a material center column, a key weakness of the ST reactor concept. This work summarizes the design space for an ST-PCC in terms of flux amplification, aspect ratio, and elongation, based on the zero-beta Taylor-relaxed analysis of Tang & Boozer [Phys. Plasmas 13, 042514 (2006)]. The paper will discuss (1) equilibrium and stability properties of the ST-PCC, (2) issues for an engineering design, and (3) key differences between the proposed ST-PCC and the ongoing Proto-Sphera effort in Italy.

  4. Proposed Experiment to Study Relaxation Formation of a Spherical Tokamak with a Plasma Center Column

    Science.gov (United States)

    Hsu, S. C.; Tang, X. Z.

    2007-06-01

    A spherical tokamak (ST) with a plasma center column (PCC) can be formed via driven magnetic relaxation of a screw pinch plasma. An ST-PCC could in principle eliminate many problems associated with a material center column, a key weakness of the ST reactor concept. This work summarizes the design space for an ST-PCC in terms of flux amplification, aspect ratio, and elongation, based on the zero-β Taylor-relaxed analysis of Tang & Boozer [Phys. Plasmas 13, 042514 (2006)]. The paper will discuss (1) equilibrium and stability properties of the ST-PCC, (2) issues for an engineering design, and (3) key differences between the proposed ST-PCC and the ongoing Proto-Sphera effort in Italy.

  5. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  6. Information Retrieval eXperience (IRX): Towards a Human-Centered Personalized Model of Relevance

    NARCIS (Netherlands)

    Sluis, van der Frans; Broek, van den Egon L.; Dijk, van Betsy; Hoeber, O.; Li, Y.; Huang, X.J.

    2010-01-01

    We approach Information Retrieval (IR) from a User eXperience (UX) perspective. Through introducing a model for Information Retrieval eXperience (IRX), this paper operationalizes a perspective on IR that reaches beyond topicality. Based on a document's topicality, complexity, and emotional value, a

  7. Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center

    OpenAIRE

    Ferreira, Flávia Regina; Ogawa, Marilia Marufuji; Nascimento, Luiz Fernando Costa; Tomimori, Jane

    2014-01-01

    BACKGROUND: Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE: To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS: Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral cente...

  8. Causes of amenorrhea in Korea: Experience of a single large center

    OpenAIRE

    2014-01-01

    Objective To investigate the causes of amenorrhea in Korean women. Methods Medical records from 1,212 women with amenorrhea who visited the Department of Obstetrics and Gynecology, Asan Medical Center, between January 1989 and December 2011 were retrospectively reviewed. Amenorrhea was categorized as either primary or secondary. Results Primary amenorrhea was identified in 132 of the patients (10.9%) and secondary amenorrhea in 1,080 (89.1%). The most frequent causes of primary amenorrhea wer...

  9. Chromogranin A as serum marker for gastroenteropancreatic neuroendocrine tumors: a single center experience and literature review.

    OpenAIRE

    Christoph J Auernhammer; Christine Spitzweg; Burkhard Göke; Hoffmann, Johannes N.; Herrmann, Karin A.; Alexander Haug; Michael Vogeser; Axel Kuttner; Michael Lauseker; Svenja Nölting

    2012-01-01

    The aim of this study was to assess the clinical sensitivities of the tumor markers chromogranin A (CgA), urinary 5-hydroxyindoleacetic acid (5-HIAA) and alkaline phosphatase (AP) in neuroendocrine tumors (NETs) of the GastroEnteroPancreatic-(GEP-) system depending on tumor primary location and metastatic spread. In a retrospective single-center series, sensitivities were evaluated in serum samples from 110 patients with midgut (n = 62) and pancreatic (n = 48) NETs. CgA levels were analyzed b...

  10. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon.

    Science.gov (United States)

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  11. Cytomegalovirus Reactivation in Adult Recipients of Autologous Stem Cell Transplantation: a Single Center Experience

    OpenAIRE

    Al-Rawi, Omar; Abdel-Rahman, Fawzi; Al-Najjar, Rula; Abu-Jazar, Husam; Salam, Mourad; Saad, Mustafa

    2015-01-01

    Introduction Cytomegalovirus (CMV) reactivation and infection are well-recognized complications after allogeneic stem cell transplantation (SCT). Only a few studies have addressed CMV reactivation after autologous SCT (ASCT). Methods We retrospectively reviewed medical records of 210 adult patients who underwent ASCT for lymphoma or multiple myeloma (MM) at a single center from January 1st, 2007 until December 31st, 2012. All patients were monitored weekly with CMV antigenemia test till day 4...

  12. Natalizumab treatment in multiple sclerosis: the experience from two Brazilian MS centers

    OpenAIRE

    Enedina Maria Lobato Oliveira; Renata Faria Simm; Gorana Dasic; Marília Mamprim de Morais; Samira Luiza dos Apostolos Perreira; Dagoberto Callegaro

    2015-01-01

    Objective Analyze the demographics, clinical characteristics, efficacy and safety of natalizumab treatment in Brazilian patients with multiple sclerosis (MS) followed up for at least 12 months, in two tertiary MS care centers in São Paulo.Method We evaluated the effect of natalizumab treatment on annualized relapse rate and disability progression in 75 patients with MS treated with natalizumab for at least 12 months. A subgroup analysis was performed to evaluate efficacy of natalizumab treatm...

  13. Cost analysis of awake versus asleep deep brain stimulation: a single academic health center experience.

    Science.gov (United States)

    Jacob, R Lorie; Geddes, Jonah; McCartney, Shirley; Burchiel, Kim J

    2016-05-01

    OBJECT The objective of this study was to compare the cost of deep brain stimulation (DBS) performed awake versus asleep at a single US academic health center and to compare costs across the University HealthSystem Consortium (UHC) Clinical Database. METHODS Inpatient and outpatient demographic and hospital financial data for patients receiving a neurostimulator lead implant (from the first quarter of 2009 to the second quarter of 2014) were collected and analyzed. Inpatient charges included those associated with International Classification of Diseases, Ninth Revision (ICD-9) procedure code 0293 (implantation or replacement of intracranial neurostimulator lead). Outpatient charges included all preoperative charges ≤ 30 days prior to implant and all postoperative charges ≤ 30 days after implant. The cost of care based on reported charges and a cost-to-charge ratio was estimated. The UHC database was queried (January 2011 to March 2014) with the same ICD-9 code. Procedure cost data across like hospitals (27 UHC hospitals) conducting similar DBS procedures were compared. RESULTS Two hundred eleven DBS procedures (53 awake and 158 asleep) were performed at a single US academic health center during the study period. The average patient age ( ± SD) was 65 ± 9 years old and 39% of patients were female. The most common primary diagnosis was Parkinson's disease (61.1%) followed by essential and other forms of tremor (36%). Overall average DBS procedure cost was $39,152 ± $5340. Asleep DBS cost $38,850 ± $4830, which was not significantly different than the awake DBS cost of $40,052 ± $6604. The standard deviation for asleep DBS was significantly lower (p ≤ 0.05). In 2013, the median cost for a neurostimulator implant lead was $34,052 at UHC-affiliated hospitals that performed at least 5 procedures a year. At Oregon Health & Science University, the median cost was $17,150 and the observed single academic health center cost for a neurostimulator lead implant was

  14. 64-row multi-dector computed tomography coronary image from a center with early experience: first illustration of learning curve

    Institute of Scientific and Technical Information of China (English)

    Sze Piaw CHIN; Tiong Kiam ONG; Wei Ling CHAN; Chee Khoon LIEW; M.Tobias Seyfarth; Fong Yean Yip ALAN; Houng Bang LIEW; Kui Hian SIM

    2006-01-01

    Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.

  15. Environmental center for integrated waste management: an experience in the Amazon

    Energy Technology Data Exchange (ETDEWEB)

    Jaramillo V, Jairo; Banalcazar, Fernando L.; Noboa Garcia, Gabriel [EnCanEcuador S.A., Houston, TX (United States)

    2004-07-01

    The creation of a large amount of both solid and liquid waste within the petroleum industry should be the reason for providing a facility that makes it possible to apply proper treatment to the waste matter, depending on the degree of complexity, especially if these operations are taking place within or in the area of influence of a national park or a biosphere reserve. EnCanEcuador has invested $1 200,000 in the construction of facilities and equipment for an integrated environmental management center, which will allow us to create in-house resources for the management of waste control. Organic waste is grinded, homogenized with sawdust and placed in a dynamic sanitary fill to form fertilizer. The leachates material will be used as foliage fertilizer. Inorganic waste is classified, grinded, compacted, packed and sent to different recycling companies or in some cases incinerated in a low emission incinerator. Drilling waste: Drilling mud water based potassium nitrate is treated through a de-nitrification process using bioremediation methods. Liquid waste: from well completion, washing vehicles, drains from production stations, is passed through an API separator system into two physical-chemical treatment pits for its later re-injection. Contaminated soil: that may be caused by petroleum activity is treated in a pit where the greatest possible amount of hydrocarbon is recovered by means of hot hydro-washing and is then treated with native bacteria in two land farming centers. Dangerous solid waste is transported to a secure fill for its confinement. Laboratory and Meteorological Station: For the control and monitoring of petroleum activities and to determine climatic variations. Plant nursery: it will have a capacity to produce 300,000 plants a year. Community Cooperatives will manage the center, enforcing our Social responsibility in our daily activities. (author)

  16. Surgery for gastrointestinal malignant melanoma:Experience from surgical training center

    Institute of Scientific and Technical Information of China (English)

    Thawatchai; Akaraviputh; Satida; Arunakul; Varut; Lohsiriwat; Cherdsak; Iramaneerat; Atthaphorn; Trakarnsanga

    2010-01-01

    AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS:Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years(r...

  17. The experience of a Power Nap Center in the largest city of Brazil

    Directory of Open Access Journals (Sweden)

    Rogerio Santos-Silva

    2016-07-01

    Full Text Available We evaluated the frequency of naps and features of nappers who took a nap in a Power Nap Center located in downtown area of São Paulo. Company database was retrospectively analyzed and 4.625 naps were evaluated (January–December 2014. Most naps (57% lasted 30 min. 33% of subjects took a nap more than once a week (73% male. Progressive growth in the number of naps across the months was observed (January=110 to December=505. Results suggest that the society is sleep deprived and taking a nap during the day could be an important strategy to improve quality of life and increase productivity.

  18. Communication for heath behavior change: experiences lived at the Center for Communication Programs at Johns Hopkins University.

    Directory of Open Access Journals (Sweden)

    Ana Carolina de Oliveira Monteiro dos SANTOS

    2016-01-01

    Full Text Available Sharing experiences is the best way to learn and contribute to the construction of knowledge. It is with this intention that arises this article, a result of the lived experience of the author in workshop taught by the Center for Communication Programs - CCP (Communication Programs Center at Johns Hopkins University in Baltimore, USA, in June 2014. In this workshop intensive of 20 days, with daily classes full-time, the author had the opportunity to study and share experiences with great thinkers and professionals from Johns Hopkins. This promoted contact with the philosophy of the institution and the methodologies they developed and implemented in countries around the world, in order to promote improvements in the health status of populations through strategic planning focused on behavior change communication. This was an experience not just in study and planning communication, but a leadership training experience, withmore aware, engaged and complete professionals and, above all, of self-knowledge and personal growth. An article would not be enough to describe all this experience, so we chose to focus on issues about the institution’s vision on health, the practice of health communication, behavior change and an overview of the essential aspects the methodology developed and used by them, called P process. In this article, the reader will come across a breach of academic theoretical reflections promoted by further technical discussions practices, managerial characteristics. This ends up reflecting the logic implemented by the CCP, which develops the practice based on a broad theoretical framework. And in the same way that the institution does not close in their theories and allows to reinvent itself, this article will also feature the author’s own reflections about some of the issues presented.

  19. Clinicopathologic spectrum of Waldenström′s macroglobulinemia: A single center experience

    Directory of Open Access Journals (Sweden)

    Sajid Raihan

    2010-07-01

    Full Text Available Waldenström′s Macroglobulinemia (WM is a B cell neoplasm characterized by infiltration of the bone marrow by a lymphoplasmacytic infiltrate and an IgM monoclonal gammopathy. We report a 15-year review of patients diagnosed with WM at our center. A total of 18 patients were diagnosed and treated at our center during the study period. Neurological symptoms were seen in almost 95% while B symptoms were present in almost 80% of patients. More than two-thirds of patients were anemic at the time of presentation and more than 90% showed bone marrow infiltration with lymphoplasmacytoid cells. Anemia, B symptoms, splenomegaly and neurological symptoms were the primary reasons in the majority of patients to initiate treatment. Chlorambucil was the primary treatment in more than half the patients followed by CVP. The median overall survival in all patients was 29 months (range 22-81 months. WM is a rare disorder and novel therapeutic modalities need to be identified to improve survival in these patients.

  20. Rapid steroid discontinuation for pediatric renal transplantation: a single center experience.

    Science.gov (United States)

    Lau, Keith K; Haddad, Maha N; Berg, Gerre M; Perez, Richard V; Butani, Lavjay

    2007-08-01

    To determine the outcomes of pediatric renal transplant recipients who received immunosuppression consisting of early withdrawal of corticosteroids at a single Northern California center. Protocols using minimal steroid exposure have been recently reported in adult transplant recipients with successful results. We examined the outcomes of pediatric renal transplant recipients who were managed at our center using a protocol with very early discontinuation of steroids after renal transplantation. We retrospectively studied the medical records of all renal transplant recipients followed at the Children's Hospital at the University of California, Davis Medical Center from 01/2004 to 12/2005. All patients were less than 18 yr of age at the time of transplantation. The immunosuppressive protocol included three tapering daily doses of methylprednisolone, together with five doses of thymoglobulin followed by maintenance therapy with tacrolimus and MMF. Eight patients with equal numbers of males and females were transplanted during this time period. There were equal numbers of Caucasians, African-Americans, Hispanics, and Asians. A total of 37.5% (3/8) of the subjects received preemptive transplantation, 25% (2/8) received peritoneal, and 37.5% (3/8) received hemodialysis before transplantation. The median (range) age at transplantation was 12.3 (3.1-16.0) year with a follow-up of 1.7 (0.9-2.8) year. At one yr post-transplantation, 57% (4/7) of patients still required anti-hypertensives. Three children required erythropoietin supplementation after transplantation. The mean delta height standard deviation score at 12 months was 0.20 +/- 0.56. There were no episodes of clinical acute rejection. One patient switched from tacrolimus to sirolimus due to biopsy-proven CAN. No patient became diabetic or required hypoglycemic agents. Surveillance biopsies showed no subclinical acute rejection in any patient. Steroid-free immunosuppression is safe in children after renal

  1. Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

    Science.gov (United States)

    McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

    2013-01-01

    In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

  2. Using the accreditation journey to achieve global impact: UHN's experience at the Kuwait Cancer Control Center.

    Science.gov (United States)

    Ladha-Waljee, Nafeesa; McAteer, Stephen; Nickerson, Veronica; Khalfan, Adil

    2014-01-01

    On January 1, 2011, Princess Margaret Cancer Centre (PM) - University Health Network (UHN) began a five-year partnership agreement with the Kuwait Ministry of Health's Kuwait Cancer Control Center (KCCC) to enhance cancer care services. Over the course of the partnership, opportunities for improvement were identified by UHN experts in order to accelerate KCCC's development toward subspecialty cancer care. Many of these opportunities involved building a robust infrastructure to support foundational hospital operation processes and procedures. Harnessing UHN's own successes in accreditation, the partnership took advantage of the national accreditation mandate in Kuwait to initiate a quality program and drive clinical improvement at KCCC. This resulted in improved staff engagement, better awareness and alignment of administration with clinical management and a stronger patient safety culture. This article discusses the successes and lessons learned at KCCC that may provide insight to healthcare providers implementing Accreditation Canada International's accreditation framework in other countries and cultures.

  3. Metastases of esophageal carcinoma to skeletal muscle:Single center experience

    Institute of Scientific and Technical Information of China (English)

    Jan Cincibuch; Miroslav Myslive(c)ek; Bohuslav Melichar; (C)estmír Neoral; Iva Metelková; Michaela Zezulová; Hana Procházková-(S)tudentová

    2012-01-01

    Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography (PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.

  4. Experience Transitioning Models and Data at the NOAA Space Weather Prediction Center

    Science.gov (United States)

    Berger, Thomas

    2016-07-01

    The NOAA Space Weather Prediction Center has a long history of transitioning research data and models into operations and with the validation activities required. The first stage in this process involves demonstrating that the capability has sufficient value to customers to justify the cost needed to transition it and to run it continuously and reliably in operations. Once the overall value is demonstrated, a substantial effort is then required to develop the operational software from the research codes. The next stage is to implement and test the software and product generation on the operational computers. Finally, effort must be devoted to establishing long-term measures of performance, maintaining the software, and working with forecasters, customers, and researchers to improve over time the operational capabilities. This multi-stage process of identifying, transitioning, and improving operational space weather capabilities will be discussed using recent examples. Plans for future activities will also be described.

  5. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    Science.gov (United States)

    Shaikh, Haroun Hassan

    2016-01-01

    Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences. PMID:27656656

  6. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    OpenAIRE

    Tomas Kucera; Haroun Hassan Shaikh; Pavel Sponer

    2016-01-01

    Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences.

  7. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Tomas Kucera

    2016-01-01

    Full Text Available Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences.

  8. Online Digital Archives Technology That Supports Rich, Student-Centered Learning Experiences

    Science.gov (United States)

    Hofer, Mark

    2004-01-01

    Today's students watch the newest movie trailers on the Web, share music files, play video games with other players over the Internet, and swap digital pictures of the latest teen idols. Donald Tapscott points out in his book Growing Up Digital that as this rich multimedia experience becomes more a part of students' lives outside of school, they…

  9. Renal angiomyolipoma in Indian population - a single center experience and review of literature

    Directory of Open Access Journals (Sweden)

    Sanjay Gogoi

    2001-01-01

    Conclusion: Our experience validates the presently accepted recommendation of conservative management in renal AML less than 4 cm in size with regard to probability of complications. However we found a poor correlation between tumor size and severity of symptoms and early intervention may be judiciously offered for relief of symptoms.

  10. Blood blister-like aneurysms: Single center experience and systematic literature review

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl [Service of Neurosurgery, University Hospital of Geneva (Switzerland); Lovblad, Karl-Olof [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Pereira, Vitor Mendes, E-mail: vitormpbr@hotmail.com [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland)

    2014-01-15

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity–mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy.

  11. Treatment outcome of patients with carcinoma of vulva: Experience from a tertiary cancer center of India

    Directory of Open Access Journals (Sweden)

    Sharma Daya

    2010-01-01

    Full Text Available Purpose: The aim of our retrospective study was to analyze and report the clinical outcome of patients with vulvar carcinoma (VC treated at our center. Materials and Methods: We retrieved the information regarding patients′ clinical details, treatment given, survival and complications from the case records of all VC patients who were treated at our center during the year 1998-2005. Overall survival (OS was determined with respect to age, histopathological grade, stage of disease, treatment group, pathological lymph node status, etc. Results: A total of 60 case records were retrieved for this retrospective analysis. Age ranged from 24 to 92 years (median 63 years. International Federation of Gynecology and Obstetrics (FIGO stage distribution was as follows: stage I: 2 patients; stage II: 17 patients; stage III: 31 patients; stage IV: 9 patients; and unknown stage: 1 patient. Thirty-three patients underwent surgery (wide local excision 3, radical vulvectomy 30. Eleven patients received postoperative radiation therapy (PORT, 12 received palliative radiation therapy (RT and 15 underwent definitive RT (5 of them received concurrent chemotherapy. Median follow-up period was 23 months (range 2-144 months. The 5-year OS for all stages was 41%. FIGO stage and pathological node positivity were found to be statistically significant prognostic factors for survival. Conclusion: Despite the majority of patients presenting in advanced stage, the 5-year OS of 41% in our series reflects a decent therapeutic outcome. The results have shown FIGO stage and pathological node positivity to be significant prognostic factors for survival. The use of preoperative chemotherapy/RT needs to be studied in our setup.

  12. Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience

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    Mozhgan Zahmatkeshan

    2013-06-01

    Full Text Available Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8% girls and 64 (51.2% boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60% patients, followed by fever in 35 (28%. Erythema (33.6%, esophageal ulcer (11.2%, and whitish patch (8.0% were the most common endoscopic findings, while reflux esophagitis (32.8%, chronic (6.4% and acute esophagitis (5.6%, and candida esophagitis (5.6% were the most common histological diagnoses. Only one (0.8% patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.

  13. Blood blister-like aneurysms: single center experience and systematic literature review.

    Science.gov (United States)

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan; Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl; Lovblad, Karl-Olof; Pereira, Vitor Mendes

    2014-01-01

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy.

  14. Neonatal screening of hearing function by otoacustic emissions: A single center experience

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    Živić Ljubica

    2012-01-01

    Full Text Available Background/Aim. Nowadays development of techniques enables detection of hearing impairment in a very short time, immediately after birth by using otoacoustic emissions. They are low-pitched sounds produced in physiologically clear cochlea and can be recorded in cochlear outer meatus. By this method, complete data are found on a whole presynaptic auditory nervous system functioning that has mostly been affected by pathological changes making it a perfect screening test. Reliability and sensibility of this method is up to 98%. The aim of this study was to present the first results of systematic neonatal screening of hearing function by otoacoustic emissions in the Clinical Center Kragujevac (Kragujevac, Serbia. Methods. This prospective study of neonatal hearing screening function, initiated systematically by the 2008 at the Clinical Center Kragujevac, included full-term newborns and premature born ones, within the first 24 h after birth, using a DPOAEs interacoustics otoread-screener. Retesting was done after a month. Results. From January 1st, 2009 to December 1st, 2010, a total number of examined infants by this method was 1,994 out of which 1,778 were full-term and 216 were premature born. The test passing was higher in the group of full-term babies (92.5% than in the preterm ones (55.1%. No bilateral answers were recorded in premature born children compared to the full-term ones, of whom a larger number was with missing lateral responses. The results of re-examination test in the group of full-term born and premature newborns were 83.7%, and 61%, respectively. Conclusion. Deliberately provoked transient otoacoustic emission is an efficient method in testing hearing function in newborns, since it is non-invasive, rapid and objective. Its correlation with audibly evoked potentials is very high, which confirms its reliability.

  15. The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

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    Hong, Jeong-Ho [Keimyung University Dongsan Medical Center, Department of Neurology (Korea, Republic of); Kang, Jihoon; Yeo, Min-Ju; Kim, Beom Joon; Jang, Min Uk; Bae, Hee-Joon [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of); Kwon, O-Ki; Hwang, Gyo Jun; Oh, Chang Wan [Seoul National University Bundang Hospital, Department of Neurosurgery (Korea, Republic of); Jung, Cheolkyu [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of); Lee, Ji Sung [Soonchunhyang University Medical Center, Biostatistical Consulting Unit (Korea, Republic of); Han, Moon-Ku, E-mail: mkhan@snu.ac.kr [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of)

    2015-04-15

    PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

  16. Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

    Science.gov (United States)

    Morgen, Evelyn Breck

    2003-01-01

    Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

  17. A single-center experience with abiraterone as treatment for metastatic castration-resistant prostate cancer

    DEFF Research Database (Denmark)

    Thortzen, Anita; Thim, Stine; Røder, Martin Andreas;

    2016-01-01

    BACKGROUND: Continuous stimulation of the androgen receptor (AR) axis is a prerequisite for growth in castration-resistant prostate cancer (CRPC). Abiraterone acetate (AA) is a potent inhibitor of extracellular and intracellular androgen synthesis by inhibition of the CYP-17 enzyme system, which...... has been shown to be up-regulated in CRPC. AA was recently introduced in the management of patients with metastatic CRPC (mCRPC) both before and after taxane-based chemotherapy. The purpose of this study is to report the initial clinical experience obtained from mCRPC patients managed on AA......% of the patients. Time to biochemical and radiological progression was 3.5 and 4.9 months, respectively. Overall survival was 13.2 months (95% CI: 9.0-17.4). CONCLUSION: Our initial experience with AA in the routine management of patients with mCRPC demonstrates an efficacy-effectiveness gap compared with clinical...

  18. [Diagnosis and treatment of pediatric subglottic stenosis: experience in a tertiary care center].

    Science.gov (United States)

    Botto, Hugo Alberto; Pérez, Cinthia Giselle; Cocciaglia, Alejandro; Nieto, Mary; Rodríguez, Hugo Aníbal

    2015-08-01

    Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of which resulting from endotracheal intubation. The diagnosis is based on the patient's clinical, radiologic evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. It must be suspected in children with respiratory distress after extubation. The therapeutic approach depends on the severity of the subglottic stenosis and the patient's symptoms. We describe our experience with the subglottic stenosis etiologies, diagnosis, treatment and outcome of patients with this condition.

  19. Modeling Approach of Regression Orthogonal Experiment Design for Thermal Error Compensation of CNC Turning Center

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The thermal induced errors can account for as much as 70% of the dimensional errors on a workpiece. Accurate modeling of errors is an essential part of error compensation. Base on analyzing the existing approaches of the thermal error modeling for machine tools, a new approach of regression orthogonal design is proposed, which combines the statistic theory with machine structures, surrounding condition, engineering judgements, and experience in modeling. A whole computation and analysis procedure is given. ...

  20. A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

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    Kiralj Aleksandar I

    2015-01-01

    Full Text Available Background/Aim. Necrotizing fasciitis (NF is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012 were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81% were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%. The majority of our patients were male (164 - 75.92%. Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%, followed by obesity (38 - 17.59% and diabetes mellitus (31 - 14.35%. Trauma was most common etiological factor (22 - 10.8% in infected wounds, followed by abdominal (15 - 6.94% and orthopedic (11 - 5.09% surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18% patients and more than one etiological factor were diagnosed in 20 (9.25% patients. The majority of our patients had type I acute NF

  1. Circumcision with Glubran® 2 in children: experience of Italian Center

    Science.gov (United States)

    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  2. Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center*

    Science.gov (United States)

    Ferreira, Flávia Regina; Ogawa, Marilia Marufuji; Nascimento, Luiz Fernando Costa; Tomimori, Jane

    2014-01-01

    BACKGROUND Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral center between 08/01/2004 and 08/31/2009. Analyzed variables were: gender, age, skin phototype, occupational and recreational sun exposure, use of photoprotection, personal and family history of non-melanoma skin cancer, clinical type and location, time between transplantation and the appearance of the first nonmelanoma skin cancer, occurrence of viral warts, timing of transplantation, type of donor, cause of kidney failure, previous transplants, comorbidities, pre-transplant dialysis, type and duration of dialysis. RESULTS 64 subjects were included. Males - 71.9%; low skin phototypes (up to Fitzpatrick III) - 89%; mean age - 57.0 years - and mean age at transplant - 47.3 years; sun exposure - 67.2% occupational - and 64.1% recreational; photoprotection - 78.2% (although only 34.4% in a regular manner); squamous cell carcinoma - 67.2%; squamous cell carcinoma/basal cell carcinoma ratio - 2:1; personal history of nonmelanoma skin cancer - 25% - and family history - 10.9%; location at photoexposed area - 98.4%; average latency time between transplantation and first nonmelanoma skin cancer appearance - 78.3 months; viral warts (HPV) after transplant - 53.1%; average timing of transplantation - 115.5 months; living donor - 64.1%; triple regimen (antirejection) - 73.2%; comorbidities - 92.2%; pre-transplant dialysis - 98.4%; hemodialysis - 71.7%; average duration of dialysis - 39.1 months; previous transplants - 3.1%; hypertension as cause of renal failure - 46.9%. CONCLUSION This study allowed

  3. Marginal living donor in kidney transplantation: experience in a Chinese single center

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Yun-peng; MA Lu-lin; ZHANG Jing; ZHANG Hong-xian; HUANG Yi; HOU Xiao-fei

    2013-01-01

    Background Living donor kidney transplantation is becoming popular in China,whereas,in clinical situations,some kidney donors may be sub-optimal,namely marginal living donor.The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.Methods Between January 2001 and December 2009,888 kidney transplantations were performed in our center; 149were living donor kidney transplantations.The living donors and recipients were followed up regularly after the operation.Of the living donors,30 donors were marginal,who were older than 60 years or suffered from kidney anomaly or some benign diseases.Among the non-marginal living kidney transplantations,58 donors and recipients had complete perioperative and follow-up data.We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age,follow-up period,donor's serum creatinine at the last follow-up,recipient's serum creatinine at the last follow-up,and graft survival at the last follow-up.Results The mean age of donors in the marginal and non-marginal living donors were (55±9) (37-66) and (43±12) (30-59) years.The mean follow-up times of the marginal and non-marginal groups were (26.4±13.4) months and (28.8±14.8)months.The donor and recipient serum creatinine levels at the last follow-up were (1.16±0.20) mg/dl and (1.30±0.24) mg/dl in the marginal group,and (1.12±0.32) mg/dl and (1.34±0.32) mg/dl in the non-marginal group.Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year.Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group.No significant differences were detected between the two groups with regard to these data.Conclusion Utilization of highly selective marginal living donors can be a safe,feasible,and effective way for the treatment of patients with end stage renal disease.

  4. Efficacy of liver transplantation for acute hepatic failure:a single-center experience

    Institute of Scientific and Technical Information of China (English)

    Xian-Jie Shi; Hong-Bin Xu; Wen-Bin Ji; Yu-Rong Liang; Wei-Dong Duan; Lei He; Ming-Jun Wang; Zhi-Ming Zhao

    2011-01-01

    BACKGROUND: Acute hepatic failure (AHF) is a devastating clinical syndrome with a high mortality rate. The outcome of AHF varies with etiology, but liver transplantation (LT) can significantly improve the prognosis and survival rate of such patients. This study aimed to detect the role of LT and artificial liver support systems (ALSS) for AHF patients and to analyze the etiology and outcome of patients with this disease. METHODS: A retrospective analysis was made of 48 consecutive patients with AHF who fulfilled the Kings College Criteria for LT at our center. We analyzed and compared the etiology, outcome, prognosis, and survival rates of patients between the transplantation (LT) group and the non-transplantation (N-LT) group. RESULTS: AHF was due to viral hepatitis in 25 patients (52.1%; hepatitis B virus in 22), drug or toxic reactions in 14 (29.2%; acetaminophen in 6), Wilson disease in 4 (8.3%), unknown reasons in 3 (6.3%), and miscellaneous conditions in 2 (4.2%). In the LT group, 36 patients (7 underwent living donor LT, and 29 cadaveric LT) had an average model for end-stage liver disease score (MELD) of 35.7. Twenty-eight patients survived with good graft function after a follow-up of 27.3± 4.5 months. During the waiting time, 6 patients were treated with ALSS and 2 of them died during hospitalization. The 30-day, 12-month, and 18-month survival rates were 77.8%, 72.2%, and 66.7%, respectively. In the N-LT group, 12 patients had an average MELD score of 34.5. Four patients were treated with ALSS and all died during hospitalization. The 90-day and 1-year survival rates were only 16.7% and 8.3%, respectively. CONCLUSIONS: Hepatitis is the most prominent cause of AHF at our center. Most patients with AHF, who fulfill the Kings College Criteria for LT, did not survive longer without LT. ALSS did not improve the prognosis of AHF patients, but may extend the waiting time for a donor. Currently, LT is still the most effective way to improve the prognosis

  5. Clinical and experimental studies of multiple sclerosis in Russia: experience of the leading national research centers

    Directory of Open Access Journals (Sweden)

    Zavalishin IA

    2015-08-01

    Full Text Available Igor A Zavalishin,1 Alexey A Belogurov Jr,2–4 Yakov A Lomakin,2 Natalia A Ponomarenko,2 Sofia N Morozova,1 Zinaida A Suslina,1,† Michael A Piradov,1 Sergey N Illarioshkin,1 Alexander G Gabibov2–5 1Research Center of Neurology, 2Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, 3Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, 4Institute of Gene Biology, RAS, 5Chemistry Department, Moscow State University, Moscow, Russia †Dr Zinaida A Suslina passed away on June 22, 2014 Abstract: Mechanisms of axonal damage and adaptive capacity in multiple sclerosis (MS, including cortical reorganization, have been actively studied in recent years. The lack of regenerative capabilities and the irreversibility of neurodegeneration in MS are critical factors for the optimization of MS treatment. In this study, we present the results of clinical and basic studies in the field of MS by two leading Russian centers. Clinical and neuroimaging correlations show that spinal damage in MS is accompanied by functional reorganization of the cerebral cortex, which is determined not only by the efferent component but also by the afferent component. Comparative analysis of MS treatment with both interferon β1b (IFN-β1b and IFN-β1a at a dosage of 22 µg for 3 years through subcutaneous administration and glatiramer acetate showed equally high efficiency in reducing the number of exacerbations in relapsing-remitting MS and secondary-progressive MS. We demonstrate a reduced risk of disability in relapsing-remitting MS and secondary-progressive MS patients in all groups treated with IFN-β1 and glatiramer acetate. MS appears to be a disease that would greatly benefit from the development of personalized therapy; thus, adequate molecular predictors of myelin degradation are greatly needed. Therefore, novel ideas related to the viral hypothesis of the etiology of MS and new targets for

  6. Cochlear implant surgery at the Clinical Center of Vojvodina - ten-year experience

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    Dankuc Dragan

    2014-01-01

    Full Text Available Introduction. The first cochlear implant surgery was performed at the Center for Cochlear Implantation of the Department of Ear, Nose and Throat Diseases, Clinical Center of Vojvodina in 2002 after long preparations and that was the first successful cochlear implantation in Serbia. Material and Methods. Over the period from November 2002 to November 2013, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Results. The analysis encompassed 99 patients, the youngest and the oldest one being 1 year and 61 years old, respectively. Prelingual and postlingual deafness developed in 84 (84.9% and in 15 (15.1%, respectively. Postlingual deafness was observed in all 11 adult patients. The prelingual deafness was diagnosed in 84 (95.4% children, whereas in four (4.6% children it occurred after the development of speech between 6 and 8 years of age. Progressive hearing loss was observed in 11 patients - seven adults and four children. The majority of our patients, i.e. 74 (74.75% manifested idiopathic deafness of unknown cause. A range of usually reported hearing loss etiologies included ototoxic medications in seven (7.07%, hereditary factor in six (6.06%, and bacterial meningitis in four (4.04% patients. Somewhat less common causes were perinatal hypoxia in three (3.03%, premature birth in three (3.03%, Down syndrome in one (1.01%, and chronic otitis media in one (1.01% patient. Conclusion. Both intraoperative and postoperative complications were analyzed in the investigated patient population. The complications developed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5% were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification and transient ataxia occurred more rarely. Stimulation of facial nerve, intraoperative

  7. The pregnancy rate and live birth rate after kidney transplantation: a single-center experience.

    Science.gov (United States)

    Fontana, I; Santori, G; Fazio, F; Valente, U

    2012-09-01

    Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Kidney transplantation recipients live longer and have better quality of life than patients on dialysis. Hypothalamic gonadal dysfunction in females who have ESRD may be reversed within the first few months after kidney transplantation, such as the ability to have children. Despite thousands of successful pregnancies in transplantation recipients, there is limited information about it. In this study, we evaluated the pregnancy rates and live birth rates in women (n = 133) who underwent kidney transplantation in our center from 1983 to 2010. Recipients of a second kidney transplantation and recipients of multiorgan transplantations were excluded. We observed 33 pregnancies with 11 live births (33.3%), 12 spontaneous abortions (36.36%), and 10 therapeutic abortions (30.3%). The pregnancy rate was 18%. The live birth rate was 33.3%. Therapeutic abortions were 36.3%, and the pregnancies resulting in fetal loss were 30.3%. The pregnancies were identified in 32 women. The majority of women (n = 32; 96.9%) had a single pregnancy, whereas 1 woman (3.1%) had two pregnancies. In our series, the pregnancy rates for kidney transplantation recipients were markedly lower and decreased more rapidly than those reported in the general population.

  8. Laparoscopic vs open donor nephrectomy: Lessons learnt from single academic center experience

    Science.gov (United States)

    Tsoulfas, Georgios; Agorastou, Polyxeni; Ko, Dicken S C; Hertl, Martin; Elias, Nahel; Cosimi, AB; Kawai, Tatsuo

    2017-01-01

    AIM To compare laparoscopic and open living donor nephrectomy, based on the results from a single center during a decade. METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy (LLDN) and 211 undergoing open donor nephrectomy (OLDN). Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular filtration rate and creatinine (Cr), donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed. RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time, donor preoperative renal function, donor and recipient postoperative kidney function, delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed, there was a statistically significant difference regarding operating time in favor of the LLDN, pointing out the importance of the learning curve. Furthermore, another significant difference between the two groups was the decreased length of stay for the LLDN (2.87 d for LLDN vs 3.6 d for OLDN). CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor. PMID:28101451

  9. Aggressive Treatment of Patients with Metastatic Colorectal Cancer Increases Survival: A Scandinavian Single-Center Experience

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    Kristoffer Watten Brudvik

    2013-01-01

    Full Text Available Background. We examined overall and disease-free survivals in a cohort of patients subjected to resection of liver metastasis from colorectal cancer (CRLM in a 10-year period when new treatment strategies were implemented. Methods. Data from 239 consecutive patients selected for liver resection of CRLM during the period from 2002 to 2011 at a single center were used to estimate overall and disease-free survival. The results were assessed against new treatment strategies and established risk factors. Results. The 5-year cumulative overall and disease-free survivals were 46 and 24%. The overall survival was the same after reresection, independently of the number of prior resections and irrespectively of the location of the recurrent disease. The time intervals between each recurrence were similar (11 ± 1 months. Patients with high tumor load given neoadjuvant chemotherapy had comparable survival to those with less extensive disease without neoadjuvant chemotherapy. Positive resection margin or resectable extrahepatic disease did not affect overall survival. Conclusion. Our data support that one still, and perhaps to an even greater extent, should seek an aggressive therapeutic strategy to achieve resectable status for recurrent hepatic and extrahepatic metastases. The data should be viewed in the context of recent advances in the understanding of cancer biology and the metastatic process.

  10. [Work experience of a stroke center in the Western region of Kazakhstan].

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    Kabdrakhmanova, G B; Ermagambetova, A P; Suleĭmanova, S Iu; Khamidulla, A A; Darin, D B

    2014-01-01

    Objectives. To analyze results of the work of a regional stroke center in Aktobe city opened in Kazakhstan according to a state program of Health Care development for 2011-2015 years "Healthy Kazakhstan". Material and methods. In total 1177 stroke patients were hospitalized, including 721 patients (61.2%) with ischemic stroke, 268 (22.8%) patients with hemorrhagic stroke, 108 (9.2%) with transitory disturbances of cerebral blood circulation, 26 (2.2%) with subarachnoid hemorrhage and 54 (4.6%) with unspecified stroke. Results. The use of thrombolytic therapy (TLT), a highly specialized method of treatment of ischemic stroke, was analyzed. Other aspects of the work, including the measures of early and continued rehabilitation, are presented. During the first day after TLT, a significant reduction in neurological disorders was observed in 22 patients (84.6%). The partial recovery was seen in 3 patients (11.5%). One patient (3.8%) had hemorrhagic transformation. Conclusions. The use of TLT in the acute stage of ischemic stroke allows to achieve the complete recovery of neurological functions so patients can return to work and full life.

  11. Sports hernia: the experience of Baylor University Medical Center at Dallas.

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    Preskitt, John T

    2011-04-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional "weekend warrior." The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months.

  12. Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience.

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    Trakulsrichai, Satariya; Tongpo, Achara; Sriapha, Charuwan; Wongvisawakorn, Sunun; Rittilert, Panee; Kaojarern, Sming; Wananukul, Winai

    2013-01-01

    Kratom (Mitragyna speciosa Korth), a native tree in Southeast Asia, is misused as an abuse drug and becomes legally widespread to several countries. Currently, it is available through the online market or by some shops. The clinical manifestations of Kratom's effects are not well-defined and the clinical studies are limited. This study was designed to identify the characteristics of Kratom poisoning and withdrawal cases from Kratom exposure cases in Ramathibodi Poison Center (RPC), Thailand, during a five-year period. We used a retrospective review of Kratom exposure cases from the RPC toxic surveillance system. A total of 52 Kratom exposure cases were identified. The trend of case consultations has been increasing. There were Kratom poisoning cases (76.9%) and withdrawal cases (23.1%). Common presenting symptoms in the poisoning group were palpitation (22.5%), followed by seizure (17.5%). For the withdrawal group, the common presenting symptoms were myalgia (33.3%), insomnia (16.67%), fatigue (16.67%), and chest discomfort (16.67%). There was a baby with withdrawal symptoms who was delivered from a chronic Kratom-abusing mother, suggesting possible exposure via the transplacental route. There were no deaths in either group. Kratom abuse can cause either poisoning or withdrawal. Most cases in both groups had good prognostic outcome.

  13. Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

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    Wong; Hoi; She; Tan; To; Cheung; Wing; Chiu; Dai; Simon; HY; Tsang; Albert; CY; Chan; Daniel; KH; Tong; Gilberto; KK; Leung; Chung; Mau; Lo

    2016-01-01

    AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.RESULTS: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable(65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival(91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality(P = 0.004, hazard ratio = 1.035, 95%CI:CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

  14. Simultaneous liver and kidney transplantation:analysis of a single-center experience

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    MA Yi; WANG Guo-dong; HE Xiao-shun; LI Qiang; LI Jun-liang; ZHU Xiao-feng; WANG Chang-xi

    2010-01-01

    Background Simultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment for combined renal and hepatic end-stage disease.However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders.This study aimed to explore the indications, surgical techniques, therapeutic experience,prevention and treatment of postoperative complications of SLKT.Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied.Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed.Results All operations were successfully performed.Postoperative complications occurred in 13 cases (59.1%), including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinal bleeding (1), and acute liver graft rejection (1).All complications were treated conservatively.In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions.Mortality at 3 months was 13.6%.The one and three year patient survival rate was 81.3% and 73.9% respectively.Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function.It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications.The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases.It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative

  15. REPEATED LIVER TRANSPLANTATION: EXPERIENCE OF RUSSIAN SCIENTIFIC CENTER OF RADIOLOGY AND SURGICAL TECHNOLOGY (RSCRST

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    D. A. Granov

    2011-01-01

    Full Text Available The article gives the report about the experience in repeated liver transplantation (LT. Totally 99 LT including 6 repeated operation at five patients performed between june 1999 and june 2011. In 3 of 6 cases bile ducts necroses was the indication to repeated LT. Retransplantations were connected with difficulties, enlargement of duration and replacement therapy volume, also explained high number of complication after operation. It is demonstrated that chronic biliary infection and bad condition of patients are the main reasons of complication and poor prognosis after repeated liver transplantation. 

  16. A Ventral Visual Stream Reading Center Independent of Sensory Modality and Visual Experience

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    Lior Reich

    2011-10-01

    Full Text Available The Visual Word Form Area (VWFA is a ventral-temporal-visual area that develops expertise for visual reading. It encodes letter-strings irrespective of case, font, or location in the visual-field, with striking anatomical reproducibility across individuals. In the blind, reading can be achieved using Braille, with a comparable level-of-expertise to that of sighted readers. We investigated which area plays the role of the VWFA in the blind. One would expect it to be at either parietal or bilateral occipital cortex, reflecting the tactile nature of the task and crossmodal plasticity, respectively. However, according to the notion that brain areas are task specific rather than sensory-modality specific, we predicted recruitment of the left-hemispheric VWFA, identically to the sighted and independent of visual experience. Using fMRI we showed that activation during Braille reading in congenitally blind individuals peaked in the VWFA, with striking anatomical consistency within and between blind and sighted. The VWFA was reading-selective when contrasted to high-level language and low-level sensory controls. Further preliminary results show that the VWFA is selectively activated also when people learn to read in a new language or using a different modality. Thus, the VWFA is a mutlisensory area specialized for reading regardless of visual experience.

  17. Lung transplantation in a Chinese single center:7 years of experience

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    HE Wen-xin; ZHANG Peng; LIU Ming; JIANG Ge-ning; DING Jia-an; GAO Wen; ZHU Yu-ming; ZHOU Xiao; CHEN Chang; WANG Hao; FAN Jiang

    2011-01-01

    Background Lung transplantation (LT) is a viable option for patients with end-stage lung diseases,but in China,the supply is limited,and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.Methods From January 2003 to May 2010,all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively,including demographic characteristics,survival rate,and the occurrences of postoperative complications,acute rejection and bronchiolitis obliterans syndrome. Results In total,37 patients underwent LT. The early mortality (<30 days) was 14% (5/37). Cumulative survival rate was 78%,70%,70% and 42% at 1,3,5 and 6 years,respectively. In 37 patients,5 (14%) developed fungal infections,9 (24%)pulmonary bacterial infections,and 6 (16%) had bronchial anastomosis complications after LT. At three months posttransplantation,a significant improvement was observed in lung function (P <0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%,85% and 80% at 1,2 and 3years after transplantation.Conclusions Despite the limited number of cases,the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.

  18. Reconstructive surgery for male stress urinary incontinence: Experiences using the ATOMS system at a single center

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    Krause, Jens

    2014-12-01

    Full Text Available Objective: To propose possible success-driven solutions for problem and complication rates encountered with the ATOMS sling system, based on first-hand experience; and to provide possible actual alternative scenarios for the treatment of male . Patients and methods: During the defined period (between 4/2010 and 04/2014, 36 patients received ATOMS system implants at our clinic. We collected pre- and post-operative evaluation data using the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF. As an expansion of the questionnaire, we added questions about post-operative perineal pain, the general satisfaction with the results of the intervention and willingness to recommend the operation to a best friend. Results: Our data shows a relatively high explantation rate, but a surprisingly high patient satisfaction rate. Explantation was required mainly due to late onset infections or other symptomatic factors. Compared to other studies early onset infections were rare. Conclusion: A non-invasive, uncomplicated adjustable system to alleviate male stress urinary incontinence remains a challenge. Although there are various systems available for the treatment of male stress urinary incontinence, it seems that despite the advantages of the ATOMS system, an artificial sphincter system may pose more advantages based on our experience, understanding and knowledge of its well-documented long-term solutions and problems.

  19. Mycetoma: experience of 482 cases in a single center in Mexico.

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    Bonifaz, Alexandro; Tirado-Sánchez, Andrés; Calderón, Luz; Saúl, Amado; Araiza, Javier; Hernández, Marco; González, Gloria M; Ponce, Rosa María

    2014-08-01

    Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  20. Mycetoma: experience of 482 cases in a single center in Mexico.

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    Alexandro Bonifaz

    2014-08-01

    Full Text Available Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013. A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11% were actinomycetomas and 38 cases (7.88% were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years. The main affected localization was lower and upper limbs (70.74% and 14.52% respectively. Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported. The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%. Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21% and Actinomadura madurae (8.7%; meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  1. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

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    Silber, Toni; Ziemann, Ulf [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany); Ernemann, Ulrike [Department of Diagnostic and Interventional Neuroradiology, University of Tübingen (Germany); Bischof, Felix, E-mail: felix.bischof@uni-tuebingen.de [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany)

    2014-12-15

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology.

  2. Cinacalcet in pediatric and adolescent chronic kidney disease: a single-center experience.

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    Alharthi, Abdulla A; Kamal, Naglaa M; Abukhatwah, Mohamed W; Sherief, Laila M

    2015-01-01

    Cinacalcet, a calcimimetic drug, has been shown to be efficacious in adult chronic kidney disease (CKD) patients; however, it was not fully studied in pediatric CKD patients. We aimed at assessing the effect of cinacalcet on intact parathyroid hormone (iPTH) secretion in children with CKD-4/5 with iPTH consistently ≥ 300 pg/mL refractory to conventional treatment. This is a prospective cohort analysis of 28 children with uncontrolled hyper-parathyroidism secondary to stage 4 and 5 CKD admitted to a tertiary center during the period from April 2012 to April 2014. Twenty-eight patients with CKD-4/5 were assessed prospectively regarding bone biochemistry, renal ultrasonography, serum iPTH level, and medications. Patients were classified into 3 groups: group 1, 6 patients with CKD-4 on supplemental and supportive therapy; group 2, 6 patients with CKD-5 on hemodialysis and; group 3, 16 patients with CKD-5 on automated peritoneal dialysis. Patients were between the ages of 9 months and 18 years on commencing cinacalcet at doses of 0.5 to 1.5 mg/kg. All patients showed at least a 60% reduction in iPTH (60%-97%). Highly significant reduction in iPTH and serum alkaline phosphatase levels was detected post-cinacalcet. The serum calcium (Ca), phosphate (P), and Ca × P product were unaffected. Treatment was well tolerated with no hypophosphatemia, hypocalcemia, or other adverse effects almost in all patients. Cinacalcet use was proven safe for all pediatric and adolescent patients with CKD-4/5 during the study period, and at the same time most of the patients reached the suggested iPTH target values.

  3. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

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    Abdel-Razeq H

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension

  4. Clinical profile of primary hyperparathyroidism from western India: A single center experience

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    Gopal R

    2010-01-01

    Full Text Available Background: Primary hyperparathyroidism (PHPT has a variable clinical presentation and symptomatic PHPT is still the predominant form of the disease in India. Data from western India is lacking. Aim : To present the clinical profile of PHPT from western India. Settings and Design : This retrospective study was conducted at a tertiary care referral center. Materials and Methods : We analyzed the clinical presentation, biochemical, radiological features, and operative findings in adult patients with PHPT (1986-2008 and compared with our published data of children and adolescent patients with PHPT. Statistical Analysis : was done with SPSS 16 software. Results : Seventy-nine patients (F: M-2:1 with age ranging from 21 to 55 years (mean 33.5±8.82 were analyzed. Skeletal manifestations (75.5%, renal calculi (40.5% and proximal muscle weakness (45.5% were the most common symptoms of presentation with mean duration of symptoms being 33.70 (median: 24, range 1-120 months. Biochemical features included hypercalcemia (total corrected calcium 12.55±1.77 mg/dl, low inorganic phosphorus (1.81±0.682 mg/dl, elevated total alkaline phosphatase (mean: 762.2; median: 559; range: 50-4930IU/L and high parathyroid hormone (PTH (mean±SD: 866.61±799.15; median: 639.5; range: 52-3820 pg/ml. Preoperative localization was achieved in 74 patients and single adenoma was found during surgery in 72 patients. Hungry bone disease was seen in 30.3% and transient hypoparathyroidism developed in 62% patients. In comparison to PHPT in children there were no significant differences with regard to clinical, laboratory and radiological features. Conclusions : PHPT in western India is symptomatic disorder with skeletal and renal mani-festations at a much younger age. Clinical profile of PHPT in children is similar to that of adults.

  5. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO).

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    Tuan, J; Vischioni, B; Fossati, P; Srivastava, A; Vitolo, V; Iannalfi, A; Fiore, M R; Krengli, M; Mizoe, J E; Orecchia, R

    2013-07-01

    We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35-37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21-74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70-74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy.

  6. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: A single center experience

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    Choi, Eun Cheol [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Kim, Jin Hee; Kim, Ok Bae; Kim, Mi Young; Oh, Young Ki; Baek, Sung Gyu [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.

  7. Neurological complications of dengue fever: Experience from a tertiary center of north India

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    Rajesh Verma

    2011-01-01

    Full Text Available Introduction: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. Materials and Methods: The patients presenting with neurological complications with positive serology (IgM antibody for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Results: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Conclusion: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

  8. Percutaneous CT-guided radiofrequency ablation of solitary small renal masses. A single center experience

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    Pieper, C.C.; Fischer, S.; Strunk, H.; Meyer, C.; Thomas, D.; Willinek, W.A.; Schild, H. [Univ. Bonn (Germany). Dept. of Radiology; Hauser, S. [Univ. Bonn (Germany). Dept. of Urology; Nadal, J. [Univ. Bonn (Germany). Inst. for Medical Biometry; Wilhelm, K. [Johanniter Hospital Bonn (Germany). Dept. of Radiology

    2015-07-15

    To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Patient records of renal RFAs (07/2003 - 11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier's method and compared with log-rank or cox tests. 38 patients (16 females, mean age 70.0 years [range 52 - 87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95 % of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4 ± 0.8 % and 50.3 ± 1.0 %, respectively (mean follow-up 54.6 months, range 1 - 127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS. There was no difference in survival between patients with benign and malignant tumors. RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression.

  9. Management of autoimmune hemolytic anemia in children and adolescents: A single center experience

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    Nazan Sarper

    2011-09-01

    Full Text Available Objective: To present and discuss the treatment of autoimmune hemolytic anemia (AIHA. Materials and Methods: The medical records of all patients (n=19 diagnosed in a tertiary hematology center between 1999 and 2010 were retrospectively reviewed.Results: Median age at diagnosis of AIHA was 5 years (range: 4 months-17 years. In all, 13 patients had primary (idiopathic AIHA, whereas 2 had primary Evans Syndrome (ES, 2 had autoimmune lymphoproliferative syndrome (ALPS+ES, and 1 had Wiskott-Aldrich syndrome (WAS+AIHA. Among the 13 primary idiopathic AIHA patients, 9 recovered following a 4-8-week course of prednisolone treatment without relapses, whereas 3 patients required a longer course of prednisolone. One AIHA patient that was very resistant to prednisolone recovered after cyclosporine A was added to the treatment. All patients with primary idiopathic AIHA were in remission for a median of 3 years (range: 4 months-10 years at the time this manuscript was written. Among the patients with primary ES, 2 had relapses similar to the ALPS patients. Splenectomy was performed in 1 primary ES patient, who at the time this report was written was also in remission. One ALPS patient required the addition of mycophenolate mofetil due to prednisolone resistance. The WAS patient was treatment resistant and died due to septicemia.Conclusions: Primary AIHA in pediatric patients generally has an acute onset and good response to corticosteroids. Primary or secondary ES has a chronic or relapsing course, and treatment may require other immunosuppressive agents in addition to corticosteroids. Complications of splenectomy must not be underestimated in patients with underlying immunodeficiency. AIHA often causes considerable morbidity and mortality in WAS.

  10. [Complications with peripherally inserted central catheters - observations and nursing experiences at one medical center in Chengdu].

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    Yue, Zhi-Ying; Li, Jun-Ying; Yu, Chun-Hua; Zhao, Shu-Zhen; Fu, Yan

    2010-06-01

    Its peripheral vein puncture point, safe insertion procedure and high rate of success have made the peripherally inserted central catheter (PICC) a particularly suitable medical device for cancer patients who require long-term intravenous chemotherapy. PICC can help avoid the pain of repeat punctures as well as reduce incidence of cytotoxic drug extravasation-induced phlebitis and tissue necrosis. With PICC, patient activity is not limited, which improves quality of life. This paper reported on complications and subsequent nursing care provided to 400 cancer patients who received PICC in our center between September 2007 and October 2008. A total of 395 cases had successful PICC insertion on the first attempt and 5 cases achieved success immediately following the second insertion attempt (overall success rate: 98.8%). The average catheter dwell-in time was 122 days (range 2-350 days), during which time no patient required repeat puncture. During the insertion process, arrhythmia occurred in 1.5% (6/400), difficult catheter propelling in 3.75% (15/400), and excessive oozing of blood in 0.3% (1/400) of subjects. During the catheter dwell-in period, sensitizing dermatitis occurred in 8% (38/400), mechanical phlebitis in 7.5% (30/400), catheter occlusion in 9.5% (38/400) (including 2% [8/400] complete and 7.5% [30/400] partial occlusions), catheter associated hematogenous infection in 3% (12/400) and venous thrombosis in 2% (8/400) of subjects. All complications were well controlled with active and effective management. In conclusion, the safety of PICC can be maximized and complications reduced when nurses fully evaluate patients prior to their operation, strictly adhere to PICC operating guidelines, detect complications early, and manage problems promptly.

  11. Cryptococcal meningitis in HIV infected: Experience from a North Indian tertiary center

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    Kumar Susheel

    2008-01-01

    Full Text Available Background: Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India. Aims: To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up. Settings and Design: A retrospective observational study undertaken in a large tertiary care center. Materials and Methods: Patient′s demographic data, presenting clinical symptomatology, physical findings, laboratory parameters, cerebrospinal fluid (CSF examination findings, side-effects of treatment, development of any complications and hospital outcome were analyzed. During follow-up any recurrence of cryptococcal meningitis, possible reasons of recurrence, type of treatment received, complications developed and outcome was recorded as well. Results: Forty patients diagnosed to have cryptococcal meningitis were analyzed. Twenty-two (55% patients had acute/ subacute presentation. Thirty-six (90% patients presented with headache and 18 (45% had altered sensorium. Twenty (50% patients had no cells in the CSF. Hypoglycorrhchia was seen in 30 (75% patients. Cryptococcal meningitis was the first acquired immune deficiency syndrome (AIDS-defining illness in 30 (75% patients. Thirty-five patients developed some adverse effects to amphotericin-B. Thirty-three patients improved with treatment while three patients died. Four patients had recurrence of cryptococcal meningitis within six months of first episode. Non-compliance of fluconazole therapy was the reason for recurrence in all of these patients. Conclusions: Cryptococcal meningitis is a common initial AIDS-defining illness. Acute and/or subacute presentation of cryptococcal meningitis is not uncommon in HIV-infected individuals. An early

  12. Five years renal transplantation data: Single-center experience from Iraq

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    Ala A Ali

    2016-01-01

    Full Text Available Renal transplantation is the treatment of choice for patients with end-stage renal disease. In Iraq, renal transplantation started in 1973 and has continued until now with live donor transplantation, since deceased donor transplant program is not approved as yet. Long-term transplant data are still scarce. The aim of our study is to present data on transplantation and medical follow-up at one year and, survival analysis at one, three and five years. A total of 250 renal transplantations were performed at the Nephrology and Renal Transplantation Center, Baghdad between January 2009 and January 2014. It is a living donor, blood group compatible donor program. All patients received triple immunosuppression (calcineurine inhibitor, mycophenolate mofetil or mycophenolic acid, and steroid. The Kaplan-Meier method was used to determine the survival rate. There were 92 live related donors, 143 unrelated donors, and 15 spouse donors. The mean age was 34.07 ± 12.2 years. The one-year graft survival for related and unrelated donor transplants was 98.9% and 91.8%, respectively. Graft survival was lower (82.9% in recipients with acute rejection episodes. The patient survival at one-year was 94%. The three-year graft and patient survival was 91% and 90%, respectively, and five-year survival for grafts and patients was 87.1% and 88%, respectively. The outcome of the renal transplantation in Iraq is improving. Long-term patient follow-up needs more meticulous attention. The development of renal transplant registry is critical for future planning. Moreover, renal transplantation practice in Iraq needs more social, religious, and governmental support.

  13. Central nervous system involvement in T-cell lymphoma: A single center experience.

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    Gurion, Ronit; Mehta, Neha; Migliacci, Jocelyn C; Zelenetz, Andrew; Moskowitz, Alison; Lunning, Matthew; Moskowitz, Craig; Hamlin, Paul; Horwitz, Steven

    2016-05-01

    Background We characterized the incidence of central nervous system (CNS) involvement, risk factors and outcome in a large single institution dataset of peripheral T-cell lymphoma (PTCL). Methods Retrospective review of the PTCL database at Memorial Sloan Kettering Cancer Center. We identified 231 patients with any subtype of PTCL between 1994-2011 with a minimum six months of follow-up or an event defined as relapse or death. Results Histologies included peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) (31.6%), angioimmunoblastic (16.9%), anaplastic large cell lymphoma (ALCL), ALK- (12.1%), ALCL, ALK + (6.1%), extranodal NK/T-cell lymphoma (7.4%), adult T-cell leukemia/lymphoma (ATLL) (7.4%), and transformed mycosis fungoides (8.7%). Seventeen patients had CNS disease (7%). Fifteen had CNS involvement with PTCL and two had diffuse large B-cell lymphoma and glioblastoma. Median time to CNS involvement was 3.44 months (0.16-103.1). CNS prophylaxis was given to 24 patients (primarily intrathecal methotrexate). Rates of CNS involvement were not different in patients who received prophylaxis. Univariate analysis identified stage III-IV, bone marrow involvement, >1 extranodal site and ATLL as risk factors for CNS disease. On multivariate analysis, >1 extranodal site and international prognostic index (IPI) ≥ 3 were predictive for CNS involvement. The median survival of patients with CNS involvement was 2.63 months (0.10-75). Conclusions Despite high relapse rates, PTCL, except ATLL, carries a low risk of CNS involvement. Prognosis with CNS involvement is poor and risk factors include: >1 extra nodal site and IPI ≥3.

  14. Is Antibiotic Usage Necessary after Donor Nephrectomy? A Single Center Experience

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    Zomorrodi Afshar

    2008-01-01

    Full Text Available Proper management of living kidney donors is a very important aspect of all renal transplants. To date, approximately 60,000 living donor nephrectomies have been performed worldwide and about 20 deaths directly related to the operation have been reported. The most common cause of death has been pulmonary embolism. Wound infection following surgery is the third most common nosocomial infection, and is dependent on the surgeon and his/her team, the operating room, number and virulence of contaminated bacteria, patient characteristics (immunity and defense, as well as time and duration of administration of antibiotics. Approach to the prophylaxis of wound infection in kidney donors varies in different transplant centers. This study was conducted at the Emam Hospital, Tabriz, Iran in order to delineate the protocol regarding antibiotic usage after donor nephrectomy. One hundred kidney donors were enrolled in the study. They were classified randomly in two groups: Group-1, comprising 50 donors, who received antibiotics immediately following surgery and for at least seven days thereafter. Group-2, comprised of 50 donors, in whom one gram of cephazoline was injected intravenously before anesthesia and continued for 24 hours after surgery. The patients were followed-up for one month with particular emphasis on occurrence of wound infection. One patient in Group-1, and two in Group-2 had wound infection; the difference was not statistically significant (p = > 0.5. Our study suggests that antibiotic prophylaxis started before incision and continued for 24 hours after donor nephrectomy is safe and effective in preventing wound infection.

  15. Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

    Institute of Scientific and Technical Information of China (English)

    Wong Hoi She; Albert CY Chan; Tan To Cheung; Kenneth SH Chok; See Ching Chan; Ronnie TP Poon; Chung Mau Lo

    2016-01-01

    BACKGROUND: Acute pancreatitis is a relatively rare but po-tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS: A total of 1632 patients with hepatocellular car-cinoma who had undergone transarterial chemoembolization from January 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com-plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS: Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa-tients was 61 years. Most (79.6%) of the patients suffered from HBV-related hepatocellular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut-ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven (0.4%) patients suffered from acute pancre-atitis post-chemoembolization. Six patients had chemoembo-lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxorubicin eluting bead had a higher risk of acute pancreatitis [6/145 (4.1%) vs 1/1487 (0.1%), P CONCLUSIONS: Acute pancreatitis after transarterial chemo-embolization could result in serious complications, especially after treatment with doxorubicin eluting bead. Continuation of current treatment with transarterial chemoembolization after acute pancreatitis is feasible providing the initial attack is completely resolved.

  16. Management and outcomes of intramedullary spinal cord tumors: A single center experience from a developing country

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    Bakhshi, Saqib K.; Waqas, Muhammad; Shakaib, Baila; Enam, Syed A.

    2016-01-01

    Background: Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery. Methods: This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified McCormick Scale was used to grade patients’ neurological status at admission, discharge, and follow-up. Statistical analysis was performed using the Statistical Package for Social Sciences version 22. Results: Forty three cases were reviewed. Mean age was 33.8 ± 15.1 years whereas median follow-up was 5 months (range: 0.25–96 months). Most patients had ependymoma (n = 16; 73%). Cervical region was the most commonly involved (n = 15; 34.9%). Gross total resection (GTR) was achieved in 30 cases (69.8%). The preoperative McCormick grade was significantly associated with follow-up McCormick grade (P value = 0.002). Eight patients (18.6%) underwent intraoperative electrophysiological monitoring, out of which GTR was achieved in all cases, and none had disease progression or recurrence. Ten patients received postoperative radiotherapy. Thirty five patients (81.4%) had progression free survival at last follow-up. Conclusions: We achieved a GTR rate of 68.9% for IMSCTs with limited resources. In few cases, where intraoperative electrophysiology was used, the rate of GTR was 100%. Preoperative neurological status was associated with better postoperative McCormick score. PMID:27656322

  17. Outcome results in children with IgA nephropathy: a single center experience

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    Bulut, Ipek Kaplan; Mir, Sevgi; Sozeri, Betul; Bulut, Mustafa Orhan; Sen, Sait; Dincel, Nida

    2012-01-01

    Background Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis. Patients manifest variable clinical symptoms (eg, microhematuria) with preserved or progressive deterioration of renal function resulting in end-stage renal disease. The aim of this study was to evaluate patients from a single center to describe the clinical features, treatments, and follow-up results of those with the disease. Methods This is a retrospective data study of all children with IgAN. Patients who had a histopathologically proven diagnosis of IgAN and were followed up for at least 5 years were included in the study. Renal biopsy, graded as Hass classification, was performed on all patients. A total of 39 patients were included in the study. Results The mean follow-up time (± standard deviation) was 10.4 ± 3.51 (range 5–16) years. Twenty-nine patients (74.4%) were male and ten (25.6%) were female. Nineteen (48.7%) patients presented with recurrent macroscopic hematuria, ten (25.6%) with microscopic hematuria ± proteinuria, six (15.4%) with nephritic syndrome, and four (10.3%) with nephrotic syndrome. All patients underwent a renal biopsy, which was graded according to the Hass classification. At the end of follow-up time, 18 (46.1%) patients were normal, 15 (38.5%) had minor urinary abnormalities, three (7.7%) had active renal disease, and three (7.7%) developed renal failure. Conclusion The results of the present study are better than those from most other series. The majority of children with IgAN in this study were admitted with recurrent macroscopic hematuria and found to have a good prognosis. We suggest that children with IgAN have a good prognosis in the first 5-year follow-up period. PMID:22334797

  18. Treatment of hepatitis C in patients with haemophilia - the Israeli National Hemophilia Center experience.

    Science.gov (United States)

    Maor, Y; Schapiro, J M; Bashari, D; Lurie, Y; Safadi, R; Segol, O; Paritsky, M; Rachlis, Z; Avidan, B; Bar-Meir, S; Martinowitz, U

    2008-03-01

    Treatment with pegylated interferon (Peg-IFN) and ribavirin, now the standard of care, has been shown to achieve sustained viral response (SVR) in up to 60% of patients with hepatitis C (HCV). Studies of response to this combination in HCV-infected haemophilia patients are scarce. The aim of the study was to report the results and safety of interferon/ribavirin treatment in HCV and HCV-/HIV-infected patients at the Israeli National Hemophilia Center. A retrospective observational cohort study was conducted on haemophilia patients infected with HCV or HCV/HIV. Patients received combination of Peg-IFN and ribavirin. Few were still treated with standard interferon. The primary end-point was sustained viral response (SVR). The secondary end-point was safety, with emphasis on increased bleeding episodes. Some 18/43 (42%) HCV mono-infected haemophilia patients achieved SVR. Relapse occurred in 14 (33%), while 11 patients (25%) were non-responders. SVR was achieved among 17/37 (46%) naïve patients receiving Peg-IFN and ribavirin. Among patients with genotype-1, SVR was achieved in 12/36 (33%) and 11/30 (37%) in the whole group and Peg-IFN treated naïve patients, respectively. In HCV/HIV co-infected patients only 1 patient achieved SVR. Severe anaemia occurred in 14/50 (28%) patients, four received erythropoietin. None maintained stable haemoglobin levels. Two patients had significant bleeding episodes. In our cohort of haemophilia patients, SVR was achieved in a lower than expected rates. A relatively high relapse rate in the HCV mono-infected patients and a very high non-response rate in the HCV/HIV co-infected patients were observed as anticipated. Anaemia was a major side effect and the use of growth factors seemed unrevealing.

  19. Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

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    Semra Eroglu

    2015-11-01

    , pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.

  20. Chromogranin A as Serum Marker for Gastroenteropancreatic Neuroendocrine Tumors: A Single Center Experience and Literature Review

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    Christoph J. Auernhammer

    2012-02-01

    Full Text Available The aim of this study was to assess the clinical sensitivities of the tumor markers chromogranin A (CgA, urinary 5-hydroxyindoleacetic acid (5-HIAA and alkaline phosphatase (AP in neuroendocrine tumors (NETs of the GastroEnteroPancreatic-(GEP- system depending on tumor primary location and metastatic spread. In a retrospective single-center series, sensitivities were evaluated in serum samples from 110 patients with midgut (n = 62 and pancreatic (n = 48 NETs. CgA levels were analyzed by a commercially-available immunoradiometric assay (CIS-bio during routine follow-up in the years 2000–2009. CgA showed a higher sensitivity for midgut (68% than pancreatic (54% NETs. A higher CgA sensitivity and significantly higher median CgA values were found in patients with liver metastases than in those without, and in patients with hepatic and additionally extra-hepatic metastases than in those with hepatic and nodal metastases alone, respectively. We found an overall sensitivity for elevated 5HIAA excretion of 69% for midgut NETs and a significant correlation between median CgA and 5-HIAA values. The sensitivity of AP and the correlations of AP/CgA-data-pairs were low in both midgut and pancreatic NETs, although highest for metastatic pancreatic NETs. The sensitivity of CgA measurement depends on the NET primary location and spread of disease. 5-HIAA and CgA showed comparable sensitivity in midgut NETs, while AP does not seem to be useful as a tumor marker in GEP-NETs.

  1. "Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.

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    Schmidt, F; Jack, T; Sasse, M; Kaussen, T; Bertram, H; Horke, A; Seidemann, K; Beerbaum, P; Koeditz, H

    2015-12-01

    In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were 14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.

  2. Relationship between renal function and extracorporeal membrane oxygenation use: a single-center experience.

    Science.gov (United States)

    Gupta, Punkaj; Carlson, Jacob; Wells, Dennis; Selakovich, Patrick; Robertson, Michael J; Gossett, Jeffrey M; Fontenot, Eudice E; Steiner, Matthew B

    2015-04-01

    The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO.

  3. Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience

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    Özdemir, Nihal; Tüysüz, Gülen; Çelik, Nigar; Yantri, Leman; Erginöz, Ethem; Apak, Hilmi; Özkan, Alp; Yıldız, İnci; Celkan, Tiraje

    2016-01-01

    Aim: An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. Material and Methods: Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients’ files. Results: A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. Conclusions: In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving

  4. Interactive data analysis for astronomy Shuttle experiments at Goddard Space Flight Center

    Science.gov (United States)

    Klinglesmith, D. A., III

    1981-01-01

    The eye as an efficient selection device for determining what is important in astronomical imagery can be greatly aided by the computer. A suitable facility, called the Interactive Astronomical Data Analysis Facility (IADAF), has been developed for the display and analysis of astronomical imagery by the Laboratory for Astronomy and Solar Physics. The Laboratory for Astronomy and Solar Physics currently has approval to fly two experiments on Spacelab. The Solar Extreme Ultraviolet Telescope (SEUTS) is to be used for the study of several fundamental problems of solar physics. The Ultraviolet Image Telescope for Astronomical Investigations (UIT) is to provide direct imagery of selected fields of view throughout the sky. A description is given of IADAF, taking into account its 16-bit computer and the COMTAL image processing display system. The use of IADAF by SEUTS and UIT is discussed.

  5. Applications of neuronavigation system in cranial surgery: experience of a single center

    Science.gov (United States)

    Nouri, Mohsen; Pahlavani, Mehrdad; Amirjamshidi, Abbas; Shirani-Bidabadi, Mohammad; Ketabchi, Ebrahim; Karimi-Yarandi, Kourosh

    2012-01-01

    Abstract: Background: Since the advent of navigational systems in neurosurgery, various implications have been introduced for them in spine and brain practices. Although, the range of surgeries in which these systems are being used is getting wider over time, their application is becoming more specific in certain situations. Methods: This means that defining specific indications for their usage is not as easy as it was previously thought. Brief reviewing of the available literature showed various navigation systems proposed and used in neurosurgery. Results: In this study, we review case selection criteria, techniques, and the results of neuronavigation applications in the patients underwent neurosurgical operations in the Sina hospital (Tehran, Iran) during 2011. Conclusions: The findings of our survey and experiences prove the efficacy and advantages of this technique that reduces the risk of neurovascular damage, neural tissue manipulation, operation time, and bleeding. Keywords: Neuronavigation, Cranial surgery, Navigational system

  6. BRAIN METASTASES OF GERM CELL TUMORS. THE RUSSIAN CANCER RESEARCH CENTER'S EXPERIENCE

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    A. A. Tryakin

    2014-07-01

    Full Text Available This paper analyzes the experience in treating 20 patients with nonseminomatous germ cell tumors metastasizing to the brain. It presents brain metastasis-associated factors: multiple lung metastases; IGCCCG poor prognosis; and a baseline human chorionic gonadotropin level of > 50000 mIU/ml. The authors have identified a group to be screened for brain metastasis, which includes patients with intermediate/poor prognosis and multiple lung metastases. Long-term survival was achieved in 45 % of patients with baseline brain damage and in 22 % of those with metastases revealed after first-line chemotherapy. The positive prognostic factors associated with long-term survival were a single brain lesion, no neurological symptoms, and achievement of clinical complete personse in the brain.

  7. Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

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    Silva BC

    2016-04-01

    Full Text Available Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC to tunneled-cuffed catheters (TCCs for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008 and B (from 2013 to 2015. Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P<0.0001. Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092. Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan–Meier model (log-rank = 0.188. TCC removal for low blood flow occurred in 8.9% of procedures. Conclusion: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic. Keywords: renal dialysis, tunneled catheters, interventional nephrology

  8. Impact of hepatitis C infection on renal transplant patients: a single-center experience in Libya.

    Science.gov (United States)

    Elzouki, Abdel-Naser Y; Gargoum, Huda M; Habas, Elmukhtar M; Rayani, Amnna A; Othman, Muftah

    2014-11-01

    The objective of this study was to assess the effect of hepatitis C virus (HCV) infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT) patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6%) were HCV-positives and 131 (54.4%) were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P<0.001). Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P<0.05), and this difference became more significant after a 12-month period of transplantation (P<0.01). Seventeen patients died during the follow-up: Seven HCV-positives (6.3%) and 10 HCV-negatives (7.6%), and there was no significant difference in the death rate following RT between the two groups (P=0.08). Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8%) HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close monitoring for graft

  9. Performance characteristics of retrograde single-balloon endoscopy: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Kaci E Christian; Karan Kapoor; Eric M Goldberg

    2016-01-01

    AIM: To evaluate the technical success, diagnostic yield(DY) and therapeutic potential of retrograde single balloon enteroscopy(rS BE). METHODS: A retrospective review of 136 rS BE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding(GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth(ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield(TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS: A total of 136 rS BE procedures were identified. Mean patient age was 57.5(± 16.2) years, 67(49.2%) were male, and 110(80.9%) procedures were performed on an outpatient basis. Indications for rS BE included GIB in 55(40.4%), evaluation of inflammatory bowel disease(IBD) in 29(21.3%), and imaging suggestive of pathology other than GIB or IBD in 43(31.6%). Nine(6.6%) rS BEs were performed for other indications. Mean ID was 68.3(± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7(± 15.5) min. Overall, 73(53.7%) cases were diagnostic and 25(18.4%) cases were therapeutic in which interventions(argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88(64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31(35.2%) cases. Follow up data was available in 93(68.4%) patients; 2(2.2%) reported post-procedural abdominal pain within 30 d

  10. Clinical Characteristics of Bowel Obstruction in Southern Iran; Results of a Single Center Experience

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    Majid Akrami

    2015-01-01

    Full Text Available Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Results: Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5% were men and 158 (38.5% were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045 and abdominal distention (32.3% vs. 67.7%; p=0.007. Intraoperative findings included adhesion band formation in 50 (48.1%, mass 18 (17.3%, and hernia 7 (6.7%. We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042. The mean hospital stay was significantly higher in those who underwent operation (8.1±7.5 vs. 2.6±2.2 days; p=0.035. Conclusion: The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better

  11. Impact of hepatitis C infection on renal transplant patients: A single-center experience in Libya

    Directory of Open Access Journals (Sweden)

    Abdel-Naser Y Elzouki

    2014-01-01

    Full Text Available The objective of this study was to assess the effect of hepatitis C virus (HCV infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6% were HCV-positives and 131 (54.4% were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P < 0.001. Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P <0.05, and this difference became more significant after a 12-month period of transplantation (P <0.01. Seventeen patients died during the follow-up: Seven HCV-positives (6.3% and 10 HCV-negatives (7.6%, and there was no significant difference in the death rate following RT between the two groups (P = 0.08. Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8% HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close

  12. High-pressure balloon dilation for male anterior urethral stricture:single-center experience

    Institute of Scientific and Technical Information of China (English)

    Shi-cheng YU; Hai-yang WU; Wei WANG; Li-wei XU; Guo-qing DING; Zhi-gen ZHANG; Gong-hui LI‡

    2016-01-01

    题目:高压球囊扩张治疗男性前尿道狭窄:单中心的临床经验  目的:评估高压球囊扩张治疗男性前尿道狭窄的有效性和安全性。  创新点:既往高压球囊扩张技术已成熟应用于输尿管狭窄的临床治疗,我们将这一技术拓宽应用于男性前尿道狭窄的治疗,并证明高压球囊扩张治疗前尿道狭窄同样安全、有效。  方法:采用回顾性病例对照研究,收集并分析了31例接受高压球囊扩张和25例接受直视下尿道内切开术治疗的前尿道患者的病例资料,比较两组患者的手术时间、手术难易程度、术后并发症(出血和感染)、术后1年狭窄复发率和术后3年狭窄复发率等相关指标。  结论:高压球囊扩张组的手术时间和术后并发症发生率要优于直视下尿道内切开术组,两组患者的远期尿道狭窄复发率无统计学差异,但高压球囊扩张组的术后1年狭窄复发率明显低于直视下尿道内切开术组。高压球囊扩张治疗男性前尿道狭窄是安全、有效的,且近期疗效要优于传统腔内治疗方式。%Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure baloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient de-mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min,P<0

  13. Atypical presentation of Merkel cell carcinoma positive to polyomavirus DNA detection: Experience from a single center

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    Iovino F

    2014-07-01

    Full Text Available Merkel cell carcinoma (MCC is a rare malignant tumor of the skin with tendency to rapid local progression and frequent spread to regional lymph nodes. In this paper we retrospectively describe the atypical presentation of 5 cases of Merkel cell carcinoma observed in our surgical department in the last ten years. Four patients had buttock localization whilst one patient had primary nodal presentation. Since integration of Merkel cell polyomavirus (MCPyV DNA into the tumor genome is frequently recorded in this type of cancer, we analyzed formalin-fixed paraffin embedded MCC tissue samples from our five patients for the presence of MCPyV DNA by means of polymerase chain reaction (PCR. MCPyV DNA was present in all five carcinomas. All patients were treated with wide surgical excision of the tumor and sentinel node biopsy. One patient had stage I disease, three patients had stage II disease, and one patient had stage III disease. Adjuvant radiotherapy was administered in all cases for local control. Chemotherapy was administered to the patient with primary nodal presentation and in stage III disease. Median time of follow-up was 84 months. None of the patients relapsed. Despite the low number of patients examined, our experience suggests that surgery is a necessary step whereas implementation of adjuvant therapy, radiotherapy and chemotherapy depends on individual risk assessment. Treatment outcome was very good, probably due to early detection of MCC.

  14. Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: Single-center experience

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    Gamal Mustafa Ahmed

    2012-01-01

    Full Text Available A well-functioning arteriovenous fistula (AVF is essential for the maintenance of hemodialysis (HD in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years. Seventy-one (97.3% of the study subjects had been dialyzed before creation of the AVF, 67 (91.8% of them having undergone HD with temporary access. All patients (n=73 had a native AVF as the permanent vascular access (VA. A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%. Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15 and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount.

  15. Ureteroscopy and Laser Lithotripsy for Treatment of Ureteral Stones in Pregnants: Single Center Experience

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    Mustafa Okan İstanbulluoğlu

    2016-03-01

    Full Text Available Objective: To report our ureteroscopic laser lithotrip­sy experiences in the treatment of symptomatic ureter stones in pregnants which do not respond to conservative treatment Methods: A total of 6 pregnants aged between 22-33 years in second or third trimester were studied. Holmium-YAG laser lithotripsy was performed with 6.5 F semirigid uretroscope. Results: The diagnosis of ureter stone was made with ab­dominal ultrasonography in 5 patients and with magnetic resonance in one patient. Adequate stone fragmentation was performed in 2 mid-ureter and 4 distal-ureter stones. J stent was applied in one patient after the fragmenta­tion process. The mean operation time was 24.8 ± 10.0 minutes after the entry of bladder with ureteroscope un­der spinal anesthesia. No urologic, anesthetic or obstetric complication was seen and all patients gave healthy birth at term. Conclusion: Fine calibrated ureteroscopes for the treat­ment of ureter stones in pregnants are fast and effective treatment modalities which decrease the operation time and remove difficulties in entering the ureter.

  16. Phenylketonuria. Experience at one center in the first year of screening in California.

    Science.gov (United States)

    Peterson, R M; Koch, R; Schaeffler, G E; Wohlers, A; Acosta, P B; Boyle, D

    1968-05-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance.

  17. Phenylketonuria—Experience at One Center in the First Year of Screening in California

    Science.gov (United States)

    Peterson, Raymond M.; Koch, Richard; Schaeffler, Graciela E.; Wohlers, Audrey; Acosta, Phyllis B.; Boyle, David

    1968-01-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance. PMID:5652755

  18. COMBREX-DB: an experiment centered database of protein function: knowledge, predictions and knowledge gaps.

    Science.gov (United States)

    Chang, Yi-Chien; Hu, Zhenjun; Rachlin, John; Anton, Brian P; Kasif, Simon; Roberts, Richard J; Steffen, Martin

    2016-01-01

    The COMBREX database (COMBREX-DB; combrex.bu.edu) is an online repository of information related to (i) experimentally determined protein function, (ii) predicted protein function, (iii) relationships among proteins of unknown function and various types of experimental data, including molecular function, protein structure, and associated phenotypes. The database was created as part of the novel COMBREX (COMputational BRidges to EXperiments) effort aimed at accelerating the rate of gene function validation. It currently holds information on ∼ 3.3 million known and predicted proteins from over 1000 completely sequenced bacterial and archaeal genomes. The database also contains a prototype recommendation system for helping users identify those proteins whose experimental determination of function would be most informative for predicting function for other proteins within protein families. The emphasis on documenting experimental evidence for function predictions, and the prioritization of uncharacterized proteins for experimental testing distinguish COMBREX from other publicly available microbial genomics resources. This article describes updates to COMBREX-DB since an initial description in the 2011 NAR Database Issue.

  19. Hematopoietic Stem-Cell Transplantation in the Developing World: Experience from a Center in Western India

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    Chirag A. Shah

    2015-01-01

    Full Text Available We describe our experience of first 50 consecutive hematopoietic stem-cell transplants (HSCT done between 2007 and 2012 at the Apollo Hospital, Gandhinagar, 35 autologous HSCT and 15 allogeneic HSCT. Indications for autologous transplant were multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, and acute myeloid leukemia, and indications for allogeneic transplants were thalassemia major, aplastic anaemia, chronic myeloid leukemia, and acute lymphoblastic and myeloid leukaemia. The median age of autologous and allogeneic patient’s cohort was 50 years and 21 years, respectively. Median follow-up period for all patients was 39 months. Major early complications were infections, mucositis, acute graft versus host disease, and venoocclusive disease. All of our allogeneic and autologous transplant patients survived during the first month of transplant. Transplant related mortality (TRM was 20% (N = 3 in our allogeneic and 3% (N = 1 in autologous patients. Causes of these deaths were disease relapse, sepsis, hemorrhagic complications, and GVHD. 46% of our autologous and 47% of our allogeneic patients are in complete remission phase after a median follow-up of 39 months. 34% of our autologous patients and 13% of our allogeneic patients had disease relapse. Overall survival rate in our autologous and allogeneic patients is 65.7% and 57.1%, respectively. Our results are comparable to many national and international published reports.

  20. Results of candidemia treatment in children with hematologic malignancies: single center experience

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    I. I. Kalinina

    2014-07-01

    Full Text Available Candidemia is one of the most serious infectious complications in children with hematological malignancies and has a high morta lity rate.Seven-year experience of candidemia diagnosis and therapy in patients with various hematologic malignancies w as analyzed. Candidemia registered in 37 patients (AML and MDS — 14, ALL — 10, solid tumors — 5, histocytic syndromes — 4, AA — 3, other non-malignancy diseases— 2. C. non-albicans (36 isolates from 32 patients was common cause of, while C. albicans isolated in 5 patients (8 strains. Antifungal prophylactic therapy was applied to 31 patients. 22 patients at the time of candidemia have neutropenia (< 0.5 × 10 9/l. Main clinical manifestations were febrile fever (100 % cases and pneumonia (21.6 % cases. Less frequent multiorgan failure (8.1 %, septic shoc k (5.4 %, chronic disseminated candidiasis (5.4 % and meningitis (2.7 % were registered. All patients received antifungal therapy (monotherapy — 17, combination therapy — 20. Central venous catheter removed in 21 patients. In 14 patients hematopoietic recovery w as registered, none of these patients died, while from group of patients without hematopoietic recovery 6 patients died (p = 0.0001. Recurrent candidemia episodes were seen in 4 patients. Overall survival was 0.37 ± 0.09.

  1. Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

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    Armin D. Goralczyk

    2009-01-01

    Full Text Available Adult living donor liver transplantations (ALDLTs across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR. Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.

  2. Results of candidemia treatment in children with hematologic malignancies: single center experience

    Directory of Open Access Journals (Sweden)

    I. I. Kalinina

    2011-01-01

    Full Text Available Candidemia is one of the most serious infectious complications in children with hematological malignancies and has a high morta lity rate.Seven-year experience of candidemia diagnosis and therapy in patients with various hematologic malignancies w as analyzed. Candidemia registered in 37 patients (AML and MDS — 14, ALL — 10, solid tumors — 5, histocytic syndromes — 4, AA — 3, other non-malignancy diseases— 2. C. non-albicans (36 isolates from 32 patients was common cause of, while C. albicans isolated in 5 patients (8 strains. Antifungal prophylactic therapy was applied to 31 patients. 22 patients at the time of candidemia have neutropenia (< 0.5 × 10 9/l. Main clinical manifestations were febrile fever (100 % cases and pneumonia (21.6 % cases. Less frequent multiorgan failure (8.1 %, septic shoc k (5.4 %, chronic disseminated candidiasis (5.4 % and meningitis (2.7 % were registered. All patients received antifungal therapy (monotherapy — 17, combination therapy — 20. Central venous catheter removed in 21 patients. In 14 patients hematopoietic recovery w as registered, none of these patients died, while from group of patients without hematopoietic recovery 6 patients died (p = 0.0001. Recurrent candidemia episodes were seen in 4 patients. Overall survival was 0.37 ± 0.09.

  3. Strengthening the role of universities in addressing sustainability challenges: the Mitchell Center for Sustainability Solutions as an institutional experiment

    Directory of Open Access Journals (Sweden)

    David D. Hart

    2015-06-01

    Full Text Available As the magnitude, complexity, and urgency of many sustainability problems increase, there is a growing need for universities to contribute more effectively to problem solving. Drawing upon prior research on social-ecological systems, knowledge-action connections, and organizational innovation, we developed an integrated conceptual framework for strengthening the capacity of universities to help society understand and respond to a wide range of sustainability challenges. Based on experiences gained in creating the Senator George J. Mitchell Center for Sustainability Solutions (Mitchell Center, we tested this framework by evaluating the experiences of interdisciplinary research teams involved in place-based, solutions-oriented research projects at the scale of a single region (i.e., the state of Maine, USA. We employed a multiple-case-study approach examining the experiences of three interdisciplinary research teams working on tidal energy development, adaptation to climate change, and forest vulnerability to an invasive insect. Drawing upon documents, observations, interviews, and other data sources, three common patterns emerged across these cases that were associated with more effective problem-solving strategies. First, an emphasis on local places and short-term dynamics in social-ecological systems research provides more frequent opportunities for learning while doing. Second, iterative stakeholder engagement and inclusive forms of knowledge co-production can generate substantial returns on investment, especially when researchers are dedicated to a shared process of problem identification and they avoid framing solutions too narrowly. Although these practices are time consuming, they can be accelerated by leveraging existing stakeholder relationships. Third, efforts to mobilize interdisciplinary expertise and link knowledge with action are facilitated by an organizational culture that emphasizes mutual respect, adaptability, and solutions

  4. Pregnancy after renal transplantation: ten-year single-center experience.

    Science.gov (United States)

    Ghafari, A; Sanadgol, H

    2008-01-01

    There has been an increase in the number of pregnancies among renal transplant recipients. Our experience included 61 pregnancies in 53 patients from January 1997 to April 2007, with 6 patients having multiple pregnancies. Patients were studied for clinical, obstetrical, and perinatal outcomes. The mean patient age was 24.5 years (range, 19-38). They all received living donor kidneys. The mean transplantation-pregnancy interval was 2.7 years (range, 1.7-5.3 years). Immunosuppressive drugs consisted of cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone (pred) in 38 patients (72%); CsA, azathioprine (AZA), plus pred were used in 15 patients (28%). Pregnancy complications were chronic hypertension in 21 patients (40%), anemia in 28 (52.6%), and urinary tract infection in 18 (34%). Twelve patients (22.6%) received blood transfusions. Pre-eclampsia was diagnosed in 14 cases (26.4%) and renal dysfunction in 11 (20.7%) with pre-eclampsia assumed to be the main cause. Three patients (5.6%) had graft losses as a result of hemorrhagic shock, sepsis, and eclampsia. Premature rupture of membranes occurred in 6 cases (11.3%), and preterm delivery occurred in 14 cases (26.4%). Eleven (20.7%) newborns were small for gestational age. One club foot and one large facial hemangioma occurred in 2 infants, respectively. One case of neonatal death was registered as a result of excessive prematurity. One mother died due to sepsis. Cesarean section was performed in 24 patients (45.2%), the main indications being related to hypertension and fetal distress. There were no significant differences between MMF-treated and AZA-treated patients with respect to clinical, obstetrical, and perinatal outcomes. This group of patients was characterized by a wide range of antenatal and perinatal problems that must be managed in specialized tertiary units to achieve the best results. MMF may be as safe as AZA in pregnancy.

  5. Successful Splenectomy for Hypersplenism in Wilson’s Disease: A Single Center Experience from China

    Science.gov (United States)

    Chen, Huai-Zhen; Wu, Yun-Hu; Fang, Xiang; Zhang, Jing; Wang, Zhen; Han, Yong-Sheng; Wang, Yu

    2015-01-01

    Splenomegaly and pancytopenia are common in Wilson’s disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson’s Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients

  6. Successful Splenectomy for Hypersplenism in Wilson's Disease: A Single Center Experience from China.

    Directory of Open Access Journals (Sweden)

    Liang-Yong Li

    Full Text Available Splenomegaly and pancytopenia are common in Wilson's disease (WD and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS. All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson's Disease Rating Scale (UWDRS showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most

  7. Single center experience in endovascular aortic repair: review of technical and clinical aspects

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    Sinan Demirtaş

    2014-09-01

    Full Text Available Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complicationsand additional operations. Methods:Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR applicated into 19 patients. Thoracic endovascular aor tic repair (TEVAR applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three atients. Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3% due to contrast nephropathy. Reexploration was applicated in two patients (6.7% due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

  8. Liver transplantation in children with hyper-reduced grafts - a single-center experience.

    Science.gov (United States)

    Thomas, Naveen; Thomas, Gordon; Verran, Deborah; Stormon, Michael; O'Loughlin, Edward; Shun, Albert

    2010-05-01

    In small infants and babies who receive split or living-related adult left lateral segmental liver grafts, further reduction (hyper-reduction) of the graft may be necessary to optimize the size of the graft for the child. We report our experience with hyper-reduction of adult left lateral segment grafts in nine children. A retrospective review of the medical records of children who received hyper-reduced grafts at the Children's Hospital at Westmead, Australia was performed. Of 215 liver transplants performed on 186 children between 1986 and May 2009, 147 were reduced grafts. Nine grafts were further reduced (hyper-reduced) after an on-table assessment of graft size relative to the available abdominal space was made. Mean graft size reduction was by 30%. The pledgetted technique of resection was used in four patients. All required delayed closure of the abdomen, and in three patients, fascial closure was not possible and a Surgisis patch (Cook Surgical International, West Lafayette, IN, USA) was placed to augment the abdominal capacity. Two children had hepatic artery thrombosis. One was successfully thrombectomized. In the other, technical problems with the donor liver contributed to death 10 days post-transplant. Two bile leaks, one from the cut surface and the other at the anastomotic site, were oversewn at the time of abdominal closure. On follow-up (median 33 months), two developed biliary strictures requiring dilatation. Hyper-reduction of segmental grafts can be safely performed when needed. In view of its versatility, it may be preferable to hyper-reduce a graft rather than use a monosegment graft. Comparable long-term results are possible. The pledgetted technique of resection is easy, quick, and safe. The fact that it can be performed after revascularization with minimal blood loss adds great flexibility to this technically challenging procedure.

  9. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience

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    Antigoni Mavroudi

    2012-01-01

    Full Text Available Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from persistent diarrhea and eczema. The second one presented with abdominal pain with no signs of rejection, abdominal discomfort, vomiting when ingesting milk proteins and responded well to the elimination diet. The third patient presented with facial angioedema and hoarseness of voice. She had multiple food allergies and reacted to milk, egg and sesame. All the patients had elevated total Immunoglobulin E (IgE and elevated specific IgE antibodies to the implicated food allergens. The first patient presented clinical manifestations of allergy when she was 19 months old. The second patient became allergic at the age of 16 and the third patient at the age of 3. The symptoms of food allergy persisted for 8 years in the first case and for 2 years in the other two cases. Low levels of specific IgE antibodies to the implicated food allergens and an enhanced T-helper 1 cell immune response toward interferon-gamma production were markers of tolerance acquisition. The long term prognosis in our cases was excellent. Food allergy resolved in all the patients. The long term prognosis of acquired food allergy after liver transplantation is currently obscure. More studies would be needed including greater number of patients to determine whether acquired food allergy is transient in pediatric liver recipients.

  10. The efficacy of topiramate in adult refractory status epilepticus: experience of a tertiary care center.

    Science.gov (United States)

    Synowiec, Andrea S; Yandora, Kristin A; Yenugadhati, Vamsi; Valeriano, James P; Schramke, Carol J; Kelly, Kevin M

    2012-02-01

    Refractory status epilepticus (RSE) occurs in patients with SE when they fail to respond to traditional medical therapy. Because there are very few case reports of topiramate (TPM) treatment of RSE in adult patients, we examined our experience with TPM with regard to its safety and efficacy in seizure termination in RSE in an adult patient population. We report a retrospective review of 35 adult patients with RSE who were treated with TPM in addition to other antiepileptic drugs (AEDs) between 2003 and 2010. After failure of initial treatments of benzodiazepines and weight-based intravenous loading doses of standard AEDs, TPM tablets were crushed and administered via nasogastric tube. Data were collected on age, gender, history of epilepsy, etiology of RSE, daily dose of TPM, co-therapeutic agents, treatment response, and disposition. Following initiation of TPM use and discontinuation of continuous intravenous anesthetics with no additional AEDs administered, cumulative cessation of RSE in patients was 4/35 (11%) at one day, 10/35 (29%) at two days, and 14/35 (40%) at three days. However, when including all patients and comparing the two patient groups in which RSE was or was not terminated within three days of initiating TPM as the last or not last AED given, there was no significant difference. Time to TPM response was not associated with the type of seizures, etiology of SE, or whether there was a history of epilepsy. There were no documented side effects or complications of therapy with TPM. This study provides support for the use of TPM as an adjunctive agent in the treatment of RSE.

  11. Status of the Ultracold neutron source upgrade at LANSCE [PowerPoint

    Energy Technology Data Exchange (ETDEWEB)

    Pattie Jr., Robert Wayne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-10-31

    Several slides show the source and flux of ultracold neutrons produced. In summary, an upgraded UCN source has been designed, and parts are currently being fabricated. Nickel phosphorus-coated guides will improve transport to the experiment hall. The source will be installed in the spring of 2016 and commissioned in the fall of 2016.

  12. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

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    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  13. Extracorporeal membrane oxygenation during double-lung transplantation: single center experience

    Institute of Scientific and Technical Information of China (English)

    XU Ling-feng; LI Xin; GUO Zhen; XU Mei-yin; GAO Cheng-xin; ZHU Jin-hong; JI Bing-yang

    2010-01-01

    Background For patients with end-stage lung diseases, lung transplantation is the final therapeutic option. Sequential double-lung transplantation is recognized as an established procedure to avoid cardiopulmonary bypass (CPB). But some of the sequential double-lung transplantations require CPB support during the surgical procedure for various reasons. However, conventional CPB may increase the risk of bleeding and early allograft dysfunction. Extracorporeal membrane oxygenation (ECMO) is more advantageous than conventional CPB during the perioperative period of transplantation. Replacing traditional CPB with ECMO is promising for those patients needing cardiopulmonary support during a sequential double-lung transplantation procedure. This study aimed to summarize the preliminary experience of ECMO practice in lung transplantation.Methods Between November 2002 and October 2008, twelve patients with end-stage lung diseases undergoing sequential double-lung transplantation were subjected to ECMO during the surgical procedure. Eleven patients were prepared were prepared for the procedure via transverse thoracostomy (clamshell) and cannulated through the ascending aorta and right atrium for ECMO. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package (CB1V97R1, Medtronic, Inc., USA) were used for all of the patients.Results During ECMO,the blood flow rate was set between 1.88-2.0 L·m~(-2)·min~(-1) to keep hemodynamic and oxyhgen saturation stable; colloid oncotic pressure was maintained at more than 18 mmHg with albumin and hematocrit (HCT) kept at 28% or more. Two patients died early in this series and the other 10 patients were weaned from ECMO successfully. The duration of ECMO was 1.38-67.00 hours, and postoperative intubation was 10.5-67.0 hours.Conclusions As an established

  14. [Post-transplant lymphoproliferative disease in liver transplant recipients--Merkur University Hospital single center experience].

    Science.gov (United States)

    Filipec-Kanizaj, Tajana; Budimir, Jelena; Colić-Cvrlje, Vesna; Kardum-Skelin, Ika; Sustercić, Dunja; Naumovski-Mihalić, Slavica; Mrzljak, Anna; Kolonić, Slobodanka Ostojić; Sobocan, Nikola; Bradić, Tihomir; Dolić, Zrinka Misetić; Kocman, Branislav; Katicić, Miroslava; Zidovec-Lepej, Snjezana; Vince, Adriana

    2011-09-01

    favoring the diagnosis. The management of PTLD poses a major therapeutic challenge and although there is reasonable agreement about the overall principles of treatment, there is still considerable controversy about the optimal treatment of individual patients. EBV-related PTLDs are a significant cause of mortality in patients undergoing orthotopic liver transplantation with the observed mortality rate of up to 50%. This paper presents the experience acquired at Merkur University Hospital in the diagnosis and treatment of patients with liver transplantation and PTLD.

  15. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

    Science.gov (United States)

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun

    2016-01-01

    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  16. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

    Directory of Open Access Journals (Sweden)

    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  17. EXPERIENCE TUTORIALS IN THE GRADUATE FROM THE CENTER OF UPDATE OF THE MAGISTERIUM IN THE STATE OF DURANGO

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    Diana María Espinosa Sánchez

    2013-09-01

    Full Text Available Following the experiences we have had in the Teacher Upgrading Center in tutorials graduate programs in the State of Durango we could detect the strengths and weaknesses, enabling us to make the diagnosis in order to reduce them and develop strengths. The biggest problem that humanity is to educate its members and society as it enters the twenty-first century requires changes and improvements to the educational systems, it is clear the need of teaching and learning for the continued existence of society, higher education institutions should strive to achieve development in man and woman, tutoring in higher education, is a complementary action to develop ethical behavior, intellectual skills and teaching skills. The study is predominantly qualitative and case study method.

  18. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  19. Beam Position and Phase Monitors Characterized and Installed in the LANSCE CCL

    Energy Technology Data Exchange (ETDEWEB)

    Gilpatrick, John D [Los Alamos National Laboratory; Kutac, Vincent G. [Los Alamos National Laboratory; Martinez, Derwin [Los Alamos National Laboratory; McCrady, Rodney C. [Los Alamos National Laboratory; O' Hara, James F. [Los Alamos National Laboratory; Olivas, Felix R. [Los Alamos National Laboratory; Shurter, Robert B. [Los Alamos National Laboratory; Watkins, Heath A. [Los Alamos National Laboratory

    2012-04-11

    The Los Alamos Neutron Science Center - Risk Mitigation Project is in the process of replacing older Coupled-Cavity-Linac (CCL) Beam-Position Monitors (BPMs) with newer Beam Position and Phase Monitors (BPPMs) and their associated electronics and cable plants. In many locations, these older BPMs include a separate Delta-T loop for measuring the beam's central phase and energy. Thirty-one BPPMs have been installed and many have monitored the charged particle beam. The installation of these newer BPPMs is the first step to installing complete BPPM measurement systems. Prior to the installation, a characterization of each BPPM took place. The characterization procedure includes a mechanical inspection, a vacuum testing, and associated electrical tests. The BPPM electrical tests for all four electrodes include contact resistance measurements, Time Domain Reflectometer (TDR) measurements, relative 201.25-MHz phase measurements, and finally a set of position-sensitive mapping measurements were performed which included associated fitting routines. This paper will show these data for a typical characterized BPPM.

  20. The National Criticality Experiments Research Center at the Device Assembly Facility, Nevada National Security Site: Status and Capabilities, Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    S. Bragg-Sitton; J. Bess; J. Werner

    2011-09-01

    The National Criticality Experiments Research Center (NCERC) was officially opened on August 29, 2011. Located within the Device Assembly Facility (DAF) at the Nevada National Security Site (NNSS), the NCERC has become a consolidation facility within the United States for critical configuration testing, particularly those involving highly enriched uranium (HEU). The DAF is a Department of Energy (DOE) owned facility that is operated by the National Nuclear Security Agency/Nevada Site Office (NNSA/NSO). User laboratories include the Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL). Personnel bring their home lab qualifications and procedures with them to the DAF, such that non-site specific training need not be repeated to conduct work at DAF. The NNSS Management and Operating contractor is National Security Technologies, LLC (NSTec) and the NNSS Safeguards and Security contractor is Wackenhut Services. The complete report provides an overview and status of the available laboratories and test bays at NCERC, available test materials and test support configurations, and test requirements and limitations for performing sub-critical and critical tests. The current summary provides a brief summary of the facility status and the method by which experiments may be introduced to NCERC.

  1. Distance to the Center of the Milky Way Galaxy: An Experiment for Intermediate-Level Students Using Research Data and Professional Analysis Tools

    Science.gov (United States)

    Fitzgerald, M. T.; Feteris, S. M.; Gillessen, S.; Eisenhauer, F.

    2008-01-01

    The most recent data on stars orbiting Sagittarius A*, the black hole at the center of the Milky Way galaxy, have been used in an experiment undertaken by second-year university students to determine the distance R[theta] to the center of the galaxy. Students applied each of Kepler's 17th-century laws, in turn, to 21st-century data. The…

  2. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak

    2015-02-01

    Full Text Available Purpose. The effect of patient centered medical home (PCMH curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents.Methods. Twenty four (24 Internal Medicine residents—12 Traditional (TR track residents and 12 Teaching Health Center (THC track residents—began training in Academic Year (AY 2011 at the Wright Center for Graduate Medical Education (WCGME. They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents.Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance.Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  3. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

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    Silviu Grisaru

    2011-01-01

    Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

  4. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2014-01-01

    Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

  5. Recent Experiences of the NASA Engineering and Safety Center (NESC) GN and C Technical Discipline Team (TDT)

    Science.gov (United States)

    Dennehy, Cornelius J.

    2010-01-01

    The NASA Engineering and Safety Center (NESC), initially formed in 2003, is an independently funded NASA Program whose dedicated team of technical experts provides objective engineering and safety assessments of critical, high risk projects. The GN&C Technical Discipline Team (TDT) is one of fifteen such discipline-focused teams within the NESC organization. The TDT membership is composed of GN&C specialists from across NASA and its partner organizations in other government agencies, industry, national laboratories, and universities. This paper will briefly define the vision, mission, and purpose of the NESC organization. The role of the GN&C TDT will then be described in detail along with an overview of how this team operates and engages in its objective engineering and safety assessments of critical NASA projects. This paper will then describe selected recent experiences, over the period 2007 to present, of the GN&C TDT in which they directly performed or supported a wide variety of NESC assessments and consultations.

  6. Experiences at Langley Research Center in the application of optimization techniques to helicopter airframes for vibration reduction

    Science.gov (United States)

    Murthy, T. Sreekanta; Kvaternik, Raymond G.

    1991-01-01

    A NASA/industry rotorcraft structural dynamics program known as Design Analysis Methods for VIBrationS (DAMVIBS) was initiated at Langley Research Center in 1984 with the objective of establishing the technology base needed by the industry for developing an advanced finite-element-based vibrations design analysis capability for airframe structures. As a part of the in-house activities contributing to that program, a study was undertaken to investigate the use of formal, nonlinear programming-based, numerical optimization techniques for airframe vibrations design work. Considerable progress has been made in connection with that study since its inception in 1985. This paper presents a unified summary of the experiences and results of that study. The formulation and solution of airframe optimization problems are discussed. Particular attention is given to describing the implementation of a new computational procedure based on MSC/NASTRAN and CONstrained function MINimization (CONMIN) in a computer program system called DYNOPT for the optimization of airframes subject to strength, frequency, dynamic response, and fatigue constraints. The results from the application of the DYNOPT program to the Bell AH-1G helicopter are presented and discussed.

  7. CMS Software Distribution and Installation Systems:Concepts,Practical Solutions and Experience at Fermilab as a CMS Tier 1 Center

    Institute of Scientific and Technical Information of China (English)

    NataliaM.Ratnikova; GregoryE.Graham

    2001-01-01

    The CMS Collaboration of 2000 scientists involves 150 institutions from 31 nations spread all over the world.CMS software system integration and release management is performed at CERN.Code management is based on CVS,with read or write access to the repository via a CVS server,Software configuration,release management tools(SCRAM) are being developed at CERN.Software releases are then distributed to regional centers,where the software is used by a local community for a wide variety of tasks,such as software development detector simulation and reconstruction and physics analysis.Depending on specific application,the system environment and local hardware requirements,different approaches and tools are used for the CMS software installation at different places.This presentation describes concepts and reactial solutions for a variety of ways of software distribution,with an emphasis on the CMS experience at Fermilab,Installation and usage of different models used for the production farm,for code development and for physics analysis are described.

  8. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  9. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    Energy Technology Data Exchange (ETDEWEB)

    Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E [Surgical Center-Neurophysiology Division of Medical Tecnology Department, Garrahan Children' s Hospital, Combate de los Pozos 1881, Buenos Aires (Argentina)

    2007-11-15

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.

  10. Demystifying the Chemistry Literature: Building Information Literacy in First-Year Chemistry Students through Student-Centered Learning and Experiment Design

    Science.gov (United States)

    Bruehl, Margaret; Pan, Denise; Ferrer-Vinent, Ignacio J.

    2015-01-01

    This paper describes curriculum modules developed for first-year general chemistry laboratory courses that use scientific literature and creative experiment design to build information literacy in a student-centered learning environment. Two curriculum units are discussed: Exploring Scientific Literature and Design Your Own General Chemistry…

  11. The impact of center experience on results of reduced intensity:allogeneic hematopoietic SCT for AML. An analysis from the Acute Leukemia Working Party of the EBMT

    DEFF Research Database (Denmark)

    Giebel, S; Labopin, M; Mohty, M

    2013-01-01

    Allogeneic hematopoietic SCT with reduced-intensity conditioning (RIC-HSCT) is increasingly adopted for the treatment of older adults with AML. Our goal was to verify for the first time, if center experience influences outcome of RIC-HSCT. Results of 1413 transplantations from HLA-matched related...

  12. The impact of center experience on results of reduced intensity : allogeneic hematopoietic SCT for AML. An analysis from the Acute Leukemia Working Party of the EBMT

    NARCIS (Netherlands)

    Giebel, S.; Labopin, M.; Mohty, M.; Mufti, G. J.; Niederwieser, D.; Cornelissen, J. J.; Janssen, J. J. W. M.; Milpied, N.; Vindelov, L.; Petersen, E.; Arnold, R.; Bacigalupo, A.; Blaise, D.; Craddock, C.; Nagler, A.; Frassoni, F.; Sadus-Wojciechowska, M.; Rocha, V.

    2013-01-01

    Allogeneic hematopoietic SCT with reduced-intensity conditioning (RIC-HSCT) is increasingly adopted for the treatment of older adults with AML. Our goal was to verify for the first time, if center experience influences outcome of RIC-HSCT. Results of 1413 transplantations from HLA-matched related or

  13. Sofosbuvir and Simeprevir Combination Therapy for HCV Genotype 1 Infection: Results of a Single-Center VA Experience.

    Science.gov (United States)

    Sclair, Seth N; Hernandez, Maria Del Pilar; Vance, Evan; Gilinski, Dani; Youtseff, Helen; Toro, Maribel; Antoine, Marie; Jeffers, Lennox J; Peyton, Adam

    2016-08-01

    Treatment of chronic hepatitis C virus (HCV) infection remains a priority in the veterans affairs (VA) health care system nationwide, as there is a high burden of liver disease due to HCV infection among US veterans. The combination of sofosbuvir and simeprevir was the first all-oral antiviral regimen used in clinical practice to treat veterans with HCV infection. In this study, we report a single-center experience showing both the feasibility and effectiveness of this all-oral combination to treat HCV genotype 1 infection. One hundred patients with HCV genotype 1 infection were treated between December 2013 and June 2014. Eighty-six patients were treated with sofosbuvir and simeprevir, with or without ribavirin, for 12 weeks; 12 patients were treated with sofosbuvir, pegylated interferon, and ribavirin for 12 weeks; and 2 patients were treated with sofosbuvir and ribavirin for 24 weeks. Overall, treatment was well tolerated and feasible, with compliance rates over 95% in patients treated with all-oral therapy. The sustained virologic response (SVR) rate for sofosbuvir and simeprevir (88.4%) was superior to the rate for sofosbuvir, pegylated interferon, and ribavirin (50.0%). Subgroup analysis showed diminished SVR rates in cirrhotic patients vs noncirrhotic patients. There were no significant differences in SVR when comparing treatment with or without ribavirin or among genotype subtypes. In conclusion, this study demonstrated excellent completion rates for all-oral treatment of veterans with chronic HCV infection. Additionally, treatment was highly effective, nearing a 90% cure rate. Thus, we recommend that the VA health care system continue to incorporate new HCV medications into its formulary so as to expand HCV treatment for US veterans.

  14. The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience.

    Science.gov (United States)

    Ros-Ruiz, Silvia; Alonso-Esteve, Ángela; Gutiérrez-Vílchez, Elena; Rudas-Bermúdez, Edisson; Hernández, Domingo

    2016-01-01

    Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. Furthermore, a good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion by nephrologists compared to surgeons on early catheter complications and on technique survival. We also examine whether PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. We performed 313 consecutive procedures: 192 catheter insertions and 121 catheter removal from January 1, 2006 to December 31, 2013. The main reasons for catheter removal were: renal transplantation, 52 (43%) follow of transfer to HD, 48 (40%) and catheter malfunction, 16 (13%). The patients were mostly male (63.4%) with the mean age of 50.8±15.1 years and 23.8 were diabetics. We only observed seven (2.5%) early complications (<4 weeks) associated to peritoneal catheter surgery (3 peritonitis episodes, 2 hemoperitoneum episodes, one complicated hernia and one omental entrapment). There were not significant differences in surgery-related complications in both periods. The penetration ratio of PD after 2006 was 117% higher compared with procedures performing before this date. In conclusions, we have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists with a minimal incidence of complications associated.

  15. 9/11-Related Experiences and Tasks of Landfill and Barge Workers: Qualitative Analysis from the World Trade Center Health Registry

    Directory of Open Access Journals (Sweden)

    Cone James E

    2011-05-01

    Full Text Available Abstract Background Few studies have documented the experiences of individuals who participated in the recovery and cleanup efforts at the World Trade Center Recovery Operation at Fresh Kills Landfill, on debris loading piers, and on transport barges after the September 11, 2001 terrorist attack. Methods Semi-structured telephone interviews were conducted with a purposive sample of workers and volunteers from the World Trade Center Health Registry. Qualitative methods were used to analyze the narratives. Results Twenty workers and volunteers were interviewed. They described the transport of debris to the Landfill via barges, the tasks and responsibilities associated with their post-9/11 work at the Landfill, and their reflections on their post-9/11 experiences. Tasks included sorting through debris, recovering human remains, searching for evidence from the terrorist attacks, and providing food and counseling services. Exposures mentioned included dust, fumes, and odors. Eight years after the World Trade Center disaster, workers expressed frustration about poor risk communication during recovery and cleanup work. Though proud of their contributions in the months after 9/11, some participants were concerned about long-term health outcomes. Conclusions This qualitative study provided unique insight into the experiences, exposures, and concerns of understudied groups of 9/11 recovery and cleanup workers. The findings are being used to inform the development of subsequent World Trade Center Health Registry exposure and health assessments.

  16. O doador marginal: experiência de um centro de transplante de fígado The marginal donor: a single-center experience in orthotopic liver transplantation

    Directory of Open Access Journals (Sweden)

    Olival Cirilo Lucena da Fonseca-Neto

    2008-03-01

    Full Text Available RACIONAL: Desde que o uso de enxertos marginais é solução aceita para escassez de órgãos para transplante, ele tornou-se muito comum em todo mundo e a literatura vem mostrando efetividade desses enxertos no transplante de fígado. OBJETIVO: Apresentar a experiência do Serviço de Transplante Hepático do Hospital Universitário Oswaldo Cruz, em transplante de fígado com o uso de doadores marginais. MÉTODOS: Estudo retrospectivo em 137 transplantes ortotópicos de fígado, usando enxertos marginais entre 1999 e 2006, com acompanhamento mínimo de 180 dias. Os receptores foram classificados de acordo com a função inicial do enxerto no pós-operatório como normal (FN e disfunção primária (DP. RESULTADOS: Não foi observada diferença estatisticamente significante entre os grupos FN e DP com os seguintes parâmetros dos doadores: idade, sódio sérico, tempo de protrombina, esteatose hepática, transaminases sérica, pressão sanguínea, drogas vasoativas, índice de massa corpórea, parada cardíaca antes da doação de órgão, doador em assistolia e tempo de isquemia quente. Análise da curva de sobrevida (Kaplan-Meier de pacientes e de enxertos de fígado de pacientes que receberam fígado de doadores ideais versus doadores marginais não mostrou diferença com significância estatística. CONCLUSÃO: Pode ser recomendado o uso de enxertos marginais para transplantes hepáticos, inclusive os provenientes de doadores com o coração parado.BACKGROUND: Since marginal grafts are a solution to deal with the shortage of organ donors, its use became more common worldwide, and the literature had shown its effectiveness in the liver transplantation (LT outcomes. AIM: To present a single center experience, at the Liver Transplantation Unit of Oswaldo Cruz University Hospital, with orthotopic LT using marginal organ donors. METHODS: Retrospectivety review of 137 orthotopic LT using marginal grafts between 1999 and 2006, with a minimum 180

  17. Research experiments planned for the Integrated Solar Energy Heating/Cooling System for the proposed new Physical Science Education Center in Richmond, Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Iachetta, F.A.

    1976-06-01

    A review of the Integrated Solar Energy Heating and Cooling system for the New Physical Science Education Center in Richmond is provided and several potential experiments were developed for possible inclusion in the design. The evaluation of the system performance includes instrumentation for the (A) collector subsystem, (B) heating mode, (C) cooling mode (adsorption chiller, centrifugal chiller), and (D) the storage system. Research experiments dealing with experimental collectors, stratification in thermal storage tanks, insolation/material life studies, and corrosion studies are included. Separate abstracts were prepared for three papers in this report.

  18. The identification, characterization and optimization of small molecule probes of cysteine proteases: experiences of the Penn Center for Molecular Discovery with cathepsin B and cathepsin L.

    Science.gov (United States)

    Huryn, Donna M; Smith, Amos B

    2009-01-01

    During the pilot phase of the NIH Molecular Library Screening Network, the Penn Center for Molecular Discovery focused on a series of projects aimed at high throughput screening and the development of probes of a variety of protease targets. This review provides our medicinal chemistry experience with two such targets--cathepsin B and cathepsin L. We describe our approach for hit validation, characterization and triage that led to a critical understanding of the nature of hits from the cathepsin B project. In addition, we detail our experience at hit identification and optimization that led to the development of a novel thiocarbazate probe of cathepsin L.

  19. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    OpenAIRE

    Sills Eric; Hancock John S; Pope Karla

    2006-01-01

    Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and ...

  20. Outpatient management of intra-corporeal left ventricular assist device system in children: a multi-center experience.

    Science.gov (United States)

    Schweiger, M; Vanderpluym, C; Jeewa, A; Canter, C E; Jansz, P; Parrino, P E; Miera, O; Schmitto, J; Mehegan, M; Adachi, I; Hübler, M; Zimpfer, D

    2015-02-01

    Little is known about the outcomes of children supported on intracorporeal left ventricular assist device (HVAD), and the feasibility of outpatient management. All centers with pediatric patients discharged from the hospital on the device were identified using company database. A total of 14 centers were contacted, with 9 centers, contributing data retrospectively. From 2011 to 2013, 12 pediatric patients (7 females), mean aged 11.9 ± 2.3 years (range 8-15), mean weight 43 ± 19 kg (range 18-81), mean body surface area 1.3 ± 0.3 m(2) (range 0.76-1.96) were identified. Diagnosis included: dilated cardiomyopathy (CMP) (n = 5), noncompaction CMP (n = 4), toxic CMP (n = 2) and viral CMP (n = 1). Indications for support were permanent support (n = 1), bridge to recovery (n = 1) and bridge to transplantation (n = 10). Prior to HVAD implantation, all patients received intravenous inotropes and two patients were on temporary mechanical support. Overall mortality was 0%. Mean duration of inpatient and outpatient support were 56 (range: 19-95 days) and 290 days (range: 42-790), respectively. Mean readmission rate was 0.02 per patient month (2.1 per patient). No adverse events involving emergency department occurred. Eight children resumed local schooling. Home discharge of children supported on HVAD is feasible and safe. School integration can be achieved. There is wide center variability to discharge practice for children.

  1. National Rehabilitation Information Center

    Science.gov (United States)

    ... including News and Notes) Welcome to the National Rehabilitation Information Center! We are conducting improvements to the ... experience. We apologize for any inconvenience The National Rehabilitation Information Center ( NARIC ) is the library of the ...

  2. Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Bimal Patel

    2015-01-01

    Full Text Available Background: Primary central nervous system lymphomas (PCNSL constitute a rare group of extranodal non-Hodgkin′s lymphomas (NHLs. Aim: To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. Materials and Methods: This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Inclusion criteria: Cases of PCNSL involving brain. Exclusion criteria: Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. Results: There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years and with a male predominance (male: female (M:F = 2.3:1. Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL, two with a Burkitt′s lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51 of cases. Germinal center B-cell (GCB phenotype was seen in 18/51 cases (34.3%. Conclusion: DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are

  3. Klystron Modulator Design for the Los Alamos Neutron Science Center Accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Reass, William A. [Los Alamos National Laboratory; Baca, David M. [Los Alamos National Laboratory; Partridge, Edward R. [retired; Rees, Daniel E. [Los Alamos National Laboratory

    2012-06-22

    This paper will describe the design of the 44 modulator systems that will be installed to upgrade the Los Alamos Neutron Science Center (LANSCE) accelerator RF system. The klystrons can operate up to 86 kV with a nominal 32 Amp beam current with a 120 Hz repetition rate and 15% duty cycle. The klystrons are a mod-anode design. The modulator is designed with analog feedback control to ensure the klystron beam current is flat-top regulated. To achieve fast switching while maintaining linear feedback control, a grid-clamp, totem-pole modulator configuration is used with an 'on' deck and an 'off' deck. The on and off deck modulators are of identical design and utilize a cascode connected planar triode, cathode driven with a high speed MOSFET. The derived feedback is connected to the planar triode grid to enable the flat-top control. Although modern design approaches suggest solid state designs may be considered, the planar triode (Eimac Y-847B) is very cost effective, is easy to integrate with the existing hardware, and provides a simplified linear feedback control mechanism. The design is very compact and fault tolerant. This paper will review the complete electrical design, operational performance, and system characterization as applied to the LANSCE installation.

  4. Role of water quality assessments in hospital infection control: Experience from a new oncology center in eastern India

    Directory of Open Access Journals (Sweden)

    Ramkrishna Bhalchandra

    2014-01-01

    Full Text Available Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.

  5. [New perspective in liaison psychiatry. Experience at the Pediatric Hospital of the National Medical Center Siglo XXI].

    Science.gov (United States)

    Sauceda García, J M; Maldonado Durán, J M; Angel Montoya Cabrera, M

    1994-01-01

    In hospitalized and chronically ill children, the prevalence of psychopathology is very high. It is necessary that in its prevention, diagnosis and treatment not only professionals of the mental health disciplines intervene but also that the pediatricians, nurses and the family of the patient himself participate actively. Consultation Liaison Child Psychiatry activities at the Pediatric Hospital of the National Medical Center "Siglo XXI" are described. Its goal is to incorporate the mental health professional to the team of hospital care and promote that pediatricians gain a greater conscience of psychological and social factors that are crucial for the sick child.

  6. An 800-MeV proton radiography facility for dynamic experiments

    Energy Technology Data Exchange (ETDEWEB)

    King, N.S.P.; Adams, K.; Alrick, K.R.; Crow, M.L.; Cushing, S.B.; Eddleman, J.C.; Fife, T.T.; Gallegos, R.A.; Gray, N.T.; Hogan, G.E.; Holmes, V.H.; Knudsson, J.N.; London, R.K.; Lopez, R.R.; McDonald, T.E.; McClelland, J.B.; Merrill, F.E.; Morley, K.B.; Morris, C.L.; Naivar, F.J.; Pazuchanics, P.D.; Pillai, C.; Riedel, C.M.; Sarracino, J.S.; Shelley, F.E. Jr.; Stacy, H.L.; Takala, B.E.; Tucker, H.E.; Yates, G.J.; Ziock, H.-J.; Zumbro, J.D. [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Ables, E. [Livermore National Laboratory, Livermore, CA 94550 (United States); Balzar, Stephen [Bechtel Nevada, Los Alamos, NM 87545 (United States); Barnes, P.D. Jr. [Livermore National Laboratory, Livermore, CA 94550 (United States); Flores, Paul [Bechtel Nevada, Los Alamos, NM 87545 (United States); Fujino, D. [Livermore National Laboratory, Livermore, CA 94550 (United States); Hartouni, E.P. [Livermore National Laboratory, Livermore, CA 94550 (United States); Jaramillo, S.A. [Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Parker, E.L. [Livermore National Laboratory, Livermore, CA 94550 (United States); Park, H.S. [Livermore National Laboratory, Livermore, CA 94550 (United States); Thompson, Richard [Bechtel Nevada, Los Alamos, NM 87545 (United States)

    1999-11-03

    The capability has successfully been developed at the Los Alamos Nuclear Science Center (LANSCE) to utilize a spatially and temporally prepared 800 MeV proton beam to produce proton radiographs. A series of proton bursts are transmitted through a dynamic object and transported, via a unique magnetic lens system, to an image plane. The magnetic lens system permits correcting for the effects of multiple coulomb scattering which would otherwise completely blur the spatially transmitted information at the image plane. The proton radiographs are recorded either on a time integrating film plate or with a recently developed multi-frame electronic imaging camera system. The latter technique permits obtaining a time dependent series of proton radiographs with time intervals (modulo 358 ns) up to many microseconds and variable time intervals between images. One electronically shuttered, intensified, CCD camera is required per image. These cameras can detect single protons interacting with a scintillating fiber optic array in the image plane but also have a dynamic range which permits recording radiographs with better than 5% statistics for observation of detailed density variations in the object. A number of tests have been carried out to characterize the quality of the proton radiography system for absolute mass determination, resolution, and dynamic range. Initial dynamic experiments characterized the temporal and spatial behavior of shock propagation in a high explosive sample with up to six images per experiment. Based on experience with the prototype system, a number of upgrades are being implemented including the anticipated capability for enhanced mass discrimination through differential multiple coulomb scattering radiographs and more images with improved imaging techniques.

  7. An 800-MeV proton radiography facility for dynamic experiments

    Science.gov (United States)

    King, N. S. P.; Ables, E.; Adams, Ken; Alrick, K. R.; Amann, J. F.; Balzar, Stephen; Barnes, P. D., Jr.; Crow, M. L.; Cushing, S. B.; Eddleman, J. C.; Fife, T. T.; Flores, Paul; Fujino, D.; Gallegos, R. A.; Gray, N. T.; Hartouni, E. P.; Hogan, G. E.; Holmes, V. H.; Jaramillo, S. A.; Knudsson, J. N.; London, R. K.; Lopez, R. R.; McDonald, T. E.; McClelland, J. B.; Merrill, F. E.; Morley, K. B.; Morris, C. L.; Naivar, F. J.; Parker, E. L.; Park, H. S.; Pazuchanics, P. D.; Pillai, C.; Riedel, C. M.; Sarracino, J. S.; Shelley, F. E., Jr.; Stacy, H. L.; Takala, B. E.; Thompson, Richard; Tucker, H. E.; Yates, G. J.; Ziock, H.-J.; Zumbro, J. D.

    1999-11-01

    The capability has successfully been developed at the Los Alamos Nuclear Science Center (LANSCE) to utilize a spatially and temporally prepared 800 MeV proton beam to produce proton radiographs. A series of proton bursts are transmitted through a dynamic object and transported, via a unique magnetic lens system, to an image plane. The magnetic lens system permits correcting for the effects of multiple coulomb scattering which would otherwise completely blur the spatially transmitted information at the image plane. The proton radiographs are recorded either on a time integrating film plate or with a recently developed multi-frame electronic imaging camera system. The latter technique permits obtaining a time dependent series of proton radiographs with time intervals (modulo 358 ns) up to many microseconds and variable time intervals between images. One electronically shuttered, intensified, CCD camera is required per image. These cameras can detect single protons interacting with a scintillating fiber optic array in the image plane but also have a dynamic range which permits recording radiographs with better than 5% statistics for observation of detailed density variations in the object. A number of tests have been carried out to characterize the quality of the proton radiography system for absolute mass determination, resolution, and dynamic range. Initial dynamic experiments characterized the temporal and spatial behavior of shock propagation in a high explosive sample with up to six images per experiment. Based on experience with the prototype system, a number of upgrades are being implemented including the anticipated capability for enhanced mass discrimination through differential multiple coulomb scattering radiographs and more images with improved imaging techniques.

  8. Farm machinery injuries: the 15-year experience at an urban joint trauma center system in a rural state.

    Science.gov (United States)

    Jawa, Randeep S; Young, David H; Stothert, Joseph C; Yetter, Diane; Dumond, Robbie; Shostrom, Valerie K; Cemaj, Samuel; Rautiainen, Risto H; Mercer, David W

    2013-01-01

    Farm machinery is a major source of injury. The objective of this study is to characterize the incidence, injury characteristics, and outcomes of patients admitted with farm machinery injuries (FMIs) to an urban joint trauma system in a rural state. A retrospective 15-year review of the trauma registries of the two trauma centers that function as a single state-designated Level I joint trauma center system was conducted. There were 65 admissions for FMIs at hospital A and 41 at hospital B; this represents under 0.4% of total trauma admissions. The patients ranged in age from 2 to 87 years. At hospital A, 89% of admitted patients sustained extremity injuries, 16% sustained torso trauma, 92% required surgical intervention, and the mortality rate was 0%. At hospital B, 60% of admitted patients sustained extremity injuries, 36.6% of patients sustained torso trauma, 63% required surgical intervention, and the mortality rate was 14.6%. Tractor-related injuries were responsible for 17% of admissions at hospital A and 69% at hospital B. Of the six fatalities, five were tractor related. The data demonstrate that FMIs affect people in nearly all decades of life. FMIs at the two hospitals had differing injury characteristics and outcomes, in large part secondary to the differing frequency of tractor-related injuries. FMIs frequently required surgical intervention.

  9. The McGill Pain Questionnaire in Amharic: Zwai Health Center patients' reports on the experience of pain.

    Science.gov (United States)

    Aboud, Frances E; Hiwot, Mismay G; Arega, Adefris; Molla, Mesfin; Samson, S; Seyoum, Nebyou; Ressom, Shewangizaw; Worku, Solomon; Mulatu, Mesfin; Egale, Tewedros

    2003-01-01

    This paper presents for the first time an Amharic translation of the McGill Pain Questionnaire developed by Melzack and used in many countries around the world. It allows for a quantitative and qualitative assessment of the intensity, location, and nature of experienced pain, as well as conditions that relieve pain. Data collected from one hundred patients attending the Zwai Health Center indicated that 81% reported pain at the time, one-quarter of whom were in severe pain. The most commonly chosen descriptors were: burning, stabbing, sore, gnawing, aching, and cramping. Descriptors were often associated with certain diagnoses: burning with gastrointestinal problems, stabbing with respiratory diseases, and gnawing or aching with myalgia/neuralgia. Approximately 40% of those in pain had previously sought relief from a clinic or pharmacy and were attending the center because the pain persisted. Analgesics were more likely to be prescribed for those in mild pain, while other medication without analgesics were prescribed for those in severe pain. The McGill Pain Questionnaire--Amharic (MPQ-Am) could be a useful tool for future studies of illness-specific pain, and of the effectiveness of pharmaceutical and non-pharmaceutical strategies for pain management.

  10. Low-cost semirigid ureteroscopy is effective for ureteral stones: Experience of a single high volume center

    Directory of Open Access Journals (Sweden)

    Roberto Giulianelli

    2014-06-01

    Full Text Available Aim of the study: To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments. Methods: We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%, 86 in the mid (13.06% and 368 (57.76% in the distal ureter. In 504 patients (76.5% ureterohydronephrosis (Grade II-III was observed. In 57 patients (8.6%, we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1% had more than one stone in their distal ureter and 96 (14.8% had a proximal ureteral stone treated in the same surgery as well. Results: The overall stone-free rate for ureteral stones was 86.1% (567/658. Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients, 84.8% (73/86 patients and 96.4% (355/368 patients, respectively. One hundred and twenty patients (18.3% required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74% and URS plus Retrograde Intra-Renal Surgery (RIRS in 23 patients (3.54%. The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%, erosions of urothelium leading to significant bleeding in 15 pts (2.27%, severe pain in 4 pts (0.6%, fever in 3 pts (0.45% and one case of ureteral avulsion (0.15%. Conclusions: This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the

  11. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.

    Directory of Open Access Journals (Sweden)

    Elysia Larson

    Full Text Available In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.3,003 women participated in the discrete choice experiment (93% response rate completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001, followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001 and modern medical equipment and drugs (β = 0.66 p<0.001. Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.

  12. Total-skin electron irradiation for cutaneous T-cell lymphoma: The Northern Israel Oncology Center experience

    Energy Technology Data Exchange (ETDEWEB)

    Kuten, A.; Stein, M.; Mandelzweig, Y.; Tatcher, M.; Yaacov, G.; Epelbaum, R.; Rosenblatt, E. (Northern Israel Oncology Center, Haifa (Israel). Radiotherapy Unit)

    1991-07-01

    Total skin electron irradiation (TSEI) is effective and frequently used in the treatment of cutaneous T-cell lymphoma. A treatment technique has been developed at our center, using the Philips SL 75/10 linear accelerator. In our method, the patient is irradiated in a recumbent position by five pairs of uncollimated electron beams at a source to skin distance of 150 cm. This method provides a practical solution to clinical requirements with respect to uniformity of electron dose and low X-ray contamination. Its implementation does not require special equipment or modification of the linear accelerator. 19 of 23 patients (83%) with mycosis fungoides, treated by this method, achieved complete regression of their cutaneous lesions. (orig.).

  13. The War on Poverty’s Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans†

    Science.gov (United States)

    Bailey, Martha J.; Goodman-Bacon, Andrew

    2015-01-01

    This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance. (JEL H75, I12, I13, I18, I32, I38, J14) PMID:25999599

  14. Intermediate photovoltaic system application experiment operational performance report. Volume 5 for Lovington Square Shopping Center, Lovington, NM

    Energy Technology Data Exchange (ETDEWEB)

    1981-12-01

    For the months of September and October, 1981, operational performance data are presented for a photovoltaic power system at a New Mexico shopping center. The electrical energy yield, incident solar energy, and efficiency of the solar cell array are given, including daily and monthly energy yield and insolation and efficiency, and energy yield as a function of power level, voltage, cell temperature, and hour of the day. Data are presented for two power conditioning units, including power conditioner input, output, and efficiency. The total photovoltaic system efficiency and capacity factor are given as well as daily availability data. Meteorological data include monthly insolation data, heating and cooling degree days, average monthly ambient temperature, monthly average wind speed and distribution of wind directions. Also included are plots of cell temperature, ambient temperature, wind speed, and insolation versus the hour of the day. Also included is a brief narrative description of the system operation and data. (LEW)

  15. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo.

    Directory of Open Access Journals (Sweden)

    Zaim Gashi

    2011-06-01

    Full Text Available Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Intera trial septal anomalies were detected in around 85% of the examined patients.

  16. Training Consumer Educators: A Curriculum and Program Handbook. A Report on the Experience of the Consumer Law Training Center.

    Science.gov (United States)

    New York Law School, NY. Consumer Law Training Center.

    Information is presented on the administration of consumer education programs to train teachers and community group leaders who will be teaching consumer education in their own communities. Suggestions and examples are based on experience in creating and teaching such a program in consumer law in New York City. The first three chapters give…

  17. Technical Failure of MR Elastography Examinations of the Liver: Experience from a Large Single-Center Study.

    Science.gov (United States)

    Wagner, Mathilde; Corcuera-Solano, Idoia; Lo, Grace; Esses, Steven; Liao, Joseph; Besa, Cecilia; Chen, Nelson; Abraham, Ginu; Fung, Maggie; Babb, James S; Ehman, Richard L; Taouli, Bachir

    2017-01-03

    Purpose To assess the determinants of technical failure of magnetic resonance (MR) elastography of the liver in a large single-center study. Materials and Methods This retrospective study was approved by the institutional review board. Seven hundred eighty-one MR elastography examinations performed in 691 consecutive patients (mean age, 58 years; male patients, 434 [62.8%]) in a single center between June 2013 and August 2014 were retrospectively evaluated. MR elastography was performed at 3.0 T (n = 443) or 1.5 T (n = 338) by using a gradient-recalled-echo pulse sequence. MR elastography and anatomic image analysis were performed by two observers. Additional observers measured liver T2* and fat fraction. Technical failure was defined as no pixel value with a confidence index higher than 95% and/or no apparent shear waves imaged. Logistic regression analysis was performed to assess potential predictive factors of technical failure of MR elastography. Results The technical failure rate of MR elastography at 1.5 T was 3.5% (12 of 338), while it was higher, 15.3% (68 of 443), at 3.0 T. On the basis of univariate analysis, body mass index, liver iron deposition, massive ascites, use of 3.0 T, presence of cirrhosis, and alcoholic liver disease were all significantly associated with failure of MR elastography (P technical failure rate of MR elastography with a gradient-recalled-echo pulse sequence was low at 1.5 T but substantially higher at 3.0 T. Massive ascites, iron deposition, and high body mass index were additional independent factors associated with failure of MR elastography of the liver with a two-dimensional gradient-recalled-echo pulse sequence. (©) RSNA, 2017.

  18. Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

    Science.gov (United States)

    Santamaria, Eric; de la Concha, Erika

    2016-10-01

    Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible.

  19. GEANT simulations of neutron capture experiments with a 4p BaF2 detector

    CERN Document Server

    Heil, M; Kaeppeler, F; Wisshak, K; Voss, F; Ullmann, J L; Haight, R C; Seabury, E H; Wilhelmy, J B; Rundberg, R S; Fowler, M M

    2004-01-01

    The goal of this research project is to give quantitative information useful for the design of a g-ray detector to investigate neutron capture (n, g) reactions on radioactive nuclei at the Manuel Lujan Jr. Neutron Scattering Center (MLNSC) moderated neutron source at LANSCE. Data for neutron energies from thermal up to approximately 500 keV are desired. The radioactive nuclei can have half-lives as short as a few months. With the sample sizes foreseen, typically 1 mg, the radioactive decay rate can exceed tens of Curies (Ci).

  20. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Sedighe Moradi

    2016-01-01

    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  1. Measurement of the 238U neutron-capture cross section and gamma-emission spectra from 10 eV to 100 keV using the DANCE detector at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Ullmann, John L [Los Alamos National Laboratory; Couture, A J [Los Alamos National Laboratory; Keksis, A L [Los Alamos National Laboratory; Vieira, D J [Los Alamos National Laboratory; O' Donnell, J M [Los Alamos National Laboratory; Jandel, M [Los Alamos National Laboratory; Haight, R C [Los Alamos National Laboratory; Rundberg, R S [Los Alamos National Laboratory; Kawano, T [Los Alamos National Laboratory; Chyzh, A [NORTH CAROLINA STATE UNIV; Baramsai, B [NORTH CAROLINA STATE UNIV; Wu, C Y [LLNL; Mitchell, G E [NORTH CAROLINA STATE UNIV; Becker, J A [LLNL; Krticka, M [CHARLES UNIV

    2010-01-01

    A careful new measurement of the {sup 238}U(n,{gamma}) cross section from 10 eV to 100 keV has been made using the DANCE detector at LANSCE. DANCE is a 4{pi} calorimetric scintillator array consisting of 160 BaF{sub 2} crystals. Measurements were made on a 48 mg/cm{sup 2} depleted uranium target. The cross sections are in general good agreement with previous measurements. The gamma-ray emission spectra, as a function of gamma multiplicity, were also measured and compared to model calculations.

  2. Centers for permanent healthcare education: an analysis on the experience of social players in the north of the state of Paraná¹

    Directory of Open Access Journals (Sweden)

    Sônia Cristina Stefano Nicoletto

    2010-01-01

    Full Text Available The policy of continuing healthcare education (CHE aims to develop healthcare workers. With the objective of analyzing the process of implementing and developing the policy in Paraná, a qualitative study involving the six regions of this state is being concluded. This paper relates to the results from the northern region, focusing on the "experiencing CHE" category. In December 2006, two focus groups were conducted involving representatives from management, training, attendance and participation. The data underwent thematic content analysis. The first CHE encounters aroused feelings of mistrust and resistance, and the center was understood as a means of enabling courses and funding sources. There was a diversity of interests and little negotiating capacity. During the process, the study participants began to talk, reflect and participate. Their teamwork was a positive experience. This experience allowed them to recognize the power of CHE for linking and mobilizing different players.

  3. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.

  4. Liquid Metal Processing and Casting Experiences at the U.S. Department of Energy's Albany Research Center

    Energy Technology Data Exchange (ETDEWEB)

    Jablonski, Paul D.; Turner, Paul C.

    2005-09-01

    In this paper we will discuss some of the early pioneering work as well as some of our more recent research. The Albany Research Center (ARC) has been involved with the melting and processing of metals since it was established in 1942. In the early days, hardly anything was known about melting refractory or reactive metals and as such, virtually everything had to be developed in-house. Besides the more common induction heated air-melt furnaces, ARC has built and/or utilized a wide variety of furnaces including vacuum arc remelt ingot and casting furnaces, cold wall induction furnaces, electric arc furnaces, cupola furnaces and reverberatory furnaces. The melt size of these furnaces range from several grams to a ton or more. We have used these furnaces to formulate custom alloys for wrought applications as well as for such casting techniques as spin casting, investment casting and lost foam casting among many. Two early spin-off industrializations were Wah Chang (wrought zirconium alloys for military and commercial nuclear applications) and Oremet (both wrought and cast Ti). Both of these companies are now part of the ATI Allegheny Ludlum Corporation.

  5. Percutaneous closure of atrial septal defects without balloon sizing in adults: Experience of a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Hasan Kaya

    2013-03-01

    Full Text Available Objective: We aimed to evaluate our clinical experienceand short-term results of percutaneous closure of secundumtype atrial septal defects (ASD in adults.Methods: We studied 71 patients (49 female, 22 male,mean age 35±14 years undergoing percutaneous closureof ASD between January 2010-October 2012 in ourclinic. All procedures were performed under sedoanalgesiawithout balloon sizing. Clinical characteristics of patients,properties of percutaneous closure intervention,complications and short-term results are evaluated.Results: Defect diameter measured by transesophagealechocardiographic examination was 19.8±6.4 mm. Devicesize used for percutaneous closure was 24.7±6.7mm. Procedure was successfully performed in 67 patients(94%. Four patients were referred for surgery because ofprocedural failure. During procedure, a patient developedtransient 2nd degree AV block, and another developeddevice thrombosis. Residual shunt was detected in threepatients at first day control echocardiographic examination.In the follow-up of 13±8 months, no residual shunt,embolic or arrhythmic complications were observed.Conclusion: Percutaneous closure of secundum ASD isa safe and effective method with high success and lowcomplication rates in experienced centers. J Clin Exp Invest2013; 4 (1: 67-72Key words: Secundum atrial septal defect, percutaneousclosure, sedoanalgesia, transesophageal echocardiography

  6. Donor safety in adult living donor liver transplantation using the right lobe:Single center experience in China

    Institute of Scientific and Technical Information of China (English)

    Fu-Gui Li; Lu-Nan Yan; Yong Zeng; Jia-Yin Yang; Qi-Yuan Lin; Xiao-Zhong Jiang; Bin Liu

    2007-01-01

    AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China.METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2±7.4years. Residual liver volume was 42.1%±4.7%. Mean operative time was 420±76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4±8.6 d; and mean follow-up period, 6 mo.RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2,and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required reoperation. Return to pre-donation activity occurred within 5-8 wk.CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

  7. Achievement of Therapeutic Goals with Low-Dose Imiglucerase in Gaucher Disease: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Irina Tukan

    2013-01-01

    Full Text Available Gaucher disease, a lysosomal storage disorder, is a multisystem disorder with variable and unpredictable onset and severity. Disease-specific enzyme replacement therapy (ERT has been shown to reverse or ameliorate disease-specific hepatosplenomegaly and anemia and thrombocytopenia. ERT also impacts bone manifestations, including bone crises, bone pain, and appearance of new osteonecrosis, and improves bone mineral density to varying degrees. The objective of this study was to assess achievement of predefined therapeutic goals based on international registry outcomes for Israeli patients with Gaucher disease receiving imiglucerase for four consecutive years on a low-dose regimen followed in a single center. All data were taken from patient files. The therapeutic goals were taken from standards published in the literature for disease-specific clinical parameters. Among 164 patients at baseline, values for spleen and liver volumes, hemoglobin and platelet counts, and Z-scores for lumbar spine and femoral were significantly different from the goal. After four years ERT, there was a significant improvement ( in each of the therapeutic goal parameters from baseline. 15.2% of these patients achieved all hematology-visceral goals. In children, there was achievement of linear growth and puberty. This survey highlights the good overall response in symptomatic patients receiving low-dose ERT with imiglucerase in Israel.

  8. Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center.

    Science.gov (United States)

    Kossakowski, Claudia A; Morresi-Hauf, Alicia; Schnabel, Philipp A; Eberhardt, Ralf; Herth, Felix J F; Warth, Arne

    2014-01-01

    Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction.

  9. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

    Directory of Open Access Journals (Sweden)

    Abdulkadir Yıldız

    2014-12-01

    Full Text Available Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV in the treatment of rheumatic mitral stenosis (MS in our clinic. Methods: We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38±11 years who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA >1.5 cm2 and absence of grade 3 mitral regurgitation. Results: We were able to perform PMBV in 48 of 53 patients (91% and all the procedures that were completed were successful. PMBV couldn’t be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 ± 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion: Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.

  10. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    Science.gov (United States)

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

  11. Background identification and suppression for the measurement of (n,g) reactions with the DANCE array at LANSCE

    CERN Document Server

    Reifarth, R; Alpizar-Vicente, A; Browne, J C; Esch, E -I; Greife, U; Haight, R C; Hatarik, R; Kronenberg, A; O'Donnell, J M; Rundberg, R S; Ullmann, J L; Vieira, D J; Wilhelmy, J B; Wouters, J M

    2013-01-01

    In the commissioning phase of the DANCE project (Detector for Advanced Neutron Capture Experiments) measurements have been performed with special emphasis on the identification and suppression of possible backgrounds for the planned (n,g) experiments. This report describes several background sources, observed in the experiment or anticipated from simulations, which will need to be suppressed in this and in similar detectors that are planned at other facilities. First successes are documented in the suppression of background from scattered neutrons captured in the detector as well as from the internal radiation. Experimental results and simulations using the GEANT code are compared.

  12. Background identification and suppression for the measurement of (n,{gamma}) reactions with the DANCE array at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Reifarth, R. E-mail: reifarth@lanl.gov; Bredeweg, T.A.; Alpizar-Vicente, A.; Browne, J.C.; Esch, E.-I.; Greife, U.; Haight, R.C.; Hatarik, R.; Kronenberg, A.; O' Donnell, J.M.; Rundberg, R.S.; Ullmann, J.L.; Vieira, D.J.; Wilhelmy, J.B.; Wouters, J.M

    2004-10-01

    In the commissioning phase of the DANCE project (Detector for Advanced Neutron Capture Experiments) measurements have been performed with special emphasis on the identification and suppression of possible backgrounds for the planned (n,{gamma}) experiments. This report describes several background sources, observed in the experiment or anticipated from simulations, which will need to be suppressed in this and in similar detectors that are planned at other facilities. First successes are documented in the suppression of background from scattered neutrons captured in the detector as well as from the internal radiation. Experimental results and simulations using the GEANT code are compared.

  13. Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

    Science.gov (United States)

    Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

    2008-01-01

    Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

  14. 电工电子实验教学示范中心建设探索%Exploration of Establishing Electrical and Electronic Experiment Center

    Institute of Scientific and Technical Information of China (English)

    郗艳华; 张辉; 王西明

    2013-01-01

    Students' practical ability and innovation ability can be promoted, the integration of resources sharing can be got, and school-running level and teaching quality can be enhanced by the construction of experimental teaching demonstration center. To improve power of professional applied talents training quality, exploration of the construction of electrical and electronic ex-perimental teaching demonstration center of ideas is provided by constructing the hierarchical experimental teaching system, opti-mizing experiment content, riching teaching methods and means, strengthening the construction of teaching staff and the experi-mental teaching platform construction.%实验教学示范中心建设能推动学生实践能力和创新能力培养,促进资源整合共享,提高学校办学水平和教学质量。该文提出了从构建实验教学平台,改革实验教学体系,优化实验教学方法和手段以及加强师资队伍建设等方面探索电工电子实验教学示范中心建设的思路,为提高电类专业应用型人才培养质量进行探讨。

  15. Three Experiments Examining the Use of Electroencephalogram,Event-Related Potentials, and Heart-Rate Variability for Real-Time Human-Centered Adaptive Automation Design

    Science.gov (United States)

    Prinzel, Lawrence J., III; Parasuraman, Raja; Freeman, Frederick G.; Scerbo, Mark W.; Mikulka, Peter J.; Pope, Alan T.

    2003-01-01

    Adaptive automation represents an advanced form of human-centered automation design. The approach to automation provides for real-time and model-based assessments of human-automation interaction, determines whether the human has entered into a hazardous state of awareness and then modulates the task environment to keep the operator in-the-loop , while maintaining an optimal state of task engagement and mental alertness. Because adaptive automation has not matured, numerous challenges remain, including what the criteria are, for determining when adaptive aiding and adaptive function allocation should take place. Human factors experts in the area have suggested a number of measures including the use of psychophysiology. This NASA Technical Paper reports on three experiments that examined the psychophysiological measures of event-related potentials, electroencephalogram, and heart-rate variability for real-time adaptive automation. The results of the experiments confirm the efficacy of these measures for use in both a developmental and operational role for adaptive automation design. The implications of these results and future directions for psychophysiology and human-centered automation design are discussed.

  16. Extranodal diffuse large B-cell lymphoma: Experience from a tertiary care oncology center in South India

    Directory of Open Access Journals (Sweden)

    K. C. Lakshmaiah

    2014-01-01

    Full Text Available Aims: Diffuse large B-cell lymphoma (DLBCL is the most common non-Hodgkin′s lymphoma (NHL with frequent extra nodal (EN presentation. The overall occurrence of lymphomas has been increasing; however, those of EN-NHL have been increasing much more rapidly. There is limited data found on EN-DLBCL in the Indian population and hence we carried out this retrospective observational study of primary EN-DLBCL at our center in Southern India. Materials and Methods: A total of 90 consecutive cases diagnosed as EN-DLBCL (according to the standard criteria by tissue biopsy confirmed by immunohistochemistry between 2007 and 2011 were included. Staging workup including computed tomography of neck, thorax and abdomen and pelvis, bone marrow aspiration and biopsy was done and International Prognostic Index (IPI calculated. Staging was according to Cotswold′s modification of Ann Arbor. The actuarial survival analysis was performed by Kaplan-Meier. Data were analyzed using the SPSS (version 16 statistical software. Results: The median age in this study was 49 years (18-88 with results showing EN-DLBCL to be 1.36 times more common in males. Advanced stages were seen in 15 subjects (16.6% and bulky disease in 13 subjects (14.4%. CD20 was positive in 89 (98.8% while 32 had high serum lactate dehydrogenase. According to the IPI most were low-risk-56 (66.6%. Overall response rate for the various combination chemotherapies was 85.7% with complete response in 62.3%. The overall survival range spanned from 2 to 123 months. Univariate analysis showed only bulky disease was associated with inferior survival. Conclusions: EN-DLBCL was present at an early age compared to nodal DLBCL, present more often in early stage and low IPI score. Chemoimmunotherapy with radiotherapy to the EN or bulky site is the standard treatment at present.

  17. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center.

    Science.gov (United States)

    Artenstein, Andrew W; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-10-01

    Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

  18. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

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    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  19. Radiological imaging features and clinicopathological correlation of hemosiderotic fibrolipomatous tumor: experience in a single tertiary cancer center

    Energy Technology Data Exchange (ETDEWEB)

    O' Driscoll, Dearbhail; Athanasian, Edward; Hameed, Meera; Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

    2015-05-01

    To determine the imaging features of hemosiderotic fibrolipomatous tumor (HFLT), which has a propensity towards local recurrence and the potential to transform into myxoinflammatory fibroblastic sarcoma (MIFS). The study included 8 patients with a diagnosis of HFLT and imaging at a tertiary cancer center. Imaging studies included radiographs (n = 2), ultrasound (n = 3), and MRI (n = 16). Imaging features were evaluated including location, calcification, sonographic echogenicity, vascular flow, size, border, signal characteristics, contrast enhancement, and blooming on MRI. The HFLT was located in the ankle/foot in 4 out of 8 and was subcutaneous in 8 out of 8, ranging in size from 2 to 18 cm. Histology at initial diagnosis was HFLT in 5 out of 8 and HFLT with MIFS in 3 out of 8. None was calcified on radiography. On ultrasound 2 out of 3 were heterogeneously echogenic with ≥10 foci of vascular flow. Two out of 8 patients had MRI only at local recurrence. The tumor border was infiltrative in 4 out of 6 at initial diagnosis and in 2 patients with MRI at recurrence only. Fat and septae were present in 7 out of 8 at initial diagnosis and at recurrence. Signal intensity was iso-/hypointense to muscle on T1-weighted sequences in more than two thirds of the tumor in 4 out of 7 and hyperintense to muscle in at least one third of the tumor on fluid-sensitive sequences in 6 out of 8. Contrast enhancement was heterogeneous in 7 out of 7; blooming in two thirds of the tumor on gradient-echo sequence MRI indicated hemorrhage. The HFLT commonly presents as a mass with an infiltrative border, interspersed fat and septations at initial diagnosis and local recurrence on MRI regardless of histology of HFLT alone or with MIFS. Hemosiderin deposits may be detected as blooming on gradient-echo sequences. (orig.)

  20. Quality Improvement in the National Cancer Institute Community Cancer Centers Program: The Quality Oncology Practice Initiative Experience

    Science.gov (United States)

    Siegel, Robert D.; Castro, Kathleen M.; Eisenstein, Jana; Stallings, Holley; Hegedus, Patricia D.; Bryant, Donna M.; Kadlubek, Pam J.; Clauser, Steven B.

    2015-01-01

    Purpose: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. Methods: A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. Results: QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). Conclusion: Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives. PMID:25538082

  1. Clinical utility of panfungal polymerase chain reaction for the diagnosis of invasive fungal disease: a single center experience.

    Science.gov (United States)

    Trubiano, J A; Dennison, A M; Morrissey, C O; Chua, K Y; Halliday, C L; Chen, S C-A; Spelman, D

    2016-02-01

    The role of panfungal polymerase chain reaction (PCR) assays for diagnosis of invasive fungal disease (IFD) is inadequately defined. We describe the use of an internal transcribed spacer 1 (ITS-1) region-directed panfungal PCR in this context at a tertiary referral transplant center. A retrospective review of patients at Alfred Health, Melbourne, Australia (2009-2014) who had clinical samples referred for panfungal PCR testing was conducted. Baseline patient characteristics, antifungal drug history, fungal culture/histopathology, and radiology results were recorded. For bronchoalveolar lavage (BAL) fluid samples, identification of a fungus other than a Candida spp. was defined as a potential pathogen.Of 138 panfungal PCR tests (108 patients), 41 (30%) were positive for a fungal product. Ninety-seven percent (134/138) of specimens were from immunocompromised hosts. Thirteen percent (19/138) of panfungal PCR positive results were for potential pathogens and potential pathogens were detected more frequently in tissue as compared with BAL (12/13 vs. 6/26; P = .0001). No positive panfungal PCR results were obtained from CSF specimens. If histopathology examination was negative, panfungal PCR identified a potential pathogen in only 12% (11/94) of specimens. For the 20 culture negative/histopathology positive specimens, diagnosis of IFD to causative species level by panfungal PCR occurred in 35% (6/20).Sterile site specimens, in particular tissue, were more frequently panfungal PCR positive for potential pathogens than BAL. The utility of panfungal PCR appears greatest in tissue specimens, as an adjunct to histopathology to improve diagnostic sensitivity and specificity. Based on the results of this study we are now only testing tissue specimens by panfungal PCR.

  2. The 17-year single-center experience with the use of azathioprine to maintain remission in ulcerative colitis.

    Science.gov (United States)

    Actis, Giovanni C; Fadda, Maurizio; Pellicano, Rinaldo; David, Ezio; Rizzetto, Mario; Sapino, Anna

    2009-06-01

    Despite the accumulation of positive data, the role of azathioprine (AZA) in the maintenance of remission of ulcerative colitis is still controversial. We looked at the follow-up of the ulcerative colitis patients who, after responding to either steroids or cyclosporin (CsA), received AZA at our referral center for over a decade. The 39 patients (29 m/10f) were treated between 1991 and 2007. Twenty-five of them had responded to CsA, the remaining 14 to corticosteroids. AZA was usually overlapped with either of the two agents at the initial dose of 2mg/kg/day. The definitions of remission, relapse, and AZA toxicity followed commonly agreed criteria. The median duration of the AZA treatment was 14 months (<1-201). Fifty-two percent and 14%, respectively, of the CsA and the steroid responders needed surgery (overall rate=38%). The figures were 32 and 15 at the first year. The majority of the patients had 1-2 relapses often in connection with withdrawal of AZA; only 3 of these relapsers needed hospitalization. AZA caused toxicity in 16/39 (41%) patients, requiring withdrawal in 23% of the cases; leukopenia (17%) and hepatitis/cholestasis (10%) ranked first and second for frequency. All of the patients in whom AZA was stopped (or reduced) relapsed. In conclusion, the 1-year colectomy rates compare favorably with the figures reported by the literature. By contrast, the toxicity rates were higher than expected. Failure to genotype or to use escalating AZA doses can only be hypothesized as causes.

  3. MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio; Schernthaner, Melanie; Pinker, Katja; Kapetas, Panagiotis; Bernathova, Maria; Polanec, Stephan H.; Bickel, Hubert; Wengert, Georg J.; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

    2016-11-15

    The purpose of this study was to compare three different biopsy devices on false-negative and underestimation rates in MR-guided, vacuum-assisted breast biopsy (VABB) of MRI-only lesions. This retrospective, single-center study was IRB-approved. Informed consent was waived. 467 consecutive patients underwent 487 MR-guided VABB using three different 8-10-gauge-VABB devices (Atec-9-gauge,A; Mammotome-8-gauge,M; Vacora-10-gauge,V). VABB data (lesion-type, size, biopsy device, histopathology) were compared to final diagnosis (surgery, n = 210 and follow-up, n = 277). Chi-square, and Kruskal-Wallis tests were applied. P values < 0.05 were considered significant. Final diagnosis was malignant in 104 (21.4 %), high risk in 64 (13.1 %) and benign in 319 (65.5 %) cases. Eleven of 328 (3.4 %) benign-rated lesions were false-negative (1/95, 1.1 %, A; 2/73, 2.7 %, M; 8/160 5.0 % V; P = 0.095). Eleven high-risk (11/77, 14.3 %) lesions proved to be malignant (3/26, 11.5 % A; 4/12, 33.3 % M; 4/39, 10.3 % V; P = 0.228). Five of 34 (14.7 %) DCIS were upgraded to invasive cancer (2/15, 13.3 %, A; 1/6, 16.6 % M; 2/13, 15.3 %, V; P = 0.977). Lesion size (P = 0.05) and type (mass vs. non-mass, P = 0.107) did not differ significantly. MR-guided VABB is an accurate method for diagnosis of MRI-only lesions. No significant differences on false-negative and underestimation rates were observed between three different biopsy devices. (orig.)

  4. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    Directory of Open Access Journals (Sweden)

    Sills Eric

    2006-03-01

    Full Text Available Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC in Harriman, Tennessee (pop. 6,757. Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI, heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups. Results Of RMC patients with myocardial infarction (MI, 94% received aspirin on arrival, a figure higher than both state (85% and national (91% averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98% than the state (74% or national (79% average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76% and national (75% average. RMC scored higher on 13 of 16 clinical process measures (p95% CI compared to state and national averages. Discussion Although acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures.

  5. Clinical characteristics of non-perianal fistulating Crohn's disease in China: a single-center experience of 184 cases

    Institute of Scientific and Technical Information of China (English)

    WANG Ge-fei; REN Jian-an; LIU Song; CHEN Jun; GU Guo-sheng; WANG Xin-bo; FAN Chao-gang; LI Jie-shou

    2012-01-01

    Background There is little information of non-perianal fistulating Crohn's disease in the consensus published by the European Crohn's and Colitis Organization in 2006 and 2010.This study was designed to demonstrate the clinical characteristics of non-perianal fistulating Crohn's disease among homogenous Chinese population.Methods One-hundred-and-eighty-four patients were retrospectively collected.All of these patients were diagnosed of Crohn's disease between February 2001 and April 2011.Results The male-to-female ratio was 2.7:1.The most common symptoms at onset were abdominal pain (88.0%),diarrhea (34.7%),and fever (28.3%).The most common disease location and behavior at diagnosis were small bowel (56.0%) and penetrating (51.6%).Among 324 non-perianal fistulae,the most common types were ileocolonic anastomotic (30.9%),terminal ileocutaneous (19.7%),and enteroenteric anastomotic (11.4%).One-hundred-and-thirty-eight (75.0%) patients received antibiotics,and β-lactam (85.5%) and metronidazole (67.4%) are most frequently used.One-hundred-and-seventy-eight (96.7%) patients suffered 514 surgical operations,and the cumulative surgical rates after 1,3,and 5 years were 38.0%,52.2%,and 58.7% respectively.Nine patients died during the follow-up period,and the cumulative survival rates after 1,3,and 5 years were 97.8%,96.7%,and 96.2% respectively.Conclusions This study displayed the clinical characteristics of non-perianal fistulating Crohn's disease in our center.Large population-based studies are required for further investigation in China.

  6. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

    Directory of Open Access Journals (Sweden)

    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  7. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

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    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  8. Presentation, Management, and Outcome of Thyroglossal Duct Cysts in Adult and Pediatric Populations: A 14-Year Single Center Experience

    Directory of Open Access Journals (Sweden)

    Hassan Al-Thani

    2016-07-01

    Full Text Available Objectives: A thyroglossal duct cyst (TDC is a frequent congenital midline anomaly of the neck that usually manifests during the first decade of life. We aimed to describe the presentation, management, and outcome of TDC in pediatric and adult cases. Methods: A retrospective observational analysis was conducted for all patients diagnosed and treated for TDC between 2000 and 2014 in a single center in Qatar. Data included patients’ demographics, presentations, preoperative investigations, anesthesia type, histopathological findings, surgical management, recurrences, and complications. Results: We identified 102 patients, of which 57% were males. The mean age of patients was 20.2±15.6 years. A bimodal distribution of TDC has been observed, which peaked between the ages of 6–13 years and at ≥19 years. The preoperative evaluation mainly includes ultrasonography (66%, thyroid function test (44%, and fine-needle aspiration cytology (10%. The median size of the cyst was 25 (2–60 mm. Patients mainly presented with an asymptomatic midline neck mass at or below the hyoid bone (82%, followed by fistula (9%, infection (2%, and dysphagia (2%. Eighty-nine cases were identified preoperatively as TDC. The histopathological findings confirmed TDC with hyoid bone in 61 cases, and TDC alone in 38 cases. Eighty patients underwent the Sistrunk procedure while excision of TDC alone was observed in 18 cases. Five cases of recurrent disease were also treated. Adults had a greater median cyst size (30 (9–60 vs. 22 (2–55 mm; p = 0.005 and required prolonged operation time (69 (1–169 vs. 32.5 (1–140 mins; p = 0.004 compared to the pediatric group. Conclusion: The occurrence of TDC shows a bimodal age distribution. Preoperative evaluation and time for surgery vary whereas clinical presentations, surgical management, and postoperative outcomes are comparable among adult and pediatric groups. Ultrasonography is the preferred diagnostic modality, and the

  9. Severe combined immunodeficiency in Serbia and Montenegro between years 1986 and 2010: a single-center experience.

    Science.gov (United States)

    Pasic, Srdjan; Vujic, Dragana; Veljković, Dobrila; Slavkovic, Bojana; Mostarica-Stojkovic, Marija; Minic, Predrag; Minic, Aleksandra; Ristic, Goran; Giliani, Silvia; Villa, Anna; Sobacchi, Cristina; Lilić, Desa; Abinun, Mario

    2014-04-01

    Severe combined immunodeficiency (SCID), including the 'variant' Omenn syndrome (OS), represent a heterogeneous group of monogenic disorders characterized by defect in differentiation of T- and/or B lymphocytes and susceptibility to infections since birth. In the period of 25 years, between January 1986 and December 2010, a total of 21 patients (15 SCID, 6 OS) were diagnosed in Mother & Child Health Institute of Serbia, a tertiary-care teaching University hospital and a national referral center for patients affected with primary immunodeficiency (PID). The diagnoses were based on anamnestic data, clinical findings, and immunological and genetic analysis. The median age at the onset of the first infection was the 2nd month of life. Seven (33 %) patients had positive family history for SCID. Out of five male infants with T-B+NK- SCID phenotype, mutation analysis revealed interleukin-2 (common) gamma-chain receptor (IL2RG) mutations in 3 with positive X-linked family history, and Janus-kinase (JAK)-3 gene defects in the other two. Six patients had T-B-NK+ SCID phenotype and further 6 features of OS, 11 of which had recombinase-activating gene (RAG1or RAG2) and 1 Artemis gene mutations. One child with T+B+NK+ SCID phenotype as well had proven RAG mutation. One child each with T-B+NK+ SCID phenotype, CD8 lymphopenia and unknown phenotype remained without known underlying genetic defect. Of the eight patients who underwent hematopoetic stem cell transplant (HSCT) 5 survived, the other 13 died between 2 days and 12 months after diagnosis was made. Early diagnosis of SCID, before onset of severe infections, offers possibility for HSCT and cure. Education of primary-care pediatricians, in particular including awareness of the risk of using live vaccines and non-irradiated blood products, should improve prognosis of SCID in our setting.

  10. A User-Centered Framework for Deriving A Conceptual Design From User Experiences: Leveraging Personas and Patterns to Create Usable Designs

    Science.gov (United States)

    Javahery, Homa; Deichman, Alexander; Seffah, Ahmed; Taleb, Mohamed

    Patterns are a design tool to capture best practices, tackling problems that occur in different contexts. A user interface (UI) design pattern spans several levels of design abstraction ranging from high-level navigation to low-level idioms detailing a screen layout. One challenge is to combine a set of patterns to create a conceptual design that reflects user experiences. In this chapter, we detail a user-centered design (UCD) framework that exploits the novel idea of using personas and patterns together. Personas are used initially to collect and model user experiences. UI patterns are selected based on personas pecifications; these patterns are then used as building blocks for constructing conceptual designs. Through the use of a case study, we illustrate how personas and patterns can act as complementary techniques in narrowing the gap between two major steps in UCD: capturing users and their experiences, and building an early design based on that information. As a result of lessons learned from the study and by refining our framework, we define a more systematic process called UX-P (User Experiences to Pattern), with a supporting tool. The process introduces intermediate analytical steps and supports designers in creating usable designs.

  11. Selective intraarterial radionuclide therapy with yttrium-90 (Y-90 microspheres for hepatic neuroendocrine metastases: Initial experience at a single center

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    Arslan Nuri

    2011-01-01

    Full Text Available Background/Aim. Selective intraarterial radionuclide therapy (SIRT with Yttrium-90 (Y-90 microspheres is also known as radioembolization and delivers high doses of radiation to hepatic tumors with minimum healthy liver exposure. The aim of this study was to present our preliminary experience in the role of liver directed radiotherapy with Y-90 microspheres for the treatment of unresectable hepatic metastases from neuroendocrine tumors (NET. Methods. The results of SIRT in 10 patients (5 males, 5 females; mean age 48.7 years; age range 24-73 years with metastatic liver disease from NETs during the period from April 2008 through August 2010 were reviewed. All patients had meticulous pre- and post-imaging studies as a part of their work-up procedure, as well as serologic tests of liver function to determine the extent of liver function damage. The patients who were eligible for SIRT had pretreatment visceral angiography to define and occlude non-target arteries. Results. The mean ± SD administered SIR-Spheres® activity was 1.49 ± 0.42 GBq (range 0.72-2.21 GBq in all the patients. These treatments delivered a dose of 99.73 ± 66.36 Gy (range 49- 420.8 Gy to the target tumors. The estimated dose to the lungs and normal liver was 4.45 ± 1.95 Gy (range 2.4-8.5 Gy and 26.73 ± 14.19 Gy (range 5-58.9 Gy, respectively. Overall response rate of 90% and patient tolerance was satisfactory for most patients. Conclusion. From our limited experience, we can conclude that SIRT with Y-90 microspheres is a safe and efficacious treatment option for patients with liver metastasis of NET without any serious side effects.

  12. Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea

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    Hong, Kyung-Wook; Choi, Su-Mi; Cho, Sung-Yeon; Lee, Hyo-Jin; Choi, Jae-Ki; Kim, Si-Hyun; Park, Sun Hee; Choi, Jung-Hyun; Yoo, Jin-Hong; Lee, Jong-Wook

    2017-01-01

    Purpose To describe the incidence, clinical courses, and risk factors for mortality of lower respiratory tract diseases (LRDs) caused by common respiratory viruses (CRVs) in stem cell transplantation (SCT) recipients. Materials and Methods We retrospectively reviewed the medical records of 1038 patients who received SCT between January 2007 and August 2011 at a single center in Korea. Results Seventy-one CRV-LRDs were identified in 67 (6.5%) patients. The human parainfluenza virus (HPIV) was the most common causative pathogen of CRV-LRDs at 100 days [cumulative incidence estimate, 23.5%; 95% confidence interval (CI), 3.3–43.7] and 1 year (cumulative incidence estimate, 69.2%; 95% CI, 45.9–92.5) following SCT. The 30-day overall mortality rates due to influenza-LRDs, respiratory syncytial virus-LRDs, HPIV-LRDs, and human rhinovirus-LRDs were 35.7, 25.8, 31.6, and 42.8%, respectively. Co-pathogens in respiratory specimens were detected in 23 (33.8%) patients. The overall mortality at day 30 after CRV-LRD diagnosis was 32.8% (22/67). High-dose steroid usage (p=0.025), a severe state of immunodeficiency (p=0.033), and lymphopenia (p=0.006) were significantly associated with death within 30 days following CRV-LRD diagnosis in a univariate analysis. Multivariate logistic regression analysis revealed that high-dose steroid usage [odds ratio (OR), 4.05; 95% CI, 1.12–14.61; p=0.033] and lymphopenia (OR, 6.57; 95% CI, 1.80–24.03; p=0.004) were independent risk factors for mortality within 30 days of CRV-LRDs. Conclusion CRV-LRDs among SCT recipients showed substantially high morbidity and mortality rates. Therefore, the implement of an active diagnostic approaches for CRV infections is required for SCT recipients with respiratory symptoms, especially those receiving high-dose steroids or with lymphopenia. PMID:28120567

  13. Predictors of caregivers’ burden of Parkinson’s disease in India: experience of a tertiary care center in India

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    Agrawal V

    2012-11-01

    Full Text Available Vikas Agrawal,1 Vinay Goyal,2 Garima Shukla,2 Madhuri Behari21Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India; 2Department of Neurology, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction: Parkinson’s disease (PD is a progressive neurodegenerative disorder characterized by increasing dependence on caregivers for activities of daily living that imposes a major burden upon the patients’ caregiver. Caregiver burden (CB refers to the physical, mental, and socioeconomic problems experienced by the caregivers of chronic patients.Patients and methods: This is a onetime cross-sectional observational study carried out in the movement disorder clinic of a tertiary referral center in India. Persons with PD were interviewed and information was collected regarding demographic and clinical details, treatment taken, and presence of non-motor features such as dementia, psychosis, depression, etc, on a pre-tested format and their caregivers were interviewed for self-perceived burden using Zerit’s caregivers’ burden inventory.Results: We interviewed 91 persons with PD (71 [78%] men, 20 [22%] women with their primary caregivers. The age of the patients ranged from 25 to 75 years (mean 56.66 ± 11.83 years. After regression analysis, depression in patients (beta = 0.352, 95% confidence interval [CI]: 0.275 to 0.790, high UPDRS-motor scores (beta = 0.255, 95% CI: 0.108 to 0.532, and presence of sleep disturbances in the atient (beta = 0.206, 95% CI: 0.817 to 11.823 were associated with increased caregiver burden and the presence of multiple caregivers was associated with lower caregiver burden (beta = −0.311, 95% CI: −10.155 to −3.436.Conclusion: The total number of caregivers was found to be an important predictor for reducing CB. Multiple caregivers is a phenomenon which has not been studied till now. Other factors which were found to have adverse predictive effect on caregiver burden are presence of

  14. Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience

    Science.gov (United States)

    Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert

    2016-01-01

    /benzodiazepines. Age and gender adjusted analysis yielded similar results. These patients are more likely to need a longer recovery periods post-endoscopy, which could result in additional time and personnel requirements. The final predictive model has good predictive ability for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg and fair predictive ability for Fentanyl ≥ 50 mcg and Midazolam ≥ 2 mg. The external validity of this model is planned to be tested in another center. PMID:28042391

  15. Allogeneic Stem Cell Transplantation in Congenital Hemoglobinopathies Using a Tailored Busulfan-Based Conditioning Regimen: Single-Center Experience.

    Science.gov (United States)

    Zaidman, Irina; Rowe, Jacob M; Khalil, Abdalla; Ben-Arush, Myriam; Elhasid, Ronit

    2016-06-01

    Hematopoietic stem cell transplantation (HSCT) is the only proven curative option for patients with hemoglobinopathies, both thalassemia and sickle cell anemia (SCA). A busulfan-based myeloablative conditioning regimen is the standard of care for HSCT in these patients, although increased treatment-related morbidity, including veno-occlusive disease (VOD), has been demonstrated. Thirty-eight pediatric patients, median age 8 years (range, 6 months to 22 years), suffering from hemoglobinopathy were treated at Rambam Medical Center in Haifa, Israel, between 1998 and 2011. Thirty-four patients had thalassemia major and 4 had SCA. The 38 patients underwent 40 HSCTs, 34 of which were first transplants and 6 second transplants. Most transplants (32/40) were from matched sibling donors. Sources of stem cells were peripheral blood in 30 transplants, bone marrow in 7 transplants, and cord blood in 3 transplants. All received different customized busulfan-based conditioning regimens tailored by pharmacokinetic analysis of busulfan levels. Primary engraftment occurred in 37 of 40 transplants. Neutrophil engraftment (>.5 × 10(9)/L) occurred at a median of 15.3 days post-transplantation (range, 10 to 45). Platelet transfusion independence (>20 × 10(9)/L) occurred at a median of 22.3 days (range, 11 to 60). The rate of 5-year overall survival for thalassemia patients after first transplantation was 90.5% ± 5.3%. The rate of 5-year thalassemia-free survival was 81.7% ± 6.8%. Cumulative incidence of acute graft-versus-host disease (GVHD) was 17.6%. Rate of grades III to IV GVHD was 8.8%. Cumulative incidence of chronic GVHD was 23.5%, with 11.8% incidence of extensive chronic GVHD. One patient developed VOD. Full donor chimerism occurred in 36.4% of patients with class 1 + 2 thalassemia, compared with 78.6% in class 3 thalassemia (P = .049). Overall survival above 90% in patients undergoing their first transplant was demonstrated using busulfan

  16. Taquiarritmias supraventriculares no feto. Experiência de uma unidade de referência em cardiologia fetal Fetal supraventricular tachyarrhythmias. Experience of a fetal cardiology reference center

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    Paulo Zielinsky

    1998-05-01

    Full Text Available OBJETIVO: Avaliar a forma de apresentação, diagnóstico e tratamento das taquiarritmias supraventriculares fetais, através do relato de uma série de casos acompanhados em um centro terciário de cardiologia fetal. MÉTODOS: São descritos 25 casos de taquiarritmia supraventricular diagnosticados intra-útero, no período de janeiro/89 a outubro/97, em uma população compreendendo 3117 gestantes. RESULTADOS: Foram diagnosticados 17 casos de taquiarritmia supraventricular e 8 casos de flutter atrial fetal. As idades gestacionais variaram de 26 a 40 semanas. Doze fetos apresentavam hidropisia no momento do diagnóstico (6 com taquicardia supraventricular (TSV e 6 com flutter atrial. Quatro fetos com TSV apresentavam cardiopatias estruturais (dois casos de anomalia de Ebstein e dois com comunicação interventricular. Todos os fetos foram internados na Unidade de Cardiologia Fetal para monitorização e tratamento. Entre os 17 fetos com TSV, 12 apresentaram reversão da arritmia após administração de digoxina, mas esta medida não foi eficaz em nenhum paciente com flutter. Dois pacientes com TSV e seis com flutter necessitaram interrupção da gestação para cardioversão elétrica pós-natal. A mortalidade foi de 3/17 no grupo da TSV (incluindo dois pacientes com anomalia de Ebstein e de 0/8 no grupo com flutter. CONCLUSÃO: As taquiarritmias supraventriculares fetais são eventos raros na população geral. Entretanto, podem provocar insuficiência cardíaca e óbito intra-uterino. Como a resposta ao tratamento é satisfatória, tornam-se de extrema importância o diagnóstico precoce e o tratamento adequado.PURPOSE: To describe the presentation, diagnosis and treatment of fetal supraventricular tachyarrhythmias in a series of fetuses followed in a tertiary Fetal Cardiology Center. METHODS: Twenty-five fetuses with diagnosis of supraventricular tachyarrhytmia were reported from January 1989 to October 1997, among 3117 pregnant women

  17. Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

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    Priyambada Binita

    2005-10-01

    mortality. Those patients who continued to have a GCS score of 50 for more than 24 hours (to rule out concussion or recovery underwent tracheostomy. All these patients were finally assessed for mortality rate and hospital stay, the statistical analysis was carried out using SPSS10 version. The final outcome (in terms of mortality was analyzed utilizing chi-square test and p value Results At admission both tracheostomy and non-tracheostomy groups were matched with respect to GCS score and SAPS score. The average day of tracheostomy was 2.18 ± 1.0038 days. The GCS scores on days 1, 2, 3, 4, 5, 10 between tracheostomy and non-tracheostomized group were comparable. However the difference in the GCS scores was statistically significant on day 15 being higher in the tracheostomy group.Thus early tracheostomy was observed to improve the mortality rate significantly in patients with isolated closed head injury Conclusion It may be concluded that early tracheostomy is beneficial in patients with isolated closed head injury which is severe enough to affect systemic physiological parameters, in terms of decreased mortality and intubation associated complications in centers where ICU care is not readily available. Also, in a selected group of patients, early tracheostomy may do away with the need for prolonged mechanical ventilation.

  18. The use of failure mode and effect analysis in a radiation oncology setting: the Cancer Treatment Centers of America experience.

    Science.gov (United States)

    Denny, Diane S; Allen, Debra K; Worthington, Nicole; Gupta, Digant

    2014-01-01

    Delivering radiation therapy in an oncology setting is a high-risk process where system failures are more likely to occur because of increasing utilization, complexity, and sophistication of the equipment and related processes. Healthcare failure mode and effect analysis (FMEA) is a method used to proactively detect risks to the patient in a particular healthcare process and correct potential errors before adverse events occur. FMEA is a systematic, multidisciplinary team-based approach to error prevention and enhancing patient safety. We describe our experience of using FMEA as a prospective risk-management technique in radiation oncology at a national network of oncology hospitals in the United States, capitalizing not only on the use of a team-based tool but also creating momentum across a network of collaborative facilities seeking to learn from and share best practices with each other. The major steps of our analysis across 4 sites and collectively were: choosing the process and subprocesses to be studied, assembling a multidisciplinary team at each site responsible for conducting the hazard analysis, and developing and implementing actions related to our findings. We identified 5 areas of performance improvement for which risk-reducing actions were successfully implemented across our enterprise.

  19. Dual grafts in adult-to-adult living donor liver transplantation: a single center experience in Taiwan.

    Science.gov (United States)

    Yang, Chin-Hsiang; Chen, Chao-Long; Wang, Chih-Chi; Concejero, Allan M; Wang, Shih-Ho; Liu, Yueh-Wei; Yong, Chee-Chien; Lin, Tsan-Shiun

    2009-02-01

    Volume mismatch is encountered when a single live donor cannot provide adequate graft volume to the recipient with a remnant liver volume which is safe for donation. Our objective is to present our experience in living donor liver transplantation using dual grafts. Record review of 4 dual graft recipients was done. The results were compared with 122 consecutive patients who received a single right lobe. All dual graft recipients were surviving with satisfactory liver function at a median follow-up of 21 months. Two recipients received 1 right and 1 left lobe graft, while the other 2 recipients received 2 left lobe grafts. One donor developed biloma and was managed by percutaneous drainage. The first recipient required re-laparotomy for postoperative bleeding. The second recipient underwent re-laparotomy for bile leak. The third recipient developed grade II decubitus ulcers due to a prolonged sedentary position. When compared with recipients who received a single right lobe, the operative time was prolonged in the dual graft group. There was no apparent increase in the rate of vascular and biliary complications or the incidence of acute cellular rejection. Actuarial patient survivals were comparable in both groups. Dual graft transplantation provides sufficient volume in the recipient without jeopardizing donor safety.

  20. Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

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    Marjanović Ivan

    2016-01-01

    Full Text Available We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

  1. Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

    Institute of Scientific and Technical Information of China (English)

    Kwang Yeol Paik; Seong Ho Choi

    2009-01-01

    AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in five patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, pre- and intra-operative definite localization and careful operative techniques are required.

  2. Comparison of Optimal Cardiovascular Risk Factor Management in Patients with Type 2 Diabetes Who Attended Urban Medical Health Center with those Attended a Tertiary Care Center: Experiences from Tehran, Iran

    Science.gov (United States)

    Moradi, Sedighe; Haji Ghanbari, Mohammad Javad; Ebrahimi, Hedyeh

    2016-01-01

    Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD accounts for primary cause of death among diabetic patients. Physicians, especially in the primary care setting, have effective role in the management of cardiovascular risk factors. Therefore, we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic patients attending to an urban health center as a primary care center with Institute of Endocrinology and Metabolism Diabetes Clinic (IEMDC) as a tertiary center. Methods: This cross-sectional study was performed on 200 adult diabetic patients attending urban health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients’ cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and smoking history were recorded. The number of patients who did not achieve the target according to the American Diabetes Association guidelines was determined and compared. Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004). The duration of diabetes was longer among urban center patients (P glycosylated hemoglobin level, high-density lipoprotein level, and systolic BP. Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers. PMID:27761215

  3. Full retroauricular skin and fascia expansion in microtia reconstruction:a single center experience of 166 cases

    Institute of Scientific and Technical Information of China (English)

    Ji-Hua Wang; Ting Tang; Yong-Jing He; Ying-Jia Zhang; Yun Yang

    2016-01-01

    Aim: Ear reconstruction is a challenge for plastic and reconstructive surgeons. The ear requires sufifcient skin coverage and a three-dimensional (3D) cartilage framework. In this paper, the authors present their 10-year experience in microtia reconstruction using tissue expansion and an autogenous rib cartilage framework.Methods: Ear reconstruction was performed in 3 operative stages. During the ifrst procedure, a 50-80 mL kidney or cylinder-shaped expander was implanted deep to the subcutaneous fascia of the retroauricular mastoid region. Over a period of 3-5 months, the expander was iflled to a ifnal volume of 80-110 mL. In the next operation, the retroauricular fascia was eliminated or reserved following expander removal, and the autogenous costal cartilage framework was placed below the expanded skin lfap. At the third and ifnal stage, the earlobe transposition, tragus construction and conchal deepening were performed.Results:A total of 165 patients (166 ears) were reconstructed using tissue expansion and an autogenous rib cartilage framework. Complications included hematomas in 3 cases, expander exposure in 8 cases, cartilage exposure in 6 cases, infection and cartilage resorption in 2 cases, exposure of steel wire in 4 cases, and aseptic seroma in 2 cases. Follow-up ranging from 3 months to 5 years showed that 159 patients were satisifed with the reconstructed ear including size, location, projection, convolution, skin-colour matching, symmetry with opposite ear.Conclusion:Expansion of the retroauricular skin and fascia can provide sufifcient non-hair-bearing skin and tissue for coverage of a three-dimensional costal cartilage framework. Avoidance and prompt treatment of complications are advised in order to obtain a satisfactory reconstruction of the ear.

  4. Pre- and postnatal transplantation of fetal mesenchymal stem cells in osteogenesis imperfecta: a two-center experience.

    Science.gov (United States)

    Götherström, Cecilia; Westgren, Magnus; Shaw, S W Steven; Aström, Eva; Biswas, Arijit; Byers, Peter H; Mattar, Citra N Z; Graham, Gail E; Taslimi, Jahan; Ewald, Uwe; Fisk, Nicholas M; Yeoh, Allen E J; Lin, Ju-Li; Cheng, Po-Jen; Choolani, Mahesh; Le Blanc, Katarina; Chan, Jerry K Y

    2014-02-01

    Osteogenesis imperfecta (OI) can be recognized prenatally with ultrasound. Transplantation of mesenchymal stem cells (MSCs) has the potential to ameliorate skeletal damage. We report the clinical course of two patients with OI who received prenatal human fetal MSC (hfMSC) transplantation and postnatal boosting with same-donor MSCs. We have previously reported on prenatal transplantation for OI type III. This patient was retransplanted with 2.8 × 10(6) same-donor MSCs per kilogram at 8 years of age, resulting in low-level engraftment in bone and improved linear growth, mobility, and fracture incidence. An infant with an identical mutation who did not receive MSC therapy succumbed at 5 months despite postnatal bisphosphonate therapy. A second fetus with OI type IV was also transplanted with 30 × 10(6) hfMSCs per kilogram at 31 weeks of gestation and did not suffer any new fractures for the remainder of the pregnancy or during infancy. The patient followed her normal growth velocity until 13 months of age, at which time longitudinal length plateaued. A postnatal infusion of 10 × 10(6) MSCs per kilogram from the same donor was performed at 19 months of age, resulting in resumption of her growth trajectory. Neither patient demonstrated alloreactivity toward the donor hfMSCs or manifested any evidence of toxicities after transplantation. Our findings suggest that prenatal transplantation of allogeneic hfMSCs in OI appears safe and is of likely clinical benefit and that retransplantation with same-donor cells is feasible. However, the limited experience to date means that it is not possible to be conclusive and that further studies are required.

  5. En-Bloc Transplant of the Liver, Kidney and Pancreas: Experience from a Latin American Transplant Center

    Science.gov (United States)

    Caicedo, Luis A.; Villegas, Jorge I.; Serrano, Oscar; Millán, Mauricio; Sepúlveda, Mauricio; Jiménez, Diego; García, Jairo; Posada, Juan G.; Mesa, Liliana; Duran, Carlos; Schweineberg, Johanna; Dávalos, Diana; Manzi, Eliana; Sabogal, Angie; Aristizabal, Ana María; Echeverri, Gabriel J.

    2017-01-01

    Case series Patient: Male, 38 • Male, 48 Final Diagnosis: En-bloc transplantation (liver, kidney, pancreas) Symptoms: Encephalopathy • adynamia • ascites • asthenia Medication: — Clinical Procedure: En-bloc transplantation Specialty: Transplantology Objective: Unusual setting of medical care Background: En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages. This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique. Case Report: The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent. Conclusions: En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control. PMID:28148909

  6. Preliminary experience in adult-to-adult living donor liver transplantation in a single center in China

    Institute of Scientific and Technical Information of China (English)

    YAN Lunan; CHEN Zheyu; LIU Jiangwen; WU Hong; LI Bo; ZENG Yong; WEN Tianfu; ZHAO Jichun; WANG Wentao; YANG Jiayin; XU Mingqing; MA Yukui

    2007-01-01

    The aim of this paper is to report the authors'experience in performing adult-to-adult living donor liver transplantation (LDLT)by using a modified technique in using grafts of the right lobe of the liver.From January 2002 to September 2006,56 adult patients underwent LDLT using right lobe grafts at the Wlest China Hospital.Sichuan University Medical School,China.All patients underwent a modified operation designed to improve the reconstruction of the right hepatic vein (RHV)and the tributariers of the middle hepatic vein(MHV)by interposing a vessel graft,and by anastomosing the hepatic arteries and bile ducts.There were no severe complications or deaths in all donors.Fifty-two (92.8%) recipients survived the operations.Among the 56 recipients,complications were seen in 15 recipients(26.8%),including hepatic vein stricture(one case),small-for-size syndrome(one case),hepatic artery thrombosis(two cases),intestinal bleeding (one case),bile leakage(two cases),left subphrenic abscess (one case),renal failure(two cases)and pulmonary infection (five cases).Within three months after transplantation,four recipients(7.1 4%)died due to smallfor-size syndrome(one case),renal failure(one case)and multiple organ failure(two cases).All patients underwent direct anastomoses of the RHV and the inferior vena cava (IVC),and in 23 cases,reconstruction of the right inferior hepatic vein was also done.In 24 patients,the reconstruction of the tributaries of the MHV was also done by interposing a vessel graft to provide sufficient venous outflow.Trifurcation of the portal vein was seen in nine cases.Thus,veno-plasty or separate anastomoses were performed.The graft and recipient body weight ratios(GRWR)were between 0.72%and 1.43%,and in three cases it was<0.8%.The graft weight to recipient standard liver volume ratios (GV/SLV) were between 31.86%and 71.68%.among which four cases had<40%.No "small-for-size syndrome"occurred.With modification of the surgical technique,especially in the

  7. A experiência social da psicose no contexto de um Centro de Atenção Psicossocial The social experience of psychosis in the context of a Psychosocial Care Center

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    Marcelo Kimati Dias

    2011-04-01

    Full Text Available Este estudo discute as relações existentes entre os aspectos institucionais de um Centro de Atenção Psicossocial (Caps e a experiência de pacientes psicóticos. Com o referencial da experiência social da psicose, mais ampla do que a descrição da vivência de sintomas, mas considerando aspectos culturais da experiência, foram realizados três estudos de caso em dois momentos diferentes. Todos os pacientes estudados foram entrevistados tanto em 1995 quanto em 2003. Além dos próprios sujeitos, foram realizadas entrevistas abertas com seus familiares e profissionais que os atendem, considerando assim as redes de rela��ão social dos pacientes. Enfatizaram-se três planos principais: (1 estudo da história do adoecimento; (2 estudo das representações da doença; e (3 descrição do cotidiano e das relações sociais dos pacientes. A partir de uma abordagem antropológica, foram realizadas considerações a respeito do tratamento de pacientes psicóticos inseridos nos Centros de Atenção Psicossocial.This study discusses the relations existing between the institutional aspects of a Psychosocial Care Center (Caps and the experience of psychotic patients. Using the referential base of the social experience of psychosis, which is broader in scope than a description of the experience of symptoms, while considering cultural aspects of the experience, three case studies were conducted at two different times. All of the patients studied were interviewed in 1995 and again in 2003. In addition to interviews with the subjects themselves, open interviews were conducted with their families and their professional carers, thereby taking the social relationship networks of the patients into consideration. Three central aspects were emphasized: (1 study of the history of the illness; (2 study of the representations of the disease; and (3 description of the everyday life and social relationships of the patients. Aspects with respect to the treatment

  8. Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.

    LENUS (Irish Health Repository)

    Hayes, Christopher Ruslan

    2012-02-01

    INTRODUCTION: A recent single-center report indicated that the performance of atrial fibrillation ablation in patients on uninterrupted warfarin using a conventional deflectable tip electrode ablation catheter may be as safe as periprocedural discontinuation of warfarin and bridging with heparin. Novel multi-electrode array catheters for atrial fibrillation ablation are currently undergoing clinical evaluation. While offering the possibility of more rapid atrial fibrillation ablation, they are stiffer and necessitate the deployment of larger deflectable transseptal sheaths, and it remains to be determined if they increase the risk of cardiac perforation and vascular injury. Such potential risks would have implications for a strategy of uninterrupted periprocedural anticoagulation. METHOD AND RESULTS: We audited the safety outcomes of our atrial fibrillation ablation procedures using multi-electrode array ablation catheters in patients on uninterrupted warfarin (CHADS2 score>or=2) and in patients not on warfarin (uninterrupted aspirin). Two bleeding complications occurred in 49 patients on uninterrupted warfarin, both of which were managed successfully without longterm sequelae, and no bleeding complication occurred in 32 patients not on warfarin (uninterrupted aspirin). There were no thromboembolic events or other complication with either anticoagulant regimen. CONCLUSION: Despite the larger diameter and increased stiffness of multi-electrode array catheters and their deflectable transseptal sheaths, their use for catheter ablation in patients with atrial fibrillation on uninterrupted warfarin in this single-center experience does not appear to be unsafe, and thus, an adequately powered multicenter prospective randomized controlled trial should be considered.

  9. A Student-Centered, Inquiry-Based Approach to Young's Double-Slit Experiment (and Other Investigations of Light's Wave Character)

    Science.gov (United States)

    Meyer, Daniel Z.

    2017-03-01

    Young's double-slit experiment is one of the most historically significant works in physics, and one that is easily done in an introductory physics class. It is also an excellent example of an investigation that allows us to infer the nature of phenomena beyond direct observation. Unfortunately, perhaps because of this, it is often also an excellent example of the problem with canned cookbook labs. Students dutifully go through the physical motions of the investigation and can easily get good measurements. But actual intellectual engagement is missing. This paper details an instructional sequence that allows an authentic, student-centered approach to this historic investigation. Key to the approach is creating the context in which students can meaningfully devise an investigation into light's wave character.

  10. Historical Center of Quito: an experience for the preservation of courtyard houses with an emphasis on user awareness

    Directory of Open Access Journals (Sweden)

    Sanchez, Lorena Marina

    2016-03-01

    Full Text Available The early declaration of Quito as a World Heritage site in 1978, makes this city a Latin American example with a remarkable preservationist experience. Its Historical Centre composes a blend of periods and goods, emphasizing on the presence of Spanish-Aborigine syncretism stands. This hybridation survives in the buffer area, made up of different neighborhoods, through a residential property typology: the patio houses. With endless complexities to their approach, these homes comprise the residential identity of Quito, but they have only recently taken on a new protagonism within a residential protection framework. Therefore, and through a historical-architectural and social approach, has been investigated the patrimonial fragment of the neighbourhood of San Juan, which is representative of what happens in the buffer area. Diagnosisand guidelines are exposed from a conception of exploratory study, mainly qualitative and focused on users awareness. This approximation has been carried on through the observation in situ, the analysis of planimetry, bibliography, photographs, the carrying out of interviews and opinion polls. Thus, final reflections are presented along with a methodological development feasible of being adapted to other residential properties in other urban contexts. La temprana declaración de Quito como Patrimonio de la Humanidad en 1978 la convierte en un ejemplo latinoamericano con una singular experiencia preservacionista. Su Centro Histórico compone una amalgama de períodos y bienes, destacándose la presencia del sincretismo español-aborigen. Esta hibridación sobrevive en el área de amortiguación, compuesta por diferentes barrios, a través de una tipología residencial característica: las casas patio. Con un sinfín de complejidades para su tratamiento, estas viviendas componen gran parte de la identidad habitacional quiteña, aunque sólo recientemente han adquirido un nuevo protagonismo dentro del marco de protecci

  11. New concepts and outcomes for children with hepatoblastoma based on the experience of a tertiary center over the last 21 years

    Directory of Open Access Journals (Sweden)

    Ana Cristina Aoun Tannuri

    2015-06-01

    Full Text Available OBJECTIVE: The aim of this study was to summarize the experience of a tertiary center in treating hepatoblastoma for the last 21 years. PATIENTS AND METHODS: Fifty-eight cases were included. The tumor extent and prognosis were assessed using the PRETEXT system. The following data were analyzed: age at diagnosis, comorbidities, prematurity, treatment modalities, histopathological findings, surgical details and complications, treatment outcomes, chemotherapy schedules, side effects and complications. Treatment outcomes included the occurrence of local or distant recurrence, the duration of survival and the cause of death. The investigation methods were ultrasonography, CT scan, serum alpha-fetoprotein level measurement and needle biopsy. Chemotherapy was then planned, and the resectability of the tumor was reevaluated via another CT scan. RESULTS: The mean numbers of neoadjuvant cycles and postoperative cycles of chemotherapy were 6±2 and 1.5±1.7, respectively. All children except one were submitted for surgical resection, including 50 partial liver resections and 7 liver transplantations. Statistical comparisons demonstrated that long-term survival was associated with the absence of metastasis ( p= 0.04 and the type of surgery (resection resulted in a better outcome than transplantation ( p= 0.009. No associations were found between vascular invasion, incomplete resection, histological subtype, multicentricity and survival. The overall 5-year survival rate of the operated cases was 87.7%. CONCLUSION: In conclusion, the experience of a Brazilian tertiary center in the management of hepatoblastoma in children demonstrates that long survival is associated with the absence of metastasis and the type of surgery. A multidisciplinary treatment involving chemotherapy, surgical resection and liver transplantation (including transplantations using tissue from living donors led to good outcomes and survival indexes.

  12. User-Centered Design of Serious Games for Older Adults Following 3 Years of Experience With Exergames for Seniors: A Study Design

    Science.gov (United States)

    2017-01-01

    Background Seniors need sufficient balance and strength to manage in daily life, and sufficient physical activity is required to achieve and maintain these abilities. This can be a challenge, but fun and motivational exergames can be of help. However, most commercial games are not suited for this age group for several reasons. Many usability studies and user-centered design (UCD) protocols have been developed and applied, but to the best of our knowledge none of them are focusing on seniors’ use of games for physical activity. In GameUp, a European cofunded project, some prototype Kinect exergames to enhance the mobility of seniors were developed in a user-centered approach. Objective In this paper we aim to record lessons learned in 3 years of experience with exergames for seniors, considering both the needs of older adults regarding user-centered development of exergames and participation in UCD. We also provide a UCD protocol for exergames tailored to senior needs. Methods An initial UCD protocol was formed based on literature of previous research outcomes. Senior users participated in UCD following the initial protocol. The users formed a steady group that met every second week for 3 years to play exergames and participate in the UCD during the 4 phases of the protocol. Several methods were applied in the 4 different phases of the UCD protocol; the most important methods were structured and semistructured interviews, observations, and group discussions. Results A total of 16 seniors with an average age above 80 years participated for 3 years in UCD in order to develop the GameUp exergames. As a result of the lessons learned by applying the different methodologies of the UCD protocol, we propose an adjusted UCD protocol providing explanations on how it should be applied for seniors as users. Questionnaires should be turned into semistructured and structured interviews while user consultation sessions should be repeated with the same theme to ensure that the

  13. A description of the Galactic Center excess in the Minimal Supersymmetric Standard Model and the Dark Matter signatures for the LHC and direct and indire ct detection experiments

    CERN Document Server

    Caron, Sascha; Hendriks, Luc; de Austri, Roberto Ruiz; Weniger, Christoph

    2015-01-01

    Observations with the Fermi Large Area Telescope (LAT) indicate an excess in gamma rays originating from the center of our Galaxy. A possible explanation for this excess is the annihilation of Dark Matter particles. We have investigated the annihilation of neutralinos as Dark Matter candidates within the phenomenological Minimal Supersymmetric Standard Model (pMSSM). An iterative particle filter approach was used to search for solutions within the pMSSM. We found solutions that are consistent with astroparticle physics and collider experiments, and provide a reasonable fit to the energy spectrum of the excess. The neutralino is a Bino/Higgsino mixture and a mass in the range $84-92$~GeV yielding a Dark Matter relic density $0.06 < \\Omega h^2 <0.13$. These pMSSM solutions make clear forecasts for LHC, direct and indirect DM detection experiments. If the pMSSM explanation of the excess seen by Fermi-LAT is correct, a DM signal might be discovered soon.

  14. Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

    Directory of Open Access Journals (Sweden)

    Coluccia A

    2014-09-01

    Full Text Available Anna Coluccia, Fabio Ferretti, Andrea PozzaDepartment of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, University of Siena, Siena, ItalyPurpose: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course.Patients and methods: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26 receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses.Results: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95. Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No

  15. WE-G-BRE-07: Proton Therapy Enhanced by Tumor-Targeting Gold Nanoparticles: A Pilot in Vivo Experiment at The Proton Therapy Center at MD Anderson Cancer Center

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, T; Grant, J; Wolfe, A; Gillin, M; Krishnan, S [MD Anderson Cancer Ctr., Houston, TX (United States)

    2014-06-15

    Purpose: Assess tumor-growth delay and survival in a mouse model of prostate cancer treated with tumor-targeting gold nanoparticles (AuNPs) and proton therapy. Methods: We first examined the accumulation of targeting nanoparticles within prostate tumors by imaging AuNPs with ultrasound-guided photoacoustics at 24h after the intravenous administration of goserelin-conjugated AuNPs (gAuNP) in three mice. Nanoparticles were also imaged at the cellular level with TEM in PC3 cells incubated with gAuNP for 24h. Pegylated AuNPs (pAuNP) were also imaged in vivo and in vitro for comparison. PC3 cells were then implanted subcutaneously in nude mice; 51mice with 8–10mm tumors were included. AuNPs were injected intravenously at 0.2%w/w final gold concentration 24h before irradiation. A special jig was designed to facilitate tumor irradiation perpendicular to the proton beam. Proton energy was set to 180MeV, the radiation field was 18×18cm{sup 2}, and 9cm or 13.5cm thick solid-water compensators were used to position the tumors at either the beam entrance (BE) or the SOBP. Physical doses of 5Gy were delivered to all tumors on a patient beam line at MD Anderson's Proton Therapy Center. Results: The photoacoustic experiment reveled that our nanoparticles leak from the tumor-feeding vasculature and accumulate within the tumor volume over time. Additionally, TEM images showed gAuNP are internalized in cancer cells, accumulating within the cytoplasm, whereas pAuNP are not. Tumor-growth was delayed by 11 or 32days in mice receiving gAuNP irradiated at the BE or the SOBP, relative to proton radiation alone. Survival curves (ongoing experiment) reveal that gAuNPs improved survival by 36% or 74% for tumors irradiated at the BE or SOBP. Conclusion: These important, albeit preliminary, in vivo findings reveal nanoparticles to be potent sensitizers to proton therapy. Further, conjugation of AuNPs to tumor-specific antigens that promote enhanced cellular internalization improved

  16. Design and Implementation of Experiment Apparatus Booking and Management System for Research Experiment Center%科研试验中心实验预约管理系统的设计与实现

    Institute of Scientific and Technical Information of China (English)

    沈俊辉; 马星光; 刘仁权

    2011-01-01

    The paper describes a few key points related to the establishment of centrally managed experiment booking system applied in large/mega sized research and education centers. These points include: general design idea, system structure and functionality. The system is based on ASP. Net technology and coded by C# programming language and uses SQL Server 2008 database. The system greatly improve booking processes, such as online booking, examining and endorsing, booking system management, booking system inquiry or statistics, etc. The work proves to be a successful in dealing with more demanding booking work in large scale research or education centers using network technology.%介绍了科研实验中心的试验预约管理系统的设计思路、技术架构和功能实现.该系统使用ASP.Net技术,采用C#编程语言,使用SQL Server 2008数据库,实现了科研试验中心的实验申请网上预约、审批、管理、统计等功能,为试验仪器资源的网络化管理探索了一条有效途径.

  17. Intensity-Modulated Radiotherapy in the Treatment of Oropharyngeal Cancer: An Update of the Memorial Sloan-Kettering Cancer Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Setton, Jeremy; Caria, Nicola; Romanyshyn, Jonathan; Koutcher, Lawrence; Wolden, Suzanne L.; Zelefsky, Michael J.; Rowan, Nicholas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sherman, Eric J.; Fury, Matthew G.; Pfister, David G. [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wong, Richard J.; Shah, Jatin P.; Kraus, Dennis H. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shi Weiji; Zhang Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Schupak, Karen D.; Gelblum, Daphna Y.; Rao, Shyam D. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy Y., E-mail: Leen2@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-01-01

    Purpose: To update the Memorial Sloan-Kettering Cancer Center's experience with intensity-modulated radiotherapy (IMRT) in the treatment of oropharyngeal cancer (OPC). Methods and Materials: Between September 1998 and April 2009, 442 patients with histologically confirmed OPC underwent IMRT at our center. There were 379 men and 63 women with a median age of 57 years (range, 27-91). The disease was Stage I in 2%, Stage II in 4%, Stage III in 21%, and Stage IV in 73% of patients. The primary tumor subsite was tonsil in 50%, base of tongue in 46%, pharyngeal wall in 3%, and soft palate in 2%. The median prescription dose to the planning target volume of the gross tumor was 70 Gy for definitive (n = 412) cases and 66 Gy for postoperative cases (n = 30). A total 404 patients (91%) received chemotherapy, including 389 (88%) who received concurrent chemotherapy, the majority of which was platinum-based. Results: Median follow-up among surviving patients was 36.8 months (range, 3-135). The 3-year cumulative incidence of local failure, regional failure, and distant metastasis was 5.4%, 5.6%, and 12.5%, respectively. The 3-year OS rate was 84.9%. The incidence of late dysphagia and late xerostomia {>=}Grade 2 was 11% and 29%, respectively. Conclusions: Our results confirm the feasibility of IMRT in achieving excellent locoregional control and low rates of xerostomia. According to our knowledge, this study is the largest report of patients treated with IMRT for OPC.

  18. Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients’ Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment

    Science.gov (United States)

    Groothuis-Oudshoorn, Catharina GM; Vollenbroek-Hutten, Miriam MR; IJzerman, Maarten J

    2017-01-01

    Background Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (Phealth care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions “Intermediate” telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home

  19. The Magnetospheric Multiscale (MMS) Mission Science Data Center: Technologies, Methods, and Experiences in Making Available Large Volumes of In-Situ Particle and Field Data

    Science.gov (United States)

    Pankratz, Christopher; Kokkonen, Kim; Larsen, Kristopher; Panneton, Russell; Putnam, Brian; Schafer, Corey; Baker, Daniel; Burch, James

    2016-04-01

    On September 1, 2015 the Magnetospheric MultiScale (MMS) constellation of four satellites completed their six-month commissioning period and began routine science data collection. Science operations for the mission is conducted at the Science Operations Center (SOC) at the Laboratory for Atmospheric and Space Physics, University of Colorado in Boulder, Colorado, USA. The MMS Science Data Center (SDC) is a component of the SOC responsible for the data production, management, dissemination, archiving, and visualization of the data from the extensive suite of 100 instruments onboard the four spacecraft. As of March 2016, MMS science data are openly available to the entire science community via the SDC. This includes hundreds of science parameters, and 50 gigabytes of data per day distributed across thousands of data files. Products are produced using integrated software systems developed and maintained by teams at other institutions using their own institutional software management procedures and made available via a centralized public web site and web services. To accomplish the data management, data processing, and system integration challenges present on this space mission, the MMS SDC incorporates a number of evolutionary techniques and technologies. This presentation will provide an informatics-oriented view of the MMS SDC, summarizing its technical aspects, novel technologies and data management practices that are employed, experiences with its design and development, and lessons learned. Also presented is the MMS "Scientist-in-the-Loop" (SITL) system, which is used to leverage human insight and expertise to optimize the data selected for transmission to the ground. This smoothly operating system entails the seamless interoperability of multiple mission facilities and data systems that ultimately translate scientist insight into uplink commands that triggers optimal data downlink to the ground.

  20. Comment on Cross, Fine, Jones, and Walsh (2012): Do Mental Health Professionals Who Serve on/with Child Advocacy Centers Experience Role Conflict?

    Science.gov (United States)

    Friend, Colleen

    2012-01-01

    Cross, Fine, Jones, and Walsh's (2012) article "Mental Health Professionals in Children's Advocacy Centers: Is There Role Conflict?" challenges two recent publications' criticisms that child advocacy centers create role conflict for mental health professionals and explains how child advocacy centers actually work, describing the different roles…

  1. Simultaneous multi-tear exclusion:an optimal strategy for type B thoracic aortic dissection initially proved by a single center's 8 years experience

    Institute of Scientific and Technical Information of China (English)

    YUAN Liang-xi; BAO Jun-min; ZHAO Zhi-qing; FENG Xiang; OU Le-feng; FENG Rui; LU Qing-sheng; MEI Zhi-jun; JING Zai-ping

    2007-01-01

    Background Endovascular stent-grafting is widely used to treat thoracic aortic dissection.However,little information is available regarding outcome following simultaneous exclusion of multiple tears.This report details eight years of experience using simultaneous multi-tear exclusion for treatment of Stanford type B thoracic aortic dissection resulting in successful aortic remodeling without adverse events.Methods From September 1998 to January 2006,29 type B thoracic aortic dissection patients(24 men,5 women;27 chronic,2 acute;mean age 58 years,range 45-77 years)were treated by simultaneous multi-tear exclusion in our center.Magnetic resonance angiography was used as the preoperative evaluation method.Different kinds of stent-grafts were used.The patients were followed up with contrast-enhanced spiral computed tomography at 6 months postoperatively and yearly thereafter.Results Twenty-nine surgeries were completed successfully using at least 2 stent-grafts per patient(range:2-6,mean:2.7).No major procedure-related complications,such as rupture,paraplegia,aortic branch ischemia or cerebral infarction,were observed.During follow-up,favorable remodeling of the aorta was observed.Conclusions The mid-term result of thoracic aortic dissection with simultaneous multi-tear exclusion was satisfactory.With the improvement of stent-grafts,simultaneous multi-tear exclusion should find wider application and become an optimal strategy for thoracic aortic dissection.

  2. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Directory of Open Access Journals (Sweden)

    Chengquan Zhao

    2015-01-01

    Full Text Available Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4% submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%, followed by bone/soft tissue (21.0% and gynecologic/breast (20.2% subspecialties. Average turnaround time (TAT per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7% where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and

  3. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Science.gov (United States)

    Zhao, Chengquan; Wu, Tao; Ding, Xiangdong; Parwani, Anil V.; Chen, Hualin; McHugh, Jeffrey; Piccoli, Anthony; Xie, Qinling; Lauro, Gonzalo Romero; Feng, Xiaodong; Hartman, Douglas J.; Seethala, Raja R.; Wu, Shangwei; Yousem, Samuel; Liang, Yaoming; Pantanowitz, Liron

    2015-01-01

    Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated

  4. Why does Livermore need LANSCE?

    Energy Technology Data Exchange (ETDEWEB)

    Fortner, R. [Lawrence Livermore National Laboratory, NM (United States)

    1995-10-01

    Five years ago, I was the associate director of the nuclear test program, so I have a really close view of the role of the nuclear testing in the weapons program. My perceptions are strongly driven by the fact that we have lost testing and what that really means. I want to explain to you why I think we really need a science-based stockpile stewardship program and what the issues are interms of having lost nuclear testing.

  5. Fundamental neutron physics at LANSCE

    Energy Technology Data Exchange (ETDEWEB)

    Greene, G.

    1995-10-01

    Modern neutron sources and science share a common origin in mid-20th-century scientific investigations concerned with the study of the fundamental interactions between elementary particles. Since the time of that common origin, neutron science and the study of elementary particles have evolved into quite disparate disciplines. The neutron became recognized as a powerful tool for studying condensed matter with modern neutron sources being primarily used (and justified) as tools for neutron scattering and materials science research. The study of elementary particles has, of course, led to the development of rather different tools and is now dominated by activities performed at extremely high energies. Notwithstanding this trend, the study of fundamental interactions using neutrons has continued and remains a vigorous activity at many contemporary neutron sources. This research, like neutron scattering research, has benefited enormously by the development of modern high-flux neutron facilities. Future sources, particularly high-power spallation sources, offer exciting possibilities for continuing this research.

  6. Excel Center

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Citigroup,one of the World top 500 companies,has now settled in Excel Center,Financial Street. The opening ceremony of Excel Center and the entry ceremony of Citigroup in the center were held on March 31.Government leaders of Xicheng District,the Excel CEO and the heads of Asia-Pacific Region leaders of Citibank all participated in the ceremony.

  7. Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience.

    Science.gov (United States)

    Dağgülli, Mansur; Sancaktutar, Ahmet Ali; Dede, Onur; Utanğaç, Mehmet Mazhar; Bodakçi, Mehmet Nuri; Penbegül, Necmettin; Hatipoğlu, Namık Kemal; Çakmakçı, Süleyman

    2015-11-01

    We aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70% of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80% (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL.

  8. Different outcomes of peritoneal catheter percutaneous placement by nephrologists using a trocar versus the Seldinger technique: the experience of two Brazilian centers.

    Science.gov (United States)

    Ponce, Daniela; Banin, Vanessa B; Bueloni, Tricya Nunes; Barretti, Pasqual; Caramori, Jacqueline; Balbi, André Luís

    2014-10-01

    A good catheter implantation technique is important to allow effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with different techniques have been limited. The aim of this study was to investigate the rate of early catheter-related complications and catheter survival in two Brazilian centers, according to two different percutaneous methods of catheter implantation performed by nephrologist team. Adult incident patients recruited from January 2006 to July 2013 having undergone first peritoneal dialysis (PD) catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months. Four hundred and forty-five consecutive Tenckhoff catheters were implanted by nephrologist team percutaneously after antibiotic prophylaxis in an operating room: trocar was used in 349 (78.4 %) and Seldinger technique (ST) in 99 (21.6 %). The ST was significantly associated with a lower rate of leak (16.3 vs 3 %, p = 0.03) and outflow failure due to tip catheter migration (22.6 vs 10.1 %, p = 0.04), while early infectious complication rates were similar between the two groups (p = 0.59). Long-term catheter survival was higher in Seldinger group (log-rank, p = 0.031). By Cox multivariate analysis, adjusted for age, sex, and diabetes, the ST remained independently associated with better catheter survival [HR 0.681 (0.462-0.910), p = 0.04]. As conclusion, our experience showed better PD outcomes with the ST than trocar method of catheter implantation by nephrologist.

  9. The Place of Computed Tomography as a Guidance Modality in Percutaneous Nephrostomy: Analysis of a 10-Year Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Egilmez, H.; Oztoprak, I.; Atalar, M.; Cetin, A.; Gumus, C.; Gultekin, Y.; Bulut, S.; Arslan, M.; Solak, O. [Depts. of Radiology, Obstetrics and Gynecology, and Urology, Cumhuriyet Univ. School of Medicine, Sivas (Turkey)

    2007-09-15

    Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. Results: PCN procedures were performed via 1-3 punctures in patients with grades 0-1 and 2 hydronephrosis, and via 1-2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0-1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis. Keywords: Computed tomography; percutaneous nephrostomy; urinary obstruction.

  10. Single-Center Experience and 1-Year Follow-up Results of 'Sandwich Technique' in the Management of Common Iliac Artery Aneurysms During EVAR

    Energy Technology Data Exchange (ETDEWEB)

    Ricci, Carmelo; Ceccherini, Claudio, E-mail: claudiocec@hotmail.it; Cini, Marco; Vigni, Francesco; Leonini, Sara [Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Radiologia Interventistica (Italy); Tommasino, Giulio; Muzzi, Luigi; Tucci, Enrico; Benvenuti, Antonio; Neri, Eugenio [Policlinico Santa Maria alle Scotte, Azienda Ospedaliera Universitaria Senese, Chirurgia del Cuore e dei grossi vasi (Italy)

    2012-10-15

    Purpose: Abdominal aortic aneurysm (AAA) accompanied by common iliac artery (CIA) aneurysms requires a more demanding procedure owing to the difficulties in obtaining an adequate distal landing zone for the stent-graft limb(s), a potential site of endoleak. The 'sandwich technique' is a procedure to increase EVAR feasibility in the setting of adverse or challenging CIA anatomy. Its main advantages include no restrictions in terms of CIA diameter or length or internal iliac artery (IIA) diameter, no need to wait for a specific stent-graft. Our purpose is to describe our single-center experience and one year follow-up results of this new procedure. Materials and Methods: From April 2009 to June 2010, the sandwich technique was performed in our institution in 7 patients treated for AAA and unilateral CIA aneurysms (n. 5) or bilateral CIA aneurysms (n. 2). Inclusion criteria were the presence of unilateral or bilateral CIA aneurysm (independently from its diameter), IIA artery measuring up to 9 mm in its maximum diameter, not dilatation of IIA and EIA. Results: The mean follow-up length was 15 months (range: 14-20 months). All stent-implanted iliac branches remained patent on 1 year follow-up and IIA flow was preserved. None of the patients had symptoms of pelvic ischemia. CT scan follow-up showed aneurysm shrinkage in five patients, without any sign of endoleaks in all cases. Conclusions: In selected cases, the 'sandwich technique' showed good outcomes confirming to be a safe and easy to perform way to overcome anatomical constraints and expanding the limits of EVAR.

  11. Evolving progress in oncologic and operative outcomes for esophageal and junctional cancer: lessons from the experience of a high-volume center.

    LENUS (Irish Health Repository)

    Reynolds, John V

    2012-05-01

    Modern series from high-volume esophageal centers report an approximate 40% 5-year survival in patients treated with curative intent and postoperative mortality rates of less than 4%. An objective analysis of factors that underpin current benchmarks within high-volume centers has not been performed.

  12. Neutron Capture Experiments on Unstable Nuclei

    Energy Technology Data Exchange (ETDEWEB)

    Jon M. Schwantes; Ralf Sudowe; Heino Nitsche; Darleane C. Hoffman

    2003-12-16

    A primary objective of this project is to study neutron capture cross sections for various stable and unstable isotopes that will contribute to the Science Based Stockpile Stewardship (SBSS) program by providing improved data for modeling and interpretation of nuclear device performance. The information obtained will also be important in astrophysical modeling of nucleosynthesis. During this reporting period, the emphasis has been on preparing a radioactive target of {sup 155}Eu (half-life = 4.7 years), and several stable targets, including isotopically separated {sup 154}Sm, {sup 151}Eu, and {sup 153}Eu. Measurements of their neutron capture cross sections will be conducted in collaboration with researchers at the Los Alamos Neutron Science Center (LANSCE) facility using the Detector for Advanced Neutron Capture Experiments (DANCE). A suitable backing material (beryllium) for the targets has been selected after careful calculations of its contribution to the background of the measurements. In addition, a high voltage plating procedure has been developed and optimized. Stable targets of {sup 151}Eu and {sup 153}Eu and a target of natural Eu ({approx}50% {sup 151}Eu and {approx}50% {sup 153}Eu) have each been plated to a mass thickness of >1 mg/cm{sup 2} and delivered to the DANCE collaboration at Los Alamos National Laboratory (LANL). Natural Eu targets will be tested first to confirm that the target dimensions and backing are appropriate prior to performing measurements on the extremely valuable targets of separated isotopes. In order to prepare a target of the radioactive {sup 155}Eu, it must first be separated from the {sup 154}Sm target material that was irradiated in a very high neutron flux of 1.5x1015 neutrons/cm{sup 2}/s for 50 days. The reaction is {sup 154}Sm (n,f){sup 155}Sm (half-life = 22 minutes) {sup 155}Eu. Considerable progress has been made in developing a suitable high-yield and high-purity separation method for separating Eu from targets

  13. Guidelines for the diagnosis and management of chylomicron retention disease based on a review of the literature and the experience of two centers

    Directory of Open Access Journals (Sweden)

    Castagnetti Justine

    2010-09-01

    Full Text Available Abstract Familial hypocholesterolemia, namely abetalipoproteinemia, hypobetalipoproteinemia and chylomicron retention disease (CRD, are rare genetic diseases that cause malnutrition, failure to thrive, growth failure and vitamin E deficiency, as well as other complications. Recently, the gene implicated in CRD was identified. The diagnosis is often delayed because symptoms are nonspecific. Treatment and follow-up remain poorly defined. The aim of this paper is to provide guidelines for the diagnosis, treatment and follow-up of children with CRD based on a literature overview and two pediatric centers 'experience. The diagnosis is based on a history of chronic diarrhea with fat malabsorption and abnormal lipid profile. Upper endoscopy and histology reveal fat-laden enterocytes whereas vitamin E deficiency is invariably present. Creatine kinase (CK is usually elevated and hepatic steatosis is common. Genotyping identifies the Sar1b gene mutation. Treatment should be aimed at preventing potential complications. Vomiting, diarrhea and abdominal distension improve on a low-long chain fat diet. Failure to thrive is one of the most common initial clinical findings. Neurological and ophthalmologic complications in CRD are less severe than in other types of familial hypocholesterolemia. However, the vitamin E deficiency status plays a pivotal role in preventing neurological complications. Essential fatty acid (EFA deficiency is especially severe early in life. Recently, increased CK levels and cardiomyopathy have been described in addition to muscular manifestations. Poor mineralization and delayed bone maturation do occur. A moderate degree of macrovesicular steatosis is common, but no cases of steatohepatitis cirrhosis. Besides a low-long chain fat diet made up uniquely of polyunsaturated fatty acids, treatment includes fat-soluble vitamin supplements and large amounts of vitamin E. Despite fat malabsorption and the absence of postprandial chylomicrons

  14. Present status and plans for upgrading the Lujan neutron scattering center

    Energy Technology Data Exchange (ETDEWEB)

    Rhyne, James J [LANSCE-LC

    2010-01-01

    The Lujan Center, part of the LANSCE accelerator complex at Los Alamos National Laboratory, operates a comprehensive neutron scattering facility for the U.S. Department of Energy that serves approximately 300 users per year. This paper will discuss the current instruments and status of the facility and also focus on the plans for a major upgrade of the Center including new instruments and enhancements to specific existing instruments. The instrument suite currently includes two reflectometers (one with full polarization), an engineering diffraction machine, a diffractometer specialized to pair-distribution analysis, 2 general purpose powder diffractometers, and 2 inelastic spectrometers. To complement these spectrometers, a full range of pressure, temperature, and magnetic field sample environments is available for users. As part of the planning for a forthcoming enhancement of Lujan Center, a series of workshops have been held over the past year to encourage user input to the design for new instruments as well as major upgrades of existing machines. Many of the planned facilities are designed to take advantage of the Lujan Center 20 Hz pulse repetition rate and cold source moderators, both of which are beneficial for high-resolution instruments using long neutron wavelengths.

  15. Distribution center

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    Distribution center is a logistics link fulfill physical distribution as its main functionGenerally speaking, it's a large and hiahly automated center destined to receive goods from various plants and suppliers,take orders,fill them efficiently,and deliver goods to customers as quickly as possible.

  16. Emergency Contraceptive Pills: A 10-Year Follow-up Survey of Use and Experiences at College Health Centers in the Mid-Atlantic United States

    Science.gov (United States)

    Miller, Laura McKeller; Sawyer, Robin G.

    2006-01-01

    The authors conducted a 10-year follow-up study using a telephone survey to investigate the availability of emergency contraceptive pills (ECPs) at college health centers in the mid-Atlantic region of the United States. They also examined related issues, such as distribution procedure, existence of a written protocol, personnel involved,…

  17. Emergency Contraceptive Pill (ECP) Use and Experiences at College Health Centers in the Mid-Atlantic United States: Changes since ECP Went Over-the-Counter

    Science.gov (United States)

    Miller, Laura M.

    2011-01-01

    Objective: To investigate the availability of emergency contraceptive pills (ECPs) at college health centers since ECP went over-the-counter (OTC) in 2006. Related issues, such as distribution procedure, existence of a written protocol, personnel involved, contraindications, follow-up procedures, methods of advertising, and staff attitudes, were…

  18. 5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands

    NARCIS (Netherlands)

    M.C. Vos (Margreet); M.D. Behrendt (Myra); D.C. Melles (Damian); F.P.N. Mollema (Femke); W. de Groot (Woutrinus); G. Parlevliet (Gerard); A. Ott (Alewijn); D. Horst-Kreft (Deborah); A.F. van Belkum (Alex); H.A. Verbrugh (Henri)

    2009-01-01

    textabstractOBJECTIVE: To evaluate the effectiveness of a rigorous search and destroy policy for controlling methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. DESIGN: Hospital-based observational follow-up study. SETTING: Erasmus University Medical Center Rotterdam, a 1,2

  19. Basic and clinical research on the regulation of the intestinal barrier by Lactobacillus and its active protein components: a review with experience of one center.

    Science.gov (United States)

    Liu, Zhi-Hua; Kang, Liang; Wang, Jian-Ping

    2014-12-01

    Probiotics got protective effects on the intestinal barrier. Our present study is to review the basic and clinical progress on the regulation of the intestinal barrier by Lactobacillus and its active protein components, combing the study of our center. Our study have isolated the active component of micro integral membrane protein (MIMP) within the media place of the integral membrane protein of Lactobacillus plantarum, which was verified about the protective effects against the intestinal epithelial dysfunction. On the other hand, we also found the effects of perioperative use of probiotics in the prevention and treatment of postoperative intestinal barrier dysfunction, and reduction of the postoperative infective complications. In this review, we would like to report the founding of our center, involving in the basic and clinical research progress of regulation of intestinal barrier by Lactobacillus and its active protein component MIMP. Furthermore, we may also promote our following studies about the MIMP and its clinical verification.

  20. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data

    OpenAIRE

    Baine, Michael J.; Chi Lin

    2014-01-01

    Objectives. We examined the role of radiation therapy (RT) in pancreatic adenocarcinoma (PA) treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC) as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS) were age, gender, race, stag...

  1. Increasing the operational efficiency and safety in operation control centers: the TRANSPETRO experience; Aumentando a seguranca e eficiencia operacional em centros de controle: a experiencia da TRANSPETRO

    Energy Technology Data Exchange (ETDEWEB)

    Felicio, Marco Aurelio Fierro; Frisoli, Caetano [PETROBRAS Transporte S.A. (TRANSPETRO), Rio de Janeiro, RJ (Brazil)

    2009-12-19

    The increase in operational efficiency and safety in operation control centers has been traditionally obtained through direct actions in the operational activity itself and on the resources and systems used for that. Modern supervisory and control systems, sophisticated simulation software, cutting-edge last generation equipment and installations, clear and comprehensive procedures definitions and intensive and constant training of the operation teams are, usually, the chosen paths followed by control centers in their incessant quest for increased operational efficiency and safety. This paper presents the path followed by the TRANSPETRO's National Operational Control Center - Natural Gas (Centro Nacional de Controle Operacional - CNCO-Gas) - that has not only focused with the traditional aspects above, but has also made intensive investments in systems and data base integrations, aiming at eliminating data inconsistencies and redundancies and at including automation, standardization and systematization of non-operational and complementary operational activities. These investments allowed TRANSPETRO CNCO-Gas face the big challenge of growing that TRANSPETRO's gas transportation activity is facing now and will be facing in the near future: from 2,600 km to 7,000 km of gas pipelines, and a volume of transported natural gas from 35 MMm{sup 3}/day to 100 MMm{sup 3}/day. (author)

  2. Characteristics and outcome of warm autoimmune hemolytic anemia in adults: New insights based on a single-center experience with 60 patients.

    Science.gov (United States)

    Roumier, Mathilde; Loustau, Valentine; Guillaud, Constance; Languille, Laetitia; Mahevas, Matthieu; Khellaf, Mehdi; Limal, Nicolas; Noizat-Pirenne, France; Godeau, Bertrand; Michel, Marc

    2014-09-01

    Warm autoimmune hemolytic anemia (wAIHA) is a rare autoimmune disease with poorly known natural history and management remaining mainly empirical. To better describe the characteristics and outcome of wAIHA in adults, we performed a single-center cohort study of patients diagnosed with wAIIHA from 2001 to 2012 in our center. Sixty patients (50% women) were included, the mean age at the time of wAIHA onset was 54 ± 23 years. wAIHA was considered "primary" for 21 patients (35%) and was associated with an underlying disorder in 39 (65%), including mainly lymphoproliferative disorders and systemic lupus. All patients but two needed treatment and received corticosteroids, with an overall initial response rate of 87%. However, 63% of the patients were corticosteroid-dependent and 56% required at least one second-line treatment including mainly rituximab (n = 19). At the time of analysis, after a mean follow-up of 46 months, 28 patients (47%) were in remission and off treatment and 5 (8%) had died. The presence of an underlying lymphoproliferative disorder was associated with reduced response to corticosteroids and increased need for second-line therapy. In conclusion, in the last decade and compared to a previous series from our center, the rate of secondary wAIHA has increased and the use of rituximab has emerged as the preferred second-line treatment and corticosteroid-sparing strategy; the overall mortality has significantly decreased (8 vs. 18%).

  3. Reliability Centered Maintenance - Methodologies

    Science.gov (United States)

    Kammerer, Catherine C.

    2009-01-01

    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  4. An Approach for Calculating Student-Centered Value in Education – A Link between Quality, Efficiency, and the Learning Experience in the Health Professions

    Science.gov (United States)

    Ooi, Caryn; Reeves, Scott; Walsh, Kieran

    2016-01-01

    Health professional education is experiencing a cultural shift towards student-centered education. Although we are now challenging our traditional training methods, our methods for evaluating the impact of the training on the learner remains largely unchanged. What is not typically measured is student-centered value; whether it was ‘worth’ what the learner paid. The primary aim of this study was to apply a method of calculating student-centered value, applied to the context of a change in teaching methods within a health professional program. This study took place over the first semester of the third year of the Bachelor of Physiotherapy at Monash University, Victoria, Australia, in 2014. The entire third year cohort (n = 78) was invited to participate. Survey based design was used to collect the appropriate data. A blended learning model was implemented; subsequently students were only required to attend campus three days per week, with the remaining two days comprising online learning. This was compared to the previous year’s format, a campus-based face-to-face approach where students attended campus five days per week, with the primary outcome—Value to student. Value to student incorporates, user costs associated with transportation and equipment, the amount of time saved, the price paid and perceived gross benefit. Of the 78 students invited to participate, 76 completed the post-unit survey (non-participation rate 2.6%). Based on Value to student the blended learning approach provided a $1,314.93 net benefit to students. Another significant finding was that the perceived gross benefit for the blended learning approach was $4014.84 compared to the campus-based face-to-face approach of $3651.72, indicating that students would pay more for the blended learning approach. This paper successfully applied a novel method of calculating student-centered value. This is the first step in validating the value to student outcome. Measuring economic value to the

  5. An Approach for Calculating Student-Centered Value in Education - A Link between Quality, Efficiency, and the Learning Experience in the Health Professions.

    Science.gov (United States)

    Nicklen, Peter; Rivers, George; Ooi, Caryn; Ilic, Dragan; Reeves, Scott; Walsh, Kieran; Maloney, Stephen

    2016-01-01

    Health professional education is experiencing a cultural shift towards student-centered education. Although we are now challenging our traditional training methods, our methods for evaluating the impact of the training on the learner remains largely unchanged. What is not typically measured is student-centered value; whether it was 'worth' what the learner paid. The primary aim of this study was to apply a method of calculating student-centered value, applied to the context of a change in teaching methods within a health professional program. This study took place over the first semester of the third year of the Bachelor of Physiotherapy at Monash University, Victoria, Australia, in 2014. The entire third year cohort (n = 78) was invited to participate. Survey based design was used to collect the appropriate data. A blended learning model was implemented; subsequently students were only required to attend campus three days per week, with the remaining two days comprising online learning. This was compared to the previous year's format, a campus-based face-to-face approach where students attended campus five days per week, with the primary outcome-Value to student. Value to student incorporates, user costs associated with transportation and equipment, the amount of time saved, the price paid and perceived gross benefit. Of the 78 students invited to participate, 76 completed the post-unit survey (non-participation rate 2.6%). Based on Value to student the blended learning approach provided a $1,314.93 net benefit to students. Another significant finding was that the perceived gross benefit for the blended learning approach was $4014.84 compared to the campus-based face-to-face approach of $3651.72, indicating that students would pay more for the blended learning approach. This paper successfully applied a novel method of calculating student-centered value. This is the first step in validating the value to student outcome. Measuring economic value to the student may

  6. Person--job match among frontline staff working in residential treatment centers: the impact of personality and child psychopathology on burnout experiences.

    Science.gov (United States)

    Leon, Scott C; Visscher, Linn; Sugimura, Niwako; Lakin, Brittany L

    2008-04-01

    Prior research has shown that the personality variables extraversion and neuroticism predict burnout among frontline staff working in residential treatment centers. This study tested the hypothesis that the effect of personality on burnout would be moderated by the psychiatric characteristics of the youth served on the milieu. Two hundred and three frontline staff working in 21 residential treatment centers in Illinois serving troubled youth completed surveys regarding opinions about their jobs, the Big Five Inventory (BFI), a youth presenting problems scale for the entire milieu, and the Maslach Burnout Inventory (MBI). Results indicated that the effect of neuroticism on burnout is moderated by psychosis and posttraumatic stress disorder (PTSD); high and moderate milieu ratings of psychosis and PTSD showed a positive relationship between neurosis and burnout, while low ratings of these conditions showed no relationship. These findings suggest that the optimal work setting is a function of the interaction between specific personality characteristics and specific work environments, with implications for personnel selection and future research on person-environment fit.

  7. An 800-MeV proton radiography facility for dynamic experiments

    CERN Document Server

    King, N S P; Adams, K; Alrick, K R; Amann, J F; Balzar, S; Barnes, P D J; Crow, M L; Cushing, S B; Eddleman, J C; Fife, T T; Flores, P; Fujino, D; Gallegos, R A; Gray, N T; Hartouni, E P; Hogan, G E; Holmes, V H; Jaramillo, S A; Knudsson, J N; London, R K; Lopez, R R; McDonald, T E; McClelland, J B; Merrill, F E; Morley, K B; Morris, C L; Naivar, F J; Parker, E L; Park, H S; Pazuchanics, P D; Pillai, C; Riedel, C M; Sarracino, J S; Shelley, F E J; Stacy, H L; Takala, B E; Thompson, R; Tucker, H E; Yates, G J; Ziock, H J; Zumbro, J D

    1999-01-01

    The capability has successfully been developed at the Los Alamos Nuclear Science Center (LANSCE) to utilize a spatially and temporally prepared 800 MeV proton beam to produce proton radiographs. A series of proton bursts are transmitted through a dynamic object and transported, via a unique magnetic lens system, to an image plane. The magnetic lens system permits correcting for the effects of multiple coulomb scattering which would otherwise completely blur the spatially transmitted information at the image plane. The proton radiographs are recorded either on a time integrating film plate or with a recently developed multi-frame electronic imaging camera system. The latter technique permits obtaining a time dependent series of proton radiographs with time intervals (modulo 358 ns) up to many microseconds and variable time intervals between images. One electronically shuttered, intensified, CCD camera is required per image. These cameras can detect single protons interacting with a scintillating fiber optic ar...

  8. Preparative Isolation of Polar Antioxidant Constituents from Abies koreana Using Centrifugal Partition Chromatography Guided by DPPH center dot-HPLC Experiment

    NARCIS (Netherlands)

    Jeon, Je-Seung; Kim, Ji Hoon; Park, Chae Lee; Kim, Chul Young

    2015-01-01

    Preparative separation of antioxidant constituents from the leaves of Abies koreana Wilson (Pinaceae) was performed by centrifugal partition chromatography (CPC) with a two-phase solvent system of ethyl acetate-isopropanol-water (9:1:10, v/v) target-guided by DPPH•-HPLC experiment. In DPPH•-HPLC exp

  9. Anti-HMGCR antibodies as a biomarker for immune-mediated necrotizing myopathies: A history of statins and experience from a large international multi-center study.

    Science.gov (United States)

    Musset, Lucile; Allenbach, Yves; Benveniste, Olivier; Boyer, Olivier; Bossuyt, Xavier; Bentow, Chelsea; Phillips, Joe; Mammen, Andrew; Van Damme, Philip; Westhovens, René; Ghirardello, Anna; Doria, Andrea; Choi, May Y; Fritzler, Marvin J; Schmeling, Heinrike; Muro, Yoshinao; García-De La Torre, Ignacio; Ortiz-Villalvazo, Miguel A; Bizzaro, Nicola; Infantino, Maria; Imbastaro, Tiziana; Peng, Qinglin; Wang, Guochun; Vencovský, Jiří; Klein, Martin; Krystufkova, Olga; Franceschini, Franco; Fredi, Micaela; Hue, Sophie; Belmondo, Thibaut; Danko, Katalin; Mahler, Michael

    2016-10-01

    In an effort to find naturally occurring substances that reduce cholesterol by inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), statins were first discovered by Endo in 1972. With the widespread prescription and use of statins to decrease morbidity from myocardial infarction and stroke, it was noted that approximately 5% of all statin users experienced muscle pain and weakness during treatment. In a smaller proportion of patients, the myopathy progressed to severe morbidity marked by proximal weakness and severe muscle wasting. Remarkably, Mammen and colleagues were the first to discover that the molecular target of statins, 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), is an autoantibody target in patients that develop an immune-mediated necrotizing myopathy (IMNM). These observations have been confirmed in a number of studies but, until today, a multi-center, international study of IMNM, related idiopathic inflammatory myopathies (IIM), other auto-inflammatory conditions and controls has not been published. Accordingly, an international, multi-center study investigated the utility of anti-HMGCR antibodies in the diagnosis of statin-associated IMNM in comparison to different forms of IIM and controls. This study included samples from patients with different forms of IIM (n=1250) and patients with other diseases (n=656) that were collected from twelve sites and tested for anti-HMGCR antibodies by ELISA. This study confirmed that anti-HMGCR autoantibodies, when found in conjunction with statin use, characterize a subset of IIM who are older and have necrosis on muscle biopsy. Taken together, the data to date indicates that testing for anti-HMGCR antibodies is important in the differential diagnosis of IIM and might be considered for future classification criteria.

  10. METALS (Minority Education Through Traveling and Learning in the Sciences) and the Value of Collaborative Field-centered Experiences in the Geosciences (Invited)

    Science.gov (United States)

    White, L. D.

    2013-12-01

    METALS (Minority Education Through Traveling and Learning in the Sciences) is a field-based, geoscience diversity program developed by a collaborative venture among San Francisco State University, the University of Texas at El Paso, the University of New Orleans, and Purdue University. Since 2010, this program has created meaningful geoscience experiences for underrepresented minorities by engaging 30 high school students in experiential learning opportunities each year. During METALS field trips, the primarily urban students observe natural landforms, measure water quality, conduct beach profiles, and interpret stratigraphic and structural features in locations that have included southern Utah, southern Louisiana, central Wyoming, and northern California. In these geological settings participants are also able to focus on societally relevant, community-related issues. Results from program evaluation suggest that student participants view METALS as: (1) opening up new opportunities for field-based science not normally available to them, (2) engaging in a valuable science-based field experience, (3) an inspirational, but often physically challenging, undertaking that combines high-interest geology content with an exciting outdoor adventure, and (4) a unique social experience that brings together people from various parts of the United States. Further evaluation findings from the four summer trips completed thus far demonstrate that active learning opportunities through direct interaction with the environment is an effective way to engage students in geoscience-related learning. Students also seem to benefit from teaching strategies that include thoughtful reflection, journaling, and teamwork, and mentors are positive about engaging with these approaches. Participants appear motivated to explore geoscience topics further and often discuss having new insights and new perspectives leading to career choices in geosciences. Additionally, students who had a prior and

  11. Constructing and Implementing of the Administrating System of Experiment Teaching Center%实验教学中心管理体系的构建与实践

    Institute of Scientific and Technical Information of China (English)

    陈雪芬; 郭伟良

    2011-01-01

    构建了实验教学中心管理新体系,建立健全了实验教学人员、管理人员、实验经费、仪器设备、实验教学档案、实验项目、实验室开放、环境与安全卫生等各项规章制度,采用信息化辅助管理,确保实验教学中心管理制度得到更好贯彻与执行.使实验教学中心管理科学化、制度化、规范化,为学生提供良好的实验室实践环境,为培养创新型人才奠定了扎实的基础.%A new administrating system was constructed in which the bylaws for managing experiment teacher,laboratory administrator, experiment outlay, instruments, experiment teaching files, experiment items, laboratory opening, environment and security were established and strengthen, and the computers were employed to manage the laboratory to male sure the effects, which make the administrating of experiment teaching center scientifically, institutionally and regularized, offering a good environment for experimental teaching and study,making contribute for training innovational students.

  12. International Water Center

    Science.gov (United States)

    The urban district of Nancy and the Town of Nancy, France, have taken the initiative of creating an International Center of Water (Centre International de l'Eau à Nancy—NAN.C.I.E.) in association with two universities, six engineering colleges, the Research Centers of Nancy, the Rhine-Meuse Basin Agency, and the Chamber of Commerce and Industry. The aim of this center is to promote research and technology transfer in the areas of water and sanitation. In 1985 it will initiate a research program drawing on the experience of 350 researchers and engineers of various disciplines who have already been assigned to research in these fields. The research themes, the majority of which will be multidisciplinary, concern aspects of hygiene and health, the engineering of industrial processes, water resources, and the environment and agriculture. A specialist training program offering five types of training aimed at university graduates, graduates of engineering colleges, or experts, will start in October 1984.

  13. The rationale for and implementation of learner-centered education: experiences at the Ostrow School of Dentistry of the University of Southern California.

    Science.gov (United States)

    Navazesh, Mahvash; Rich, Sandra K; Tiber, Arnold

    2014-02-01

    This report describes the design, implementation, and function of integrated, learner-centered education at the Ostrow School of Dentistry of the University of Southern California. The 190 required courses of the previous curriculum have been condensed to forty-four courses. Four courses, presented for each of eleven trimesters of the four-year D.D.S. program, are entitled Human Structure, Human Function, Human Behavior, and Human Clinical Dentistry. An integrated biomedical sciences curriculum is supported by small-group, facilitator-based, problem-based learning (PBL) and an electronic PBL case library. Modules, rotations, and preclinical and clinical sessions make up remaining instructional units of the curriculum. Selected assessment outcomes measuring student knowledge, behavior, and skill development are discussed. As an external measure, first-attempt pass rates on the National Board Dental Examination (NBDE) Part I show a range of 87-96 percent over a ten-year period (for Classes 2005-14). First-attempt pass rates on the NBDE Part II for Classes 2005-12 ranged from 74 percent to 93 percent. Perceived barriers and opportunities for better performance on the NBDE Part II are addressed. Additionally, an exit survey, administered over the past four years, indicates a high level of student satisfaction with "depth and breadth" of their education (82-93 percent) and that graduates feel well prepared to enter the practice of dentistry (94-97 percent).

  14. Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients.

    Science.gov (United States)

    Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt

    2016-03-01

    Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.

  15. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data

    Directory of Open Access Journals (Sweden)

    Michael J. Baine

    2014-01-01

    Full Text Available Objectives. We examined the role of radiation therapy (RT in pancreatic adenocarcinoma (PA treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS were age, gender, race, stage, year of diagnosis, and treatment with surgery, chemotherapy (CT, or RT. Time to death was plotted by Kaplan-Meier method. A Cox proportional hazards model was used to evaluate prognostic factors for OS. Results. The median OS was 7.3 and 5 months for patients from UNMC and the SEER database, respectively. A Cox model of patients from UNMC showed that RT was associated with improved OS (HR 0.77, P=0.018 after adjusting for factors including age, race, gender, stage, year of diagnosis, having surgery, or having CT. Cox analysis of patients from the SEER showed similar results (HR 0.65, P<0.0001. Conclusions. RT confers an independent survival advantage in patients being treated for PA which is apparent both at UNMC and through SEER data.

  16. A score model for predicting post-liver trans-plantation survival in HBV cirrhosis-related hepatocellular carcinoma recipients:a single center 5-year experience

    Institute of Scientific and Technical Information of China (English)

    Li-Ying Wang; Xin-Hua Chen; Tian-An Jiang; Fen Chen; Shu-Sen Zheng; Xiao Xu; Wei-Lin Wang; Jian Wu; Min Zhang; Yan Shen; Sheng Yan; Hai-Yang Xie

    2015-01-01

    BACKGROUND: The prognostic prediction of liver transplan-tation (LT) guides the donor organ allocation. However, there is currently no satisfactory model to predict the recipients' outcome, especially for the patients with HBV cirrhosis-re-lated hepatocellular carcinoma (HCC). The present study was to develop a quantitative assessment model for predicting the post-LT survival in HBV-related HCC patients. METHODS: Two hundred and thirty-eight LT recipients at the Liver Transplant Center, First Affiliated Hospital, Zhejiang University School of Medicine between 2008 and 2013 were included in this study. Their post-LT prognosis was recorded and multiple risk factors were analyzed using univariate and multivariate analyses in Cox regression. RESULTS: The score model was as follows: 0.114×(Child-Pugh score)-0.002×(positive HBV DNA detection time)+0.647× (number of tumor nodules)+0.055×(max diameter of tumor nodules)+0.231×lnAFP+0.437×(tumor differentiation grade). The receiver operating characteristic curve analysis showed that the area under the curve of the scoring model for predict-ing the post-LT survival was 0.887. The cut-off value was 1.27, which was associated with a sensitivity of 72.5% and a speci-ficity of 90.7%, respectively. CONCLUSION: The quantitative score model for predicting post-LT survival proved to be sensitive and specific.

  17. Influence of Access, Anticoagulant, and Bleeding Definition on Outcomes of Primary Percutaneous Coronary Intervention: Early Experience of an US Academic Center.

    Science.gov (United States)

    Bheemarasetti, M K; Shawar, S; Chithri, S; Khalife, W I; Rangasetty, U M; Fujise, K; Gilani, S A

    2015-03-01

    Background We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22% in radial/bivalirudin vs. 5% in radial/heparin vs. 17% in femoral/bivalirudin vs. 28% in femoral/heparin group; p = 0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p definition, it went up to 25 % due to one particular component (p definition on bleeding outcomes.

  18. Recent Experiences of the NASA Engineering and Safety Center (NESC) Guidance Navigation and Control (GN and C) Technical Discipline Team (TDT)

    Science.gov (United States)

    Dennehy, Cornelius J.

    2011-01-01

    The NASA Engineering and Safety Center (NESC) is an independently funded NASA Program whose dedicated team of technical experts provides objective engineering and safety assessments of critical, high risk projects. NESC's strength is rooted in the diverse perspectives and broad knowledge base that add value to its products, affording customers a responsive, alternate path for assessing and preventing technical problems while protecting vital human and national resources. The Guidance Navigation and Control (GN&C) Technical Discipline Team (TDT) is one of fifteen such discipline-focused teams within the NESC organization. The TDT membership is composed of GN&C specialists from across NASA and its partner organizations in other government agencies, industry, national laboratories, and universities. This paper will briefly define the vision, mission, and purpose of the NESC organization. The role of the GN&C TDT will then be described in detail along with an overview of how this team operates and engages in its objective engineering and safety assessments of critical NASA.

  19. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center.

    Science.gov (United States)

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J

    2012-11-01

    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  20. Results and experience of an aquifer thermal energy storage for heating and cooling of an office building and a demonstration center

    Energy Technology Data Exchange (ETDEWEB)

    Bael, Johan van; Desmedt, Johan; Vanhoudt, Dirk [Vlaamse Instelling voor Technologisch Onderzoek (VITO), Mol (Belgium)

    2010-07-01

    Aquifer Thermal Energy Storage (ATES) was introduced in the Belgian market since 1995. Until now over 10 installations with a thermal power of more than 300 kW cooling are installed. One of the first projects consists of the integration of ATES with a nominal power of 570 kWh in an existing office building and a new built demonstration center (3,000 m{sup 2}) for new lighting systems. The ATES system exists of a doublet: a cold and a warm well. The groundwater flow between the wells amounts to 90 m{sup 3}/h in the cooling modus and 45 m{sup 3}/h in the heating modus. The ATES system delivers the complete cooling demand of both buildings and a part of the heating demand. A gas fired boiler delivers the remaining heat demand. The project was funded by the Flemish Government in the Program of the Flemish Energy Demonstration Projects. The research institute VITO monitored the project during an evaluation period of three years. The energy flows (cooling and heating delivered to both buildings), the groundwater flow, the groundwater temperatures, the electricity consumption of the ATES and the gas consumption of the boiler were measured and stored every 30 minutes. This paper provides an overview of the monitoring results. (orig.)

  1. A time-resolved iron-specific X-ray absorption experiment yields no evidence for an Fe2+ --> Fe3+ transition during QA- --> QB electron transfer in the photosynthetic reaction center.

    Science.gov (United States)

    Hermes, Sabine; Bremm, Oliver; Garczarek, Florian; Derrien, Valerie; Liebisch, Peter; Loja, Paola; Sebban, Pierre; Gerwert, Klaus; Haumann, Michael

    2006-01-17

    Previous time-resolved FTIR measurements suggested the involvement of an intermediary component in the electron transfer step Q(A)- --> Q(B) in the photosynthetic reaction center (RC) from Rhodobacter sphaeroides [Remy and Gerwert (2003) Nat. Struct. Biol. 10, 637]. By a kinetic X-ray absorption experiment at the Fe K-edge we investigated whether oxidation occurs at the ferric non-heme iron located between the two quinones. In isolated reaction centers with a high content of functional Q(B), at a time resolution of 30 micros and at room temperature, no evidence for transient oxidation of Fe was obtained. However, small X-ray transients occurred, in a similar micro- to millisecond time range as in the IR experiments, which may point to changes in the Fe ligand environment due to the charges on Q(A)- and Q(B)-. In addition, VIS measurements agree with the IR data and do not exclude an intermediate in the Q(A)- --> Q(B) transition.

  2. 实验中心主页防篡改系统的研究及实现%Research and Realization of the Homepage Tamper-proof System for the Experiment Center

    Institute of Scientific and Technical Information of China (English)

    赵维佺; 魏小锐; 刘永波; 熊辉

    2012-01-01

    Experiment center homepage is the main platform for lab open management, exhibition exchange. Because of the present serious network security situation, based on the tamper-proof system design principle and the current main technology, a webpageltamper-proof is designed for experiment center. Starting with the deployment way and implementation ,principle of webpage system, three major modules design of web firewall, real-time blocking and intelligent analysis are discussed.%实验中心主页是中心进行开放管理、对外展示和技术交流的主要平台,针对目前严峻的网络安全形势,基于对网页防篡改系统设计原理和目前主流技术的分析,为实验中心设计实现了一类网页防篡改系统。从网页防篡改系统的部署方式、实现原理入手,对Web防火墙、实时阻断模块和BI智能分析模块三大模块的设计进行了阐述。

  3. Management of Unfavorable Outcomes in Head and Neck Free Flap Reconstruction: Experience-Based Lessons from the MD Anderson Cancer Center.

    Science.gov (United States)

    Chang, Edward I; Hanasono, Matthew M; Butler, Charles E

    2016-10-01

    Complex head and neck reconstruction often mandates free tissue transfer to achieve the most optimal outcomes. Unfortunately, such challenging cases are not without risks of complications, the most dreaded of which is loss of the free flap. Aside from loss of the free flap, there are several other potential complications that can result following head and neck reconstruction. Certain complications are avoided with careful planning, others require significant revisions and in certain cases another free flap. This article presents the experience managing a series of unique complications following free flap head and neck reconstruction.

  4. Centering research

    DEFF Research Database (Denmark)

    Katan, Lina Hauge; Baarts, Charlotte

    and collected 24 portfolios in which students reflect auto-ethnographically on their educational practices. Analyzing this qualitative material, we explore how researchers and students respectively read and write to develop and advance their thinking in those learning processes that the two groups fundamentally...... share as the common aim of both research and education. Despite some similarities, we find that how the two groups engage in and benefit from reading and writing diverges significantly. Thus we have even more reason to believe that centering practice-based teaching on these aspects of research is a good...

  5. Radiofrequency Thermoablation of HCC Larger Than 3 cm and Less Than 5 cm Proximal to the Gallbladder without Gallbladder Isolation: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Antonio Orlacchio

    2014-01-01

    Full Text Available Radiofrequency ablation (RFA is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC, but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%. Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder.

  6. A Review of and Recommendations for the Management of Patients With Life-Threatening Dabigatran-Associated Hemorrhage: A Single-Center University Hospital Experience.

    Science.gov (United States)

    Kumar, Rohit; Smith, Roy E; Henry, Brian L

    2015-12-01

    Dabigatran is an oral direct thrombin inhibitor that is approved for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Dabigatran has several advantages over warfarin including predictable pharmacokinetics and pharmacodynamics which eliminates the need for routine laboratory monitoring, superiority over warfarin in preventing stroke, or systemic embolism without having an increased risk of bleeding. However, as with any anticoagulant, there remains a real chance of bleeding, including major or life-threatening hemorrhage. Many physicians feel comfortable managing bleeding complications on older anticoagulants like warfarin and heparin, due to extensive experience with the medications along with antidotes to reverse their effects as well as established protocols for treating anticoagulant-associated hemorrhage. However, most physicians have limited clinical experience with dabigatran, there is no specific antidote for dabigatran reversal and there is a paucity of protocols, guidelines, and recommendations for how to manage dabigatran-associated hemorrhage. In this review, we present a case series of patients admitted to our institution for management of bleeding while receiving dabigatran. We retrospectively reviewed these cases to evaluate the efficacy and rationale of the various anticoagulation reversal strategies employed in the context of the existing evidence found in the literature. Specific focus is placed on the therapies utilized and the coagulation studies used to manage these patients.

  7. The Extended-OPQ Method for User-Centered Quality of Experience Evaluation: A Study for Mobile 3D Video Broadcasting over DVB-H

    Directory of Open Access Journals (Sweden)

    Jumisko-Pyykkö Satu

    2011-01-01

    Full Text Available Abstract The Open Profiling of Quality (OPQ is a mixed methods approach combining a conventional quantitative psychoperceptual evaluation and qualitative descriptive quality evaluation based on naïve participants' individual vocabulary. The method targets evaluation of heterogeneous and multimodal stimulus material. The current OPQ data collection procedure provides a rich pool of data, but full benefit of it has neither been taken in the analysis to build up completeness in understanding the phenomenon under the study nor has the procedure in the analysis been probed with alternative methods. The goal of this paper is to extend the original OPQ method with advanced research methods that have become popular in related research and the component model to be able to generalize individual attributes into a terminology of Quality of Experience. We conduct an extensive subjective quality evaluation study for 3D video on mobile device with heterogeneous stimuli. We vary factors on content, media (coding, concealments, and slice modes, and transmission levels (channel loss rate. The results showed that advanced procedures in the analysis cannot only complement each other but also draw deeper understanding on Quality of Experience.

  8. Change in the risk stratification of prostate cancer after Slide Review by a uropathologist: the experience of a reference center for the treatment of prostate cancer

    Directory of Open Access Journals (Sweden)

    George Camara-Lopes

    2014-08-01

    Full Text Available Introduction Brachytherapy is an option for treating low-risk prostate cancer (PC. Biochemical control of low-risk disease can reach 95%. The practice advocated is that a review of prostate biopsies should be mandatory before choosing the best treatment for patients with PC. Our objective was to evaluate the change in PC risk after review of a prostate biopsy by an experienced uropathologist at a reference hospital. Materials and Methods Between December 2003 and August 2012, 182 men were referred to our institution for brachytherapy to treat PC. Their slides were reviewed by the same uropathologist. Results and Discussion Classification risk disagreement occurred in 71 (39% cases, including one in which no tumor was observed. The main cause of risk change was related to the Gleason score (GS, with 57 (81.4% cases upgraded to GS 7 or 8. Tumor volume was also compared, although only the number of fragments was reported in most original reports. The concordance of the number of cores affected by tumor was 43.9%, and in 49% of the cases, the number was decreased by the uropathologist. Perineural invasion (PNI was reported in one quarter of original reports, and the agreement was 58%. Conclusion Slide review by an uropathologist remains essential at reference radiotherapy centers for the treatment of PC. The change in PC risk evaluation is mainly due to the GS, but tumor volume and PNI, which are important for the characterization of tumor aggressiveness, are also misinterpreted and could drive a change in the therapy choice.

  9. Epstein-Barr virus (EBV) positive diffuse large B cell lymphoma of the elderly-experience of a single center from Turkey.

    Science.gov (United States)

    Ozsan, Nazan; Cagirgan, Seckin; Saydam, Guray; Gunes, Ajda; Hekimgil, Mine

    2013-08-01

    In the 2008 WHO lymphoma classification, 'EBV-positive diffuse large B cell lymphoma (DLBCL) of the elderly is included as a new provisional entity. We aimed to evaluate the morphological, immunophenotypic, and clinical characteristics of the cases diagnosed as 'EBV-positive DLBCL of the elderly' in our center and compared them with the 'EBV-negative DLBCL' patients older than 50 years of age. EBV status was detected by Epstein-Barr early RNA (EBER) in situ hybridization analysis. By immunohistochemistry, a panel of antibodies for CD10, Bcl-2, Bcl-6, IRF4/MUM1, CD30, and Ki67 was performed. Out of 149 DLBCL patients older than 50 years, without any known history of immunodeficiency or prior lymphoma, eight patients who fulfill the criteria were re-evaluated. Five patients were male and three were female, with a median age of 67.6 years. Four patients presented with nodal involvement; others presented with bone and soft tissue, bone marrow, and spleen infiltrations. Five cases revealed predominantly monomorphic morphology, one also contained focal areas consistent with polymorphous subtype; and three patients revealed a polymorphous infiltrate. When classified according to 'Hans criteria', five were non-GCB, and three were of the GCB cell phenotype. All cases with polymorphous morphology were revealed to be of the non-GCB cell phenotype, and all expressed IRF4/MUM1. Two patients died with disease, four patients are alive and in complete remission following R-CHOP therapy, and two patients have just recently been diagnosed. When compared with the EBV-negative group, there are no reliable morphological and immunohistochemical features indicating EBV positivity. Therefore, EBER in situ hybridization analysis is necessary to identify 'EBV-positive DLBCL of the elderly'. Further studies are needed to fully understand the details of this disease, which can lead to new treatment modalities.

  10. Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

    Directory of Open Access Journals (Sweden)

    Fabio Luiz de Menezes Montenegro

    2012-01-01

    Full Text Available Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1 is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

  11. Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

    Science.gov (United States)

    de Menezes Montenegro, Fabio Luiz; Lourenço, Delmar Muniz; Tavares, Marcos Roberto; Arap, Sergio Samir; Nascimento, Climerio Pereira; Neto, Ledo Mazzei Massoni; D'Alessandro, André; Toledo, Rodrigo Almeida; Coutinho, Flávia Lima; Brandão, Lenine Garcia; de Britto e Silva Filho, Gilberto; Cordeiro, Anói Castro; Toledo, Sergio Pereira Almeida

    2012-01-01

    Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. PMID:22584718

  12. Epidemiological and Clinical Features of Cervical Column and Cord Injuries; A 2-Year Experience from a Large Trauma Center in Southern Iran

    Directory of Open Access Journals (Sweden)

    Hamid Reza Kamravan

    2014-01-01

    Full Text Available Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran. Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients’ characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment(non-operative or operative and clinical outcome. The data were described and compared with the international literature. Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury (with or without spine cord injury was confirmed in 206 patients. The mean age of patients was 37.2±15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 (29.1% patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31(15.1% patients. Open surgery was performed in 65(31.6%.Mortality rate was 7.3% (15 patients.Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury. Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 (10% cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group.

  13. Early subclinical rejection treated with low dose i.v. steroids is not associated to graft survival impairment: 13-years' experience at a single center.

    Science.gov (United States)

    Gigliotti, Paolo; Lofaro, Danilo; Leone, Francesca; Papalia, Teresa; Senatore, Massimino; Greco, Rosita; Perri, Anna; Vizza, Donatella; Lupinacci, Simona; Toteda, Giuseppina; La Russa, Antonella; De Stefano, Roberto; Romeo, Francesco; Bonofiglio, Renzo

    2016-06-01

    Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01-1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03-1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70-16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids.

  14. Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years’ Experience in 87 Patients from Two Centers

    Energy Technology Data Exchange (ETDEWEB)

    Palussiere, Jean, E-mail: J.Palussiere@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Interventional Radiology (France); Lagarde, Philippe, E-mail: P.Lagarde@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Center, Radiation Oncology Department (France); Aupérin, Anne, E-mail: auperin@igr.fr [Institut Gustave-Roussy, Unit of Biostatistics and Epidemiology (France); Deschamps, Frédéric, E-mail: frederic.deschamps@igr.fr [Institut Gustave-Roussy, Department of Interventional Radiology (France); Chomy, François, E-mail: F.Chomy@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Center, Department of medical oncology (France); Baere, Thierry de, E-mail: debaere@igr.fr [Institut Gustave-Roussy, Department of Interventional Radiology (France)

    2015-02-15

    PurposeTo evaluate the survival outcomes of percutaneous thermal ablation (RFA + microwaves) for patients presenting N0 non-small-cell lung cancer (NSCLC) ineligible for surgery.Materials and MethodsEighty-seven patients from two comprehensive cancer centers were included. Eighty-two patients were treated with RFA electrodes and five with microwave antenna. Overall survival (OS) and disease-free survival (DFS) were estimated and predictive factors of local tumor progression, OS and DFS identified and compared by univariate and multivariate analysesResultsMedian follow-up was 30.5 months (interquartile range 16.7–51) and tumor size was 21 mm (range 10–54 mm). Treatment was incomplete for 14 patients with a local tumor progression of 11.5, 18.3, and 21.1 % at 1, 2, and 3 years, respectively. Two patients presented with neurological (grade III or IV) complications, and one died of respiratory and multivisceral failure as a result of the procedure at 29 days. In univariate analysis, increasing tumor size (P = 0.003) was the only predictive factor related to risk of local tumor progression. 5-year OS and DFS were 58.1 and 27.9 %, respectively. Sex (P = 0.044), pathology (P = 0.032), and tumor size >2 cm (P = 0.046) were prognostic factors for DFS. In multivariate analysis, pathology (P = 0.033) and tumor size >2 cm (P = 0.032) were independent prognostic factors for DFS.ConclusionsOversized and overlapping ablation of N0 NSCLC was well tolerated, effective, with few local tumor progressions, even over long-term follow-up. Increasing tumor size was the main prognostic factor linked to OS, DFS, and local tumor progression.

  15. Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients with Acute Cardiopulmonary Failure: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Ying-Jui Lin

    2013-02-01

    Full Text Available Background: Conventional therapy against acute pediatric cardiopulmonary failure (APCPF caused by a variety of disease entities remains unsatisfactory with extremely high morbidity and mortality. For refractory APCPF, extracorporeal membrane oxygenation (ECMO is one of the last resorts. Methods: In this study, the in-hospital outcomes of pediatric patients with refractory APCPF receiving ECMO support were reviewed. Results: Between August 2006 and May 2011, a single-center cohort study was performed in pediatric patients who required ECMO support due to cardiogenic shock or severe hypoxemia. A total of 22 patients with mean age of 7.0 ± 6.3 years received ECMO (male = 11; female = 11. The indications included acute fulminant myocarditis (AFM (n = 6, congenital diaphragmatic hernia (CDH (n = 3, acute respiratory distress syndrome (ARDS (n = 6, enterovirus 71 (n = 3, viral sepsis (n = 2, refractory ventricular fibrillation due to long QT syndrome (n = 1, and pulmonary edema with brain herniation (n = 1. Eighteen patients received veno-arterial (VA mode ECMO, while another four patients undertook the veno-venous (VV mode. The duration of ECMO use and hospitalization were 6.1 ± 3.1 and 24.4 ± 19.4 days, respectively. The survival rate in patients with AFM was 100% (n = 6. Successful ECMO weaning with uneventful discharge from hospital was noted in 14 (63.6% patients, whereas in-hospital mortality despite successful ECMO weaning occurred in 5 patients (22.7%. Failure in ECMO weaning and in-hospital death was noted in 3 patients (13.6%. Conclusions: ECMO resuscitation is an effective strategy in the clinical setting of APCPF.

  16. Kinetics of the addition of olefins to Si-centered radicals: the critical role of dispersion interactions revealed by theory and experiment.

    Science.gov (United States)

    Johnson, Erin R; Clarkin, Owen J; Dale, Stephen G; DiLabio, Gino A

    2015-06-04

    Solution-phase rate constants for the addition of selected olefins to the triethylsilyl and tris(trimethylsilyl)silyl radicals are measured using laser-flash photolysis and competition kinetics. The results are compared with predictions from density functional theory (DFT) calculations, both with and without dispersion corrections obtained from the exchange-hole dipole moment (XDM) model. Without a dispersion correction, the rate constants are consistently underestimated; the errors increase with system size, up to 10(6) s(-1) for the largest system considered. Dispersion interactions preferentially stabilize the transition states relative to the separated reactants and bring the DFT-calculated rate constants into excellent agreement with experiment. Thus, dispersion interactions are found to play a key role in determining the kinetics for addition reactions, particularly those involving sterically bulky functional groups.

  17. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"

    Directory of Open Access Journals (Sweden)

    Van Royen Paul

    2009-08-01

    Full Text Available Abstract Background Most research publications on Chronic Care Model (CCM implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Methods Process evaluation of an action research project (2003–2007 guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC. A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. Results The overall ACIC score improved from 1.45 (limited support at the start of the study to 5.5 (basic support at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Conclusion Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care

  18. Primary bone tumors of the spine revisited: A 10-year single-center experience of the management and outcome in a neurosurgical department

    Directory of Open Access Journals (Sweden)

    Christopher Munoz-Bendix

    2015-01-01

    Full Text Available Objective: To report a large clinical series of primary bone tumors of the spine (PBTS and review the current concepts of management. Materials and Methods: We retrospectively analyzed a clinical series of PBTS treated over the last decade (2004-2014 in the spine unit of a large European tertiary care center. Every PBTS was identified from an electronic medical-record system. Analysis comprised medical records and clinical imaging. Overall survival and outcome was measured using the Glasgow Outcome Scale (GOS at six weeks, six months and one year postoperatively. Surgical management and adjuvant/neoadjuvant strategies were analyzed. A thorough review of the current literature was performed. Results: A total of 79 patients were included. Of these, 44 (55.7% were male. The age ranged from 9 to 90 years (mean 55, and most patients were adults (93.6%. Local pain was the most common symptom and was present in 91.1% of the patients. The majority of the tumors occurred in the thoracic spine (52 patients, 65.8%. Overall 86% (68 patients of PBTS were classified as malignant and at the time of diagnosis, 7 patients (8.9% presented with non-spinal metastasis. The most common histologic types were hematopoietic tumors (72.2%, followed by chondrogenic ones (12.7%. Within hematopoietic tumors, plasmacytoma was the most frequent type (49 patients, 62%. In 12 patients (15.2% recurrences were seen during the follow-up period. Overall mean survival of benign PBTS was 100%, malignant non-hematopoietic PBTS 50% and, malignant hematopoietic PBTS 84% at one year, respectively. At six weeks and one year after the initial surgery, 79% and 54% of the patients presented a GOS >3, respectively. Conclusion: PBTS were almost exclusively seen in adults. Malignant tumors were markedly more frequent than benign tumors, with hematopoietic tumors being the most common type. For PBTS, early surgery is important in order to restore spinal stability and decompress the spinal cord

  19. Treatment of Advanced or Recurrent Endometrial Carcinoma with Doxorubicin in Patients Progressing after Paclitaxel/Carboplatin: Memorial Sloan-Kettering Cancer Center (MSKCC) Experience from 1995-2009

    Science.gov (United States)

    Makker, Vicky; Hensley, Martee L.; Zhou, Qin; Iasonos, Alexia; Aghajanian, Carol. A.

    2013-01-01

    Objective Long-term survival for patients with advanced endometrial carcinoma is poor, and limited options exist for the management of recurrent disease. Our goal was to investigate the activity of doxorubicin in the second-line setting in patients who progressed after paclitaxel/carboplatin adjuvant treatment. Methods We conducted a retrospective analysis of patients with recurrent endometrial carcinoma who were treated at Memorial Sloan-Kettering Cancer Center from 1995-2009, and who received paclitaxel/carboplatin adjuvant chemotherapy followed by second-line doxorubicin therapy at time of recurrence. The median PFS and OS times following paclitaxel/carboplatin and following second-line doxorubicin therapy were estimated using the Kaplan-Meier method. Toxicity was assessed by the treating physician at each visit and graded using version 4.0 of Common Terminology Criteria for Adverse Events (CTCAE). Patient presentation, treatment, patterns of recurrence, and patient outcomes were summarized. Results Seventeen patients were included in study analyses. The median PFS from completion of paclitaxel/carboplatin was 8.0 months (95% CI: 4.5-13.6 months). At the time of recurrence, all 17 patients were treated with doxorubicin as second-line therapy. No patient achieved objective response of stable disease. The median PFS of this cohort following doxorubicin treatment was 2.1 months (95% CI: 0.95-2.7) months. Median OS was 5.8 months (95% CI: 1.0-15.0 months). There is only one patient still alive; her median follow-up time is 49.4 months. Predominant doxorubicin-related grade 2 toxicities included nausea/vomiting (18.8%), fatigue (18.8%), and neutropenia (12.5%). No grade 3 or 4 toxicities occurred. Conclusions Among patients with advanced endometrial carcinoma who had received adjuvant paclitaxel/carboplatin, treatment with doxorubicin at time of disease recurrence failed to achieve any objective responses and was associated with a very short (2 months) time to

  20. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Sopka, Dennis M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Li Tianyu [Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States); Klayton, Tracy; Li Jinsheng; Anderson, Penny R. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Bleicher, Richard J.; Sigurdson, Elin R. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Freedman, Gary M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

    2012-11-15

    Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered 'excellent', 33% 'good', and <1.5% 'fair/poor'. For physician-reported cosmesis, boost doses {>=}16 Gy, breast size >900 cc, or boost volumes >34 cc were significantly associated with a 'fair/poor' cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with 'fair/poor' physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported 'excellent', 'good', and 'fair/poor' cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with 'fair/poor' outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose {>=}16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy

  1. Predictive factors for obtaining a correct therapeutic range using antivitamin K anticoagulants: a tertiary center experience of patient adherence to anticoagulant therapy

    Directory of Open Access Journals (Sweden)

    Jurcuţ R

    2015-09-01

    and the patient’s living conditions, INR monitoring frequency, and bleeding history. Conclusion: In a tertiary cardiology center, more than half of patients receiving VKAs are admitted with an INR falling outside the therapeutic range, irrespective of the bleeding or embolic risk. Patients with a mechanical prosthesis and complex antithrombotic regimens appear to be the most careful with INR monitoring, especially if they have a higher level of education. Identifying patient groups with the lowest time interval spent in the therapeutic range could help attending physicians educate patients focusing on specific awareness issues. Keywords: anticoagulant therapy, antivitamin K agents, patient adherence, questionnaire

  2. Clinicopathologic Characteristics and Outcomes of Histiocytic and Dendritic Cell Neoplasms: The Moffitt Cancer Center Experience Over the Last Twenty Five Years

    Energy Technology Data Exchange (ETDEWEB)

    Dalia, Samir, E-mail: samir.dalia@mercy.net [Mercy Clinic Oncology and Hematology-Joplin, 3001 MC Clelland Park Blvd, Joplin, MO 64804 (United States); Jaglal, Michael; Chervenick, Paul [Department of Malignant Hematology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33602 (United States); Cualing, Hernani [IHCFLOW Histopathology Laboratory, University of South Florida, 18804 Chaville Rd., Lutz, FL 33558 (United States); Sokol, Lubomir [Department of Malignant Hematology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33602 (United States)

    2014-11-14

    and the role of adjuvant therapy is unclear. In patients with multiple areas of involvement, treatment at tertiary care centers with multimodality treatment is likely needed. Accurate subset diagnosis will contribute to better data as well as treatment outcomes analysis of these rare disorders of adult patients in the future.

  3. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-02-10

    .843, 95% CI 1.011-3.360, p = 0.046), spine procedures (OR 1.673, 95% CI 1.036-2.702, p = 0.035), acquired CNS abnormality (OR 1.620, 95% CI 1.085-2.420, p = 0.018), and female sex (OR 1.475, 95% CI 1.062-2.049, p = 0.021). The only COA factor independently associated with SSI in the COA database included clean-contaminated wound classification (OR 3.887, 95% CI 1.354-11.153, p = 0.012), with public insurance (OR 1.966, 95% CI 0.957-4.041, p = 0.066) and spine procedures (OR 1.982, 95% CI 0.955-4.114, p = 0.066) approaching significance. Both NSQIP-P and COA multivariate model C-statistics were > 0.7. CONCLUSIONS The NSQIP-P SSI rates, but not risk factors, were similar to data from a single center.

  4. Long-term outcomes of liver transplant patients with human immunodeficiency virus infection and end-stage-liver-disease: single center experience

    Directory of Open Access Journals (Sweden)

    Vernadakis S

    2011-08-01

    Full Text Available Abstract Objective Orthotopic-liver-transplantation (OLT in patients with Human-Immunodeficiency-Virus infection (HIV and end-stage-liver-disease (ESDL is rarely reported. The purpose of this study is to describe our institutional experience on OLT for HIV positive patients. Material and methods This is a retrospective study of all HIV-infected patients who underwent OLT at the University Hospital of Essen, from January 1996 to December 2009. Age, sex, HIV transmission-way, CDC-stage, etiology of ESDL, concomitant liver disease, last CD4cell count and HIV-viral load prior to OLT were collected and analysed. Standard calcineurin-inhibitors-based immunosuppression was applied. All patients received anti-fungal and anti-pneumocystis carinii pneumonia prophylaxis post-OLT. Results Eight transplanted HIV-infected patients with a median age of 46 years (range 35-61 years were included. OLT indications were HCV (n = 5, HBV (n = 2, HCV/HBV/HDV-related cirrhosis (n = 1 and acute liver-failure (n = 1. At OLT, CD4 cell-counts ranged from 113-621 cells/μl, and HIV viral-loads from Conclusions OLT in HIV-infected patients and ESLD is an acceptable therapeutic option in selected patients. Long-term survival can be achieved without HIV disease-progression under antiretroviral therapy and management of the viral hepatitis co-infection.

  5. Centered on the Customer Experience Breakthrough Express Industry Competition%以客户体验为核心突破快递业竞争格局

    Institute of Scientific and Technical Information of China (English)

    赵永全; 于海燕

    2014-01-01

    伴随着经济的稳步发展和行业的全方位竞争,如何在更加有效地满足客户需求的基础上实现企业利润的突破,让服务的竞争核心回归服务本身,是快递业亟需解决的重要问题。文中主要围绕以客户体验为中心的差异化服务对快递业未来发展进行有益的探析。%Along with the steady development of economy and the comprehensive competition of the industry ,it has been an important problem for express industry that how to gain a breakthrough profits based on meeting the demand of customers more effectively and making the service competition core return to the service itself .This article mainly around the customer experience analyze the future of express industry .

  6. Is surgical treatment of cancer of the gastric cardia or esophagus associated with a concurrent major pulmonary operation feasible?One center's experience

    Institute of Scientific and Technical Information of China (English)

    WANG Xiao-xin; LIU Tong-lin; WANG Pei; LI Jian

    2012-01-01

    Background Pulmonary complications are a major cause of mortality after operation for cancer of the gastric cardia or esophagus.Although the risk involved in gastric cardiectomy or esophagectomy associated with a concurrent major pulmonary operation is expected to be much higher,it has seldom been evaluated on the basis of clinical experience.The aim of this study was to investigate the possibility and feasibility of the gastric cardiectomy or esophagectomy associated with a major pulmonary operation.Methods From August 2003 to January 2011,14 patients underwent concurrent gastric cardiectomy or esophagectomy and a major pulmonary operation in our hospital.This included eight for pulmonary invasion of esophageal carcinoma,and six for synchronous lung tumor.All patients underwent systematic lymph node dissection for cardiac or esophageal cancer.To prevent postoperative complications,the operative approach and dissection procedures for cardiac or esophageal carcinoma were modified according to the associated pulmonary operation and the extent of cancer invasion.All thoracotomies for cardiectomy or esophagectomy were performed on the same side as the major pulmonary operation.Results All patients underwent a curative operation.There were no deaths or postoperative complications in the six synchronous lung tumor patients.In the eight pulmonary invasion patients,one patient died of respiratory failure 11 days after operation,and postoperative complications developed in four of them,but none was fatal.Six patients were still alive.Conclusions Curative gastric cardiectomy or esophagectomy associated with concurrent major pulmonary operation is not contraindicated in patients in good condition.In selected patients,when the operative procedures for cardiectomy or esophagectomy are appropriately modified to minimize the effect of the associated pulmonary operation,the treatment is associated with a low operative morbidity and mortality with an acceptable long-term survival.

  7. Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients.

    Science.gov (United States)

    Sæhle, Terje; Eide, Per Kristian

    2015-05-01

    OBJECT In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. METHODS The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms. RESULTS The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%). Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than -5 to -10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any

  8. Predictive Parameters of CyberKnife Fiducial-less (XSight Lung) Applicability for Treatment of Early Non-Small Cell Lung Cancer: A Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Bahig, Houda; Campeau, Marie-Pierre; Vu, Toni; Doucet, Robert; Béliveau Nadeau, Dominic [Radiation Oncology Department, Centre Hospitalier de l' Université de Montréal, Montréal, Quebec (Canada); Fortin, Bernard [Radiation Oncology Department, Maisonneuve-Rosemont Hospital, Montréal, Quebec (Canada); Roberge, David; Lambert, Louise; Carrier, Jean-François [Radiation Oncology Department, Centre Hospitalier de l' Université de Montréal, Montréal, Quebec (Canada); Filion, Edith, E-mail: edith.filion.chum@ssss.gouv.qc.ca [Radiation Oncology Department, Centre Hospitalier de l' Université de Montréal, Montréal, Quebec (Canada)

    2013-11-01

    Purpose: To determine which parameters allow for CyberKnife fiducial-less tumor tracking in stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. Methods and Materials: A total of 133 lung SBRT patients were preselected for direct soft-tissue tracking based on manufacturer recommendations (peripherally located tumors ≥1.5 cm with a dense appearance) and staff experience. Patients underwent a tumor visualization test to verify adequate detection by the tracking system (orthogonal radiographs). An analysis of potential predictors of successful tumor tracking was conducted looking at: tumor stage, size, histology, tumor projection on the vertebral column or mediastinum, distance to the diaphragm, lung-to-soft tissue ratio, and patient body mass index. Results: Tumor visualization was satisfactory for 88 patients (66%) and unsatisfactory for 45 patients (34%). Median time to treatment start was 6 days in the success group (range, 2-18 days) and 15 days (range, 3-63 days) in the failure group. A stage T2 (P=.04), larger tumor size (volume of 15.3 cm{sup 3} vs 6.5 cm{sup 3} in success and failure group, respectively) (P<.0001), and higher tumor density (0.86 g/cm{sup 3} vs 0.79 g/cm{sup 3}) were predictive of adequate detection. There was a 63% decrease in failure risk with every 1-cm increase in maximum tumor dimension (relative risk for failure = 0.37, CI=0.23-0.60, P=.001). A diameter of 3.6 cm predicted a success probability of 80%. Histology, lung-to-soft tissue ratio, distance to diaphragm, patient's body mass index, and tumor projection on vertebral column and mediastinum were not found to be predictive of success. Conclusions: Tumor size, volume, and density were the most predictive factors of a successful XSight Lung tumor tracking. Tumors >3.5 cm have ≥80% chance of being adequately visualized and therefore should all be considered for direct tumor tracking.

  9. 心脏死亡器官捐献单中心经验总结%Single-center experience of organ donation after cardiac death

    Institute of Scientific and Technical Information of China (English)

    邓永林; 张玮晔; 张雅敏; 蔡金贞; 赵颖; 仲莹; 沈中阳

    2012-01-01

    目的 总结单中心开展心脏死亡器官捐献(DCD)的病历资料和经验.方法 自2010年3月至2011年10月,采用Maastricht分类第Ⅲ类标准作为潜在捐献者的临床选择标准,共发现56例潜在捐献者.56例中,40例未同意捐献,16例同意捐献(其中1例在治疗过程中因全身严重感染放弃了器官获取),最终15例成功捐献,共获取12个肝脏和22个肾脏用于移植.结果 12例肝移植受者恢复良好.20例肾移植受者中,2例采用双肾带膀胱袢移植的受者术后切除了移植肾,另外2例术后分别由于移植肾破裂和血栓形成而切除移植肾,其余受者恢复良好.结论 公民心脏死亡器官捐献可以扩大供者来源,但需严格掌握潜在捐献者的筛选标准.%Objective To summarize our experience of harvesting and using the organs of donors after cardiac death.Methods Form March 2010 to October 2011,56 potential donors were diagnosed with cardiac death,who conformed to the classification of Maastricht Ⅲ criteria.There were 40 failure cases whose family refused to donate,and one failure case who suffered from serious infection.Finally,the success ratio of donation after cardiac death was 26.8% (15/56).Twelve livers and 22 kidneys were transplanted into 12 and 20 recipients respectively.Results Twelve cases of liver transplantations had acceptable outcomes. The grafts of 4 cases out of 20 cases of kidney transplantations were removed after transplantation,and other recipients had acceptable outcomes.Conclusion Citizens organ donation after cardiac death can expand the number of suitable organs,but we need to strictly control the criteria for potential donors.

  10. Systematics of Scissors Mode in Gd Nuclei from Experiments with the DANCE Detector

    Science.gov (United States)

    Kroll, J.; Agvaanluvsan, U.; Baramsai, B.; Becker, J. A.; Bečvář, F.; Bredeweg, T. A.; Chyzh, A.; Couture, A.; Dashdorj, D.; Haight, R. C.; Jandel, M.; Keksis, A. L.; Krtička, M.; Mitchell, G. E.; O'Donnell, J. M.; Parker, W.; Rundberg, R. S.; Ullmann, J. L.; Valenta, S.; Vieira, D. J.; Walker, C. L.; Wilhelmy, J. B.; Wouters, J. M.; Wu, C. Y.

    2014-05-01

    Multi-step cascade γ-ray spectra from neutron capture at isolated resonances of 152,154-158Gd nuclei were measured at the LANSCE/DANCE time-of-flight facility in Los Alamos National Laboratory. The main objective of these experiments was to obtain new information on photon strength functions with emphasis on the role of the M1 scissors mode vibration. An analysis of the data obtained shows that the scissors mode plays a significant role in the ground state transitions, as well as in the transitions populating all excited states of the studied nuclei. The estimates of the scissors mode strength indicate that for 157,159Gd this strength is significantly higher than in neighboring even-even nuclei 156,158Gd. The results are compared with the (γ,γ‧) data for the ground-state scissors mode and the results from 3He-induced reactions.

  11. Orthographic Contributions to Perceived Word Center

    Science.gov (United States)

    Fischer, Martin H.

    2004-01-01

    We have a surprising tendency to misperceive the center of visually presented words (Fischer, 1996, 2000a, 2000b). To understand the origin of this bias, four experiments assessed the impact of letter font, letter size, and grapheme-phoneme convergences on perceived stimulus center. Fourteen observers indicated the perceived centers of words,…

  12. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature

    Institute of Scientific and Technical Information of China (English)

    Francesco; A; Polistina; Mauro; Frego; Marco; Bisello; Emy; Manzi; Antonella; Vardanega; Bortolo; Perin

    2015-01-01

    AIM: To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography(MRCP) without contrast medium and endoscopic ultrasound(EUS)/endoscopic retrograde cholangiopancreatography(ERCP) for biliary calculi. METHODS: From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven(55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calcul