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Sample records for clinical chemical values

  1. Short-term biological variation of clinical chemical values in dumeril's monitors (Varanus dumerili)

    DEFF Research Database (Denmark)

    Bertelsen, Mads Frost; Kjelgaard-Hansen, Mads Jens; Howell, Jennifer R.

    2007-01-01

    Plasma biochemical values are routinely used in the medical management of ill reptiles, and for monitoring the health of clinically normal animals. Laboratory tests, including clinical biochemical values, are subject to biological and analytical variation, the magnitude of which determines the ut...

  2. The Mayo Clinic Value Creation System.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Harper, C Michel; Noseworthy, John H

    2012-01-01

    The authors present Mayo Clinic's Value Creation System, a coherent systems engineering approach to delivering a single high-value practice. There are 4 tightly linked, interdependent phases of the system: alignment, discovery, managed diffusion, and measurement. The methodology is described and examples of the results to date are presented. The Value Creation System has been demonstrated to improve the quality of patient care while reducing costs and increasing productivity.

  3. The Nigerian Zanthoxylum : chemical and biological values ...

    African Journals Online (AJOL)

    The Nigerian Zanthoxylum is a common component of the rain forest vegetation of Southern Nigeria, and is represented by eleven species. ... The focus has been on the local uses and commercial importance of the species, the values of the various metabolites in medicine and their general potential in drug development.

  4. The social value of clinical research.

    Science.gov (United States)

    Habets, Michelle G J L; van Delden, Johannes J M; Bredenoord, Annelien L

    2014-09-05

    International documents on ethical conduct in clinical research have in common the principle that potential harms to research participants must be proportional to anticipated benefits. The anticipated benefits that can justify human research consist of direct benefits to the research participant, and societal benefits, also called social value. In first-in-human research, no direct benefits are expected and the benefit component of the risks-benefit assessment thus merely exists in social value. The concept social value is ambiguous by nature and is used in numerous ways in the research ethics literature. Because social value justifies involving human participants, especially in early human trials, this is problematic. Our analysis and interpretation of the concept social value has led to three proposals. First, as no direct benefits are expected for the research participants in first-in-human trials, we believe it is better to discuss a risk- value assessment instead of a risk - benefit assessment. This will also make explicit the necessity to have a clear and common use for the concept social value. Second, to avoid confusion we propose to limit the concept social value to the intervention tested. It is the expected improvement the intervention can bring to the wellbeing of (future) patients or society that is referred to when we speak about social value. For the sole purpose of gaining knowledge, we should not expose humans to potential harm; the ultimate justification of involving humans in research lies in the anticipated social value of the intervention. Third, at the moment only the validity of the clinical research proposal is a prerequisite for research to take place. We recommend making the anticipated social value a prerequisite as well. In this paper we analyze the use of the concept social value in research ethics. Despite its unavoidable ambiguity, we aim to find a best use of the concept, subject to its role in justifying involving humans in first

  5. Patients' Values in Clinical Decision-Making.

    Science.gov (United States)

    Faggion, Clovis Mariano; Pachur, Thorsten; Giannakopoulos, Nikolaos Nikitas

    2017-09-01

    Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Diagnostic value of chemical shift artifact in distinguishing benign lymphadenopathy

    Energy Technology Data Exchange (ETDEWEB)

    Farshchian, Nazanin, E-mail: farshchian.n@gmail.com [Department of Radiology, Kermanshah University of Medical Sciences, Kermanshah (Iran, Islamic Republic of); Tamari, Saghar; Farshchian, Negin [Department of Radiology, Kermanshah University of Medical Sciences, Kermanshah (Iran, Islamic Republic of); Madani, Hamid [Department of Pathology, Imam-Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah (Iran, Islamic Republic of); Rezaie, Mansour [Department of Biostatistics, Kermanshah University of Medical Sciences, Kermanshah (Iran, Islamic Republic of); Mohammadi-Motlagh, Hamid-Reza, E-mail: mohammadimotlagh@gmail.com [Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah (Iran, Islamic Republic of)

    2011-11-15

    Purpose: Today, distinguishing metastatic lymph nodes from secondary benign inflammatory ones via using non-invasive methods is increasingly favorable. In this study, the diagnostic value of chemical shift artifact (CSA) in magnetic resonance imaging (MRI) was evaluated to distinguish benign lymphadenopathy. Subjects and methods: A prospective intraindividual internal review board-approved study was carried out on 15 men and 15 women having lymphadenopathic lesions in different locations of the body who underwent contrast-enhanced dynamic MR imaging at 1.5 T. Then, the imaging findings were compared with pathology reports, using the statistics analyses. Results: Due to the findings of the CSA existence in MRI, a total of 56.7% of the studied lesions (17 of 30) were identified as benign lesions and the rest were malignant, whereas the pathology reports distinguished twelve malignant and eighteen benign cases. Furthermore, the CSA findings comparing the pathology reports indicated that CSA, with confidence of 79.5%, has a significant diagnostic value to differentiate benign lesions from malignant ones. Conclusion: Our study demonstrated that CSA in MR imaging has a suitable diagnostic potential nearing readiness for clinical trials. Furthermore, CSA seems to be a feasible tool to differentiate benign lymph nodes from malignant ones; however, further studies including larger numbers of patients are required to confirm our results.

  7. Value-added Chemicals from Biomass by Heterogeneous Catalysis

    DEFF Research Database (Denmark)

    Voss, Bodil

    feedstock, having retained one C-C bond originating from the biomass precursor, the aspects of utilising heterogeneous catalysis for its conversion to value added chemicals is investigated. Through a simple analysis of known, but not industrialised catalytic routes, the direct conversion of ethanol....... The results of the thesis, taking one example of biomass conversion, show that the utilisation of biomass in the production of chemicals by heterogeneous catalysis is promising from a technical point of view. But risks of market price excursions dominated by fossil based chemicals further set a criterion...... been implemented. The subject on chemical production has received less attention. This thesis describes and evaluates the quest for an alternative conversion route, based on a biomass feedstock and employing a heterogeneous catalyst capable of converting the feedstock, to a value-added chemical...

  8. Nutritional and chemical value of Amaranthus hybridus L. leaves ...

    African Journals Online (AJOL)

    The nutritional and chemical value of Amaranthus hybridus were investigated using standard analytical methods in order to assess the numerous potential of the plant leaves. The Proximate analysis showed the percentage moisture content, ash content, crude protein, crude lipid, crude fibre and carbohydrate of the leaves ...

  9. Chemical composition and nutritional value of boiled Christmas ...

    African Journals Online (AJOL)

    A study was conducted to determine the chemical composition and the nutritive value of boiled Christmas bush (Alchornea cordifolia) for starter broiler chickens. Dried Christmas bush fruits (Capsules + seed) were boiled for 30 minutes, sundried and ground into meal. The meal was analyzed for proximate composition and ...

  10. Chemical composition and nutritive value of irrigated tall fescue ...

    African Journals Online (AJOL)

    Chemical composition and nutritive value of irrigated tall fescue pasture for dairy cows. TJ Dugmore, KP Walsh, Sally J. Morning, CI MacDonald. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO ...

  11. Date fruit: chemical composition, nutritional and medicinal values, products.

    Science.gov (United States)

    Tang, Zhen-Xing; Shi, Lu-E; Aleid, Salah M

    2013-08-15

    Date fruit has served as a staple food in the Arab world for centuries. Worldwide production of date fruit has increased almost threefold over the last 40 years, reaching 7.68 million tons in 2010. Date fruit can provide many essential nutrients and potential health benefits to the consumer. Date fruit goes through four ripening stages named kimri, khalal, rutab and tamer. The main chemical components of date fruit include carbohydrates, dietary fibre, enzymes, protein, fat, minerals, vitamins, phenolic acids and carotenoids. The chemical composition of date fruit varies according to ripening stage, cultivar, growing environment, postharvest conditions, etc. The nutritional and medicinal activities of date fruit are related to its chemical composition. Many studies have shown that date fruit has antioxidant, antimutagenic, anti-inflammatory, gastroprotective, hepatoprotective, nephroprotective, anticancer and immunostimulant activities. Various date fruit-based products such as date syrup, date paste, date juice and their derived products are available. Date by-products can be used as raw materials for the production of value-added products such as organic acids, exopolysaccharides, antibiotics, date-flavoured probiotic-fermented dairy produce, bakery yeasts, etc. In this paper the chemical composition and nutritional and medicinal values of date fruit as well as date fruit-based products are reviewed. © 2013 Society of Chemical Industry.

  12. Value of FFR in clinical practice

    Directory of Open Access Journals (Sweden)

    Anil Mehra

    2015-01-01

    Full Text Available Fractional flow reserve is an important tool in the cardiac catheterization lab to assess the physiological significance of coronary lesions. This article discusses the basic concepts about FFR and its utility in clinical decision making.

  13. Value 101: the basics of clinical transformation.

    Science.gov (United States)

    Hancock, Melinda S

    2013-06-01

    Health systems should take strong steps to ensure that their current and aspiring finance leaders are fully prepared to engage with clinicians in meeting the requirements of healthcare reform. In 2012, Bon Secours held a clinical transformation finance intensive to teach finance staff how to accelerate clinical transformation within their markets. The education and skills that Bon Secours' finance professionals gained from the intensive have strengthened the health system's ability to respond to the challenges of reform.

  14. Radiation protection in clinical chemical laboratories

    International Nuclear Information System (INIS)

    Jacob, K.

    1980-01-01

    In the clinical-chemical laboratory, the problems of the personal radiation protection can be handled relatively simply. Important conditions are certain requirements as far as the building is concerned and the keeping to protection measures to invoid ingestion, inhalation, and resorption of open radioactive substances. Very intensive attention must be paid to a clean working technique in order to be able to exclude the danger of contamination which is very disturbing during the extremely sensitive measurements. The higgest problem in the handling of open radioactive substances, however, is in our opinion the waste management because it requires which space and personnel this causing high costs. Furthermore, since 1 January 1979, the permission for the final storage of radioactive waste in the shut down mine ASSE was taken back from the county collection places and it cannot be said yet if and when this permission will be given again. (orig./HP) [de

  15. The clinical value of CT in neuropediatrics

    International Nuclear Information System (INIS)

    Reisner, Th.

    1981-01-01

    Cranial computed-tomography (CT) has opened new dimensions in neuropediatric diagnosis. The relationship between clinical symptoms and CT results is presented. 1930 patients were investigated, one group is made up of 334 newborns and infants, the other group contains children in the age between 13 months and 15 years. Newborns and infants confront the neurologist with stereotyped deficiency symptoms which nevertheless can arise from many causes. CT can make an etiological classification. In childhood illnesses of neurophsychiatric nature sometimes predominate whose clinical symptoms are often minimal (e.g. cerebral seizures, hydrocephalus, perinatal brain damage, various types of headache etc.). Here again CT can give the clinical valuable indications concerning diagnosis and therapeutic procedure. (M.J.)

  16. Clinical value of CT in neuropediatrics

    Energy Technology Data Exchange (ETDEWEB)

    Reisner, Th. (Vienna Univ. (Austria). Neurologische Klinik)

    1981-11-27

    Cranial computed-tomography (CT) has opened new dimensions in neuropediatric diagnosis. The relationship between clinical symptoms and CT results is presented. 1930 patients were investigated, one group is made up of 334 newborns and infants, the other group contains children in the age between 13 months and 15 years. Newborns and infants confront the neurologist with stereotyped deficiency symptoms which nevertheless can arise from many causes. CT can make an etiological classification. In childhood illnesses of neurophyschiatric nature sometimes predominate whose clinical symptoms are often minimal (e.g. cerebral seizures, hydrocephalus, perinatal brain damage, various types of headache etc.). Here again CT can give the clinical valuable indications concerning diagnosis and therapeutic procedure.

  17. Clinical Considerations in the Assessment of Adolescent Chemical Dependency.

    Science.gov (United States)

    Winters, Ken

    1990-01-01

    Discusses relevant research findings of clinical assessment of adolescent chemical dependency so that service providers can better address these concerns. Three major issues are discussed: the definition of adolescent chemical dependency, clinical domains of assessment (chemical use problem severity, precipitating and perpetuating risk factors,…

  18. value-sensitive clinical accompaniment in community nursing science

    African Journals Online (AJOL)

    2010-11-05

    Nov 5, 2010 ... negative effects on clinical learning in community nursing science. The goal of this ..... such positive effect of value-sensitive communication during clinical .... computer games the whole morning; it was unpleasant);. 'Ons [die ...

  19. Clinical value of sodium iodide symporter

    International Nuclear Information System (INIS)

    Li Qian

    2003-01-01

    The sodium iodide symptorter (NIS) is a membrane glycoprotein that mediates iodide uptake in the thyroid gland and several extrathyroidal tissues. In addition to thyroid tissues, the expression of NIS is found in stomach, prostate, placenta and so on. Radioiodine-concentrating activity in thyroid tissues has allowed the use of radioiodine as a diagnostic and therapeutic agent for patients with thyroid disorders. However, some extrathyroid tissues also take up radioiodine, contributing to unwanted side effects of radioiodine therapy. Now that the molecule of NIS has been cloned and characterized, it may be possible to develop novel strategies to differentially modulate NIS expression and activity, enhancing it in target tissues and impeding it in others. It is also important to explore the use of NIS as an imaging reporter gene to monitor the expression profile of the transgene in transgenic mouse animal models and in patients undergoing gene therapy clinical trials

  20. Economic and clinical value of levofloxacin

    Directory of Open Access Journals (Sweden)

    Mario Eandi

    2006-12-01

    Full Text Available Levofloxacin is a newer fluoroquinolone, with broad spectrum of antibacterial activity and good tolerability. This drug has a pharmacokinetic and pharmacodynamic profile that allows a once-a-day administration and offers the potential for intravenous-to-oral switch therapy. Due to these characteristics, the principal guidelines recommend it, as an option for the empirical therapy of patients with mild or more severe community acquired pneumonia (CAP, acute exacerbation of chronic bronchitis (AECB, complicated urinary tract infection (cUTI and skin and soft tissue infection (SSTI. These pathologies are common causes of morbidity and mortality and place a large burden on medical and economic resources, specially if hospitalization is required. The implementation of a critical pathway, based on levofloxacin use and on a risk prediction rule to establish the need for hospitalization, has the potential to decrease healthcare resource consumption without impairment of clinical outcomes, with respect to conventional management. The possibility of switch therapy allows to reduce length of hospital stay, with a saving in both direct and indirect costs, and an increase in patient satisfaction. In summary, when used according to appropriateness criteria and for approved indications, levofloxacin offers favorable economic features for the healthcare provider, whilst guaranteeing a positive impact on patient functioning and quality of life.

  1. Clinical value of bile acids radioimmunoassay

    International Nuclear Information System (INIS)

    Breckwoldt, R.U.

    1981-01-01

    In 50 blood donors, 87 patients with various liver and bile disorders, 50 hemodialyse patients and 50 patients prior to and immediately after cardiac swigery, cholyl glycine (CG) and sulfolithocholyl glycine (SLCG) were determined. Long-term observations were carried out on a further 10 patients with non-A/non-B hepatitis and 10 patients without hepatitis. Correlations were found between the values of alkaline phosphatase, GPT, GOT and bilirubin. Consequently the determination of bile acid, here above all SLCG, constitutes a suitable means to detect subclinical functional liver disorders. The examination of the post-operative functional liver disorders following cardiac swigery showed that there is a distinct time shift between the mostly transitory increase in enzyme activity and the SLCG levels. Surprisingly, the long-term observations showed that increased bile acid levels are already measured during the hepatitis incubation period at normal enzyme activities. It was not possible, however to identify hepatitic patients already during incubation by assay of the bile acid level. Whereas the determination of standard laboratory parameters remains predominant in the description of liver cell damage, the importance of serum bile acid determination is seen in the description of functional liver disorders which are not characterized by increased enzyme activities. (orig.) [de

  2. Microbial chemical factories: recent advances in pathway engineering for synthesis of value added chemicals.

    Science.gov (United States)

    Dhamankar, Himanshu; Prather, Kristala L J

    2011-08-01

    The dwindling nature of petroleum and other fossil reserves has provided impetus towards microbial synthesis of fuels and value added chemicals from biomass-derived sugars as a renewable resource. Microbes have naturally evolved enzymes and pathways that can convert biomass into hundreds of unique chemical structures, a property that can be effectively exploited for their engineering into Microbial Chemical Factories (MCFs). De novo pathway engineering facilitates expansion of the repertoire of microbially synthesized compounds beyond natural products. In this review, we visit some recent successes in such novel pathway engineering and optimization, with particular emphasis on the selection and engineering of pathway enzymes and balancing of their accessory cofactors. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Understanding the value added to clinical care by educational activities. Value of Education Research Group.

    Science.gov (United States)

    Ogrinc, G S; Headrick, L A; Boex, J R

    1999-10-01

    In an era of competition in health care delivery, those who pay for care are interested in supporting primarily those activities that add value to the clinical enterprise. The authors report on their 1998 project to develop a conceptual model for assessing the value added to clinical care by educational activities. Through interviews, nine key stakeholders in patient care identified five ways in which education might add value to clinical care: education can foster higher-quality care, improve work satisfaction of clinicians, have trainees provide direct clinical services, improve recruitment and retention of clinicians, and contribute to the future of health care. With this as a base, an expert panel of 13 clinical educators and investigators defined six perspectives from which the value of education in clinical care might be studied: the perspectives of health-care-oriented organizations, clinician-teachers, patients, education organizations, learners, and the community. The panel adapted an existing model to create the "Education Compass" to portray education's effects on clinical care, and developed a new set of definitions and research questions for each of the four major aspects of the model (clinical, functional, satisfaction, and cost). Working groups next drafted proposals to address empirically those questions, which were critiqued at a national conference on the topic of education's value in clinical care. The next step is to use the methods developed in this project to empirically assess the value added by educational activities to clinical care.

  4. In Defense of a Social Value Requirement for Clinical Research.

    Science.gov (United States)

    Wendler, David; Rid, Annette

    2017-02-01

    Many guidelines and commentators endorse the view that clinical research is ethically acceptable only when it has social value, in the sense of collecting data which might be used to improve health. A version of this social value requirement is included in the Declaration of Helsinki and the Nuremberg Code, and is codified in many national research regulations. At the same time, there have been no systematic analyses of why social value is an ethical requirement for clinical research. Recognizing this gap in the literature, recent articles by Alan Wertheimer and David Resnik argue that the extant justifications for the social value requirement are unpersuasive. Both authors conclude, contrary to almost all current guidelines and regulations, that it can be acceptable across a broad range of cases to conduct clinical research which is known prospectively to have no social value. The present article assesses this conclusion by critically evaluating the ethical and policy considerations relevant to the claim that clinical research must have social value. This analysis supports the standard view that social value is an ethical requirement for the vast majority of clinical research studies and should be mandated by applicable guidelines and policies. © 2017 John Wiley & Sons Ltd.

  5. Optimizing value utilizing Toyota Kata methodology in a multidisciplinary clinic.

    Science.gov (United States)

    Merguerian, Paul A; Grady, Richard; Waldhausen, John; Libby, Arlene; Murphy, Whitney; Melzer, Lilah; Avansino, Jeffrey

    2015-08-01

    Value in healthcare is measured in terms of patient outcomes achieved per dollar expended. Outcomes and cost must be measured at the patient level to optimize value. Multidisciplinary clinics have been shown to be effective in providing coordinated and comprehensive care with improved outcomes, yet tend to have higher cost than typical clinics. We sought to lower individual patient cost and optimize value in a pediatric multidisciplinary reconstructive pelvic medicine (RPM) clinic. The RPM clinic is a multidisciplinary clinic that takes care of patients with anomalies of the pelvic organs. The specialties involved include Urology, General Surgery, Gynecology, and Gastroenterology/Motility. From May 2012 to November 2014 we performed time-driven activity-based costing (TDABC) analysis by measuring provider time for each step in the patient flow. Using observed time and the estimated hourly cost of each of the providers we calculated the final cost at the individual patient level, targeting clinic preparation. We utilized Toyota Kata methodology to enhance operational efficiency in an effort to optimize value. Variables measured included cost, time to perform a task, number of patients seen in clinic, percent value-added time (VAT) to patients (face to face time) and family experience scores (FES). At the beginning of the study period, clinic costs were $619 per patient. We reduced conference time from 6 min/patient to 1 min per patient, physician preparation time from 8 min to 6 min and increased Medical Assistant (MA) preparation time from 9.5 min to 20 min, achieving a cost reduction of 41% to $366 per patient. Continued improvements further reduced the MA preparation time to 14 min and the MD preparation time to 5 min with a further cost reduction to $194 (69%) (Figure). During this study period, we increased the number of appointments per clinic. We demonstrated sustained improvement in FES with regards to the families overall experience with their providers

  6. Improving healthcare value through clinical community and supply chain collaboration.

    Science.gov (United States)

    Ishii, Lisa; Demski, Renee; Ken Lee, K H; Mustafa, Zishan; Frank, Steve; Wolisnky, Jean Paul; Cohen, David; Khanna, Jay; Ammerman, Joshua; Khanuja, Harpal S; Unger, Anthony S; Gould, Lois; Wachter, Patricia Ann; Stearns, Lauren; Werthman, Ronald; Pronovost, Peter

    2017-03-01

    We hypothesized that integrating supply chain with clinical communities would allow for clinician-led supply cost reduction and improved value in an academic health system. Three clinical communities (spine, joint, blood management) and one clinical community-like physician led team of surgeon stakeholders partnered with the supply chain team on specific supply cost initiatives. The teams reviewed their specific utilization and cost data, and the physicians led consensus-building conversations over a series of team meetings to agree to standard supply utilization. The spine and joint clinical communities each agreed upon a vendor capping model that led to cost savings of $3 million dollars and $1.5 million dollars respectively. The blood management decreased blood product utilization and achieved $1.2 million dollars savings. $5.6 million dollars in savings was achieved by a clinical community-like group of surgeon stakeholders through standardization of sutures and endomechanicals. Physician led clinical teams empowered to lead change achieved substantial supply chain cost savings in an academic health system. The model of combining clinical communities with supply chain offers hope for an effective, practical, and scalable approach to improving value and engaging physicians in other academic health systems. This clinician led model could benefit both private and academic health systems engaging in value optimization efforts. N/A. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Significance and clinical value of the transitional zone volume (TZV ...

    African Journals Online (AJOL)

    M. El Ghoneimy

    2017-01-12

    Jan 12, 2017 ... Objective: The aim of this work was to evaluate the significance and clinical value of the TZI, which has been a point of ... Conclusion: Estimating the transition zone volume during TRUS is a reasonable way to obtain the required ... Besides the IPSS score, a complete medical and surgical history was also.

  8. The value of pathogen information in treating clinical mastitis

    NARCIS (Netherlands)

    Cha, Elva; Smith, Rebecca L.; Kristensen, Anders R.; Hertl, Julia A.; Schukken, Ynte H.; Tauer, Loren W.; Welcome, Frank L.; Gröhn, Yrjö T.

    2016-01-01

    The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the

  9. The value of pathogen information in treating clinical mastitis

    NARCIS (Netherlands)

    Cha, Elva; Smith, Rebecca L.; Kristensen, Anders R.; Hertl, Julia A.; Schukken, Ynte H.; Tauer, Loren W.; Welcome, Frank L.; Gröhn, Yrjö T.

    2016-01-01

    The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen

  10. Improving nutritive values of roughages by physical and chemical treatments

    International Nuclear Information System (INIS)

    Al-Masri, M.R.; Guenther, K.D.

    1998-05-01

    Experiments have been carried out to study the changes in the values of cell-wall constituents, total nitrogen (N), in vitro digestible crude protein (IVDCP), in vitro organic matter digestibility, and in vitro digestible energy of some agricultural residues after irradiation by various doses of gamma irradiation (0, 100, 150, 200 kilo gray, k Gy) or after spraying with different amounts of urea: 0, 20, 30, and 50 g urea/kg dry matter. The results indicated that treating with 3% - 5% urea or with 200 k Gy decreased the cell-wall constituents and increased the digestible energy values. Combined treatment resulted in a better increase in the digestible energy for all studied agricultural residues. Urea treatment increased total nitrogen and IVDCP. Gamma irradiation had no effect on N and IVDCP. (Author)

  11. Improving nutritive values of roughages by physical and chemical treatments

    International Nuclear Information System (INIS)

    Al-Masri, M.R.; Guenther, K.D.

    1998-01-01

    Experiments have been carried out to study the changes in the values of cell-wall constituents, total nitrogen (N), in vitro digestible crude protein (IVDCP), in vitro organic matter digestibility, and in vitro digestible energy of some agricultural residues after irradiation by various doses of gamma irradiation (0, 100, 150, 200 kilo gray, k Gy) or after spraying with different amounts of urea: 0, 20, 30, and 50 g urea/kg dry matter. The results indicated that treating with 3% - 5% urea or with 200 k Gy decreased the cell-wall constituents and increased the digestible energy values. Combined treatment resulted in a better increase in the digestible energy for all studied agricultural residues. Urea treatment increased total nitrogen and iVDCP. Gamma irradiation had no effect on N and IVDCP. (Author)

  12. Physico-chemical analysis and calorific values of poultry manure.

    Science.gov (United States)

    Quiroga, G; Castrillón, L; Fernández-Nava, Y; Marañón, E

    2010-05-01

    Spain is one of the major producers of broilers and laying hens in the European Union, with an overall market share of around 12%. The poultry manure that is produced is usually employed as fertilizer on cropland, either directly or after a composting process. In some cases, however, this waste is transported over 120km to be used as fertilizer, with the resulting high transport costs. In other countries, poultry manure is used as an alternative natural fuel source for power generation. In this study, poultry manure from all the laying hen farms in Asturias was characterized with a view to its possible use as an energy source. The Higher Heating Values on a dry basis (experimental) varies between 12,052 and 13,882kJ/kg. Lower Heating Values (LHVs) on a wet basis range are much lower (mean values of 2664kJ/kg) due to the high moisture content of poultry manure. Accordingly, the co-combustion of this waste with other types of waste such as forest and wood waste (LHV on a wet basis of 8044 and 15,830kJ/kg, respectively) or municipal solid waste (LHV on a wet basis of 10,725kJ/kg) should be considered as an alternative energy source. Chlorine and sulphur contents in dry matter vary around mean values of 0.64% and 0.11%, respectively. The waste also presents high amounts of Ca (4.84%) and K (2.38%). Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  13. Analysis of determination modalities concerning the exposure and emission limits values of chemical and radioactive substances

    International Nuclear Information System (INIS)

    Schieber, C.; Schneider, T.

    2002-08-01

    This document presents the generic approach adopted by various organizations for the determination of the public exposure limits values to chemical and radioactive substances and for the determination of limits values of chemical products emissions by some installations. (A.L.B.)

  14. The clinical value of planar thallium-201 myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Niemeyer, M.G.

    1989-01-01

    The clinical value of planar thalium-201 myocardial perfusion scintigraphy was examined, using visual and quantitative analysis, for the detection of presence, localization and extent of coronary disease, using coronary arteriography as gold standard. The indremental diagnostic yield of different noninvasive tests for the diagnosis and the severity of coronary artery disease was quantified by using multivariate discriminant analysis. (author). 284 refs.; 14 figs.; 37 tabs

  15. Clinical ethics and values: how do norms evolve from practice?

    Science.gov (United States)

    Spranzi, Marta

    2013-02-01

    Bioethics laws in France have just undergone a revision process. The bioethics debate is often cast in terms of ethical principles and norms resisting emerging social and technological practices. This leads to the expression of confrontational attitudes based on widely differing interpretations of the same principles and values, and ultimately results in a deadlock. In this paper I would like to argue that focusing on values, as opposed to norms and principles, provides an interesting perspective on the evolution of norms. As Joseph Raz has convincingly argued, "life-building" values and practices are closely intertwined. Precisely because values have a more indeterminate meaning than norms, they can be cited as reasons for action by concerned stakeholders, and thus can help us understand how controversial practices, e.g. surrogate motherhood, can be justified. Finally, norms evolve when the interpretations of the relevant values shift and cause a change in the presumptions implicit in the norms. Thus, norms are not a prerequisite of the ethical solution of practical dilemmas, but rather the outcome of the decision-making process itself. Struggling to reach the right decision in controversial clinical ethics situations indirectly causes social and moral values to change and principles to be understood differently.

  16. Beyond clinical utility: The multiple values of DTC genetics

    Directory of Open Access Journals (Sweden)

    Mauro Turrini

    2016-03-01

    Full Text Available One point of consensus in the otherwise very controversial discussion about the benefits and dangers of DTC genetics in the health domain is the lack of substantial clinical utility. At the same time, both the empirical and conceptual literature indicate that health-related DTC tests can have value and utility outside of the clinic. We argue that a broader and multi-faceted conceptualization of utility and value would enrich the ethical and social discussion of DTC testing in several ways: First, looking at ways in which DTC testing can have personal and social value for users – in the form of entertainment, learning, or a way to relate to others – can help to explain why people still take DTC tests, and will, further down the line, foster a more nuanced understanding of secondary and tertiary uses of DTC test results (which could very well unearth new ethical and regulatory challenges. Second, considering the economic value and broader utility of DTC testing foregrounds wider social and political aspects than have been dominant in the ethical and regulatory debates surrounding DTC genetics so far. These wider political aspects include the profound power asymmetries that characterize the collection and use of personal genetic data in many contexts.

  17. Evaluation of clinical value of serum CA19-9

    International Nuclear Information System (INIS)

    Lv Haifeng; Lin Zhiyu; Lu Xiaozhuo; Chen Yini

    2003-01-01

    The article is to study the clinical significance of serum CA19-9 in diagnosing malignant tumor occurred in digestive system and to select cut off values for differentiating diagnosis of a pancreatic neoplasms and pancreatitis. Using chemiluminescence immunoassay, serum CA19-9 level of below subjects were analyzed: control group (n=21); digestive system neoplasm group (n=125, with 7 cases conformed as pancreatic cancer); non-neoplastic disease group (n=387, with 15 cases conformed as pancreatitis secondary to destructive cholangitis). Receiver operating characteristic (ROC) curve was used for analyzing results and selecting cut off values. When cut off value was 18.4 kU/L, sensibility for conforming a digestive system neoplasm was 60.8%, while its related specificity against control group and non-neoplastic disease group was 95. 2% and 68.2%, respectively. Sensibility for diagnosing pancreatic neoplasm was 85.7%, while its related specificity against control group and non-pancreatic origin tumor group was 95.0% and 63.1%, respectively. When 37 kU/L was chosen as cut off value, specificity for differentiating diagnosis of pancreatic neoplasm and pancreatitis secondary to destructive cholangitis rose from 13.3% to 46.7%. Serum CA19-9 could be used as an aid in detecting digestive system neoplastic disease; it is a reliable marker for pancreatic neoplasm. Raising cut off value may help to differentiate pancreatic neoplasm and pancreatitis secondary to destructive cholangitis

  18. From Value Assessment to Value Cocreation: Informing Clinical Decision-Making with Medical Claims Data.

    Science.gov (United States)

    Thompson, Steven; Varvel, Stephen; Sasinowski, Maciek; Burke, James P

    2016-09-01

    Big data and advances in analytical processes represent an opportunity for the healthcare industry to make better evidence-based decisions on the value generated by various tests, procedures, and interventions. Value-based reimbursement is the process of identifying and compensating healthcare providers based on whether their services improve quality of care without increasing cost of care or maintain quality of care while decreasing costs. In this article, we motivate and illustrate the potential opportunities for payers and providers to collaborate and evaluate the clinical and economic efficacy of different healthcare services. We conduct a case study of a firm that offers advanced biomarker and disease state management services for cardiovascular and cardiometabolic conditions. A value-based analysis that comprised a retrospective case/control cohort design was conducted, and claims data for over 7000 subjects who received these services were compared to a matched control cohort. Study subjects were commercial and Medicare Advantage enrollees with evidence of CHD, diabetes, or a related condition. Analysis of medical claims data showed a lower proportion of patients who received biomarker testing and disease state management services experienced a MI (p companies have in terms of identifying value-creating healthcare interventions. However, payers and providers also need to pursue system integration efforts to further automate the identification and dissemination of clinically and economically efficacious treatment plans to ensure at-risk patients receive the treatments and interventions that will benefit them the most.

  19. Value-sensitive clinical accompaniment in community nursing science

    Directory of Open Access Journals (Sweden)

    Sonya Beukes

    2010-11-01

    The goal of this study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in the community nursing environment. An exploratory, descriptive and contextual design was used. Interactions between community nurses and students during clinical accompaniment were explored for value sensitivity by means of video recordings,participant observation and focus group interviews. Data were collected by means of video recordings, participant observation and focus group interviews. The data were analysed and coded by the researcher and the external coder, using an inductive descriptive method to identify important segments of the regularity of behaviour. The focus group interviews were transcribed, analysed and coded by the researcher and the external coder, using Tesch’s steps of analysis (Creswell 1994:155–156.Lincoln and Guba’s criteria (1985:290 for trustworthiness were applied to the study. The general findings indicate that clinical accompaniment in community nursing is not value sensitive and, as a result, guidelines for value-sensitive clinical accompaniment need to be developed for undergraduate students in the community nursing environment. The following values (values for which guidelines need to be developed were identified: respect during clinical accompaniment,value-sensitive communication and sensitivity to the quality of clinical accompaniment. Opsomming Kliniese gemeenskapsgesondheidsfasiliteite waar voorgraadse studente geplaas word vir gemeenskapsverpleegkundepraktika is dinamies en het groot veranderinge oor die laaste paar jare ondergaan. In die kliniese veld verteenwoordig gemeenskapsverpleegkundiges en voorgraadse studente verskillende rasse en taal- en etniese groepe in die Suid-Afrikaanse bevolking, elkeen met verskillende waardes. Albei partye – studente en gemeenskapsverpleegkundiges – het gerapporteer dat waardekonflik weens verskillende kulture en waardes tydens kliniese begeleiding

  20. Mo- and V-catalyzed transformation of biomass into high-value chemicals

    DEFF Research Database (Denmark)

    Nielsen, Lasse Bo; Dethlefsen, Johannes Rytter; Lupp, Daniel

    2014-01-01

    The possibility of converting biomass into higher-value chemicals has received increased attention over the last few years. If biomass could be converted into biofules or platform chemicals, then it could constitute a large source of renewable energy and economy for society.......The possibility of converting biomass into higher-value chemicals has received increased attention over the last few years. If biomass could be converted into biofules or platform chemicals, then it could constitute a large source of renewable energy and economy for society....

  1. Chemical composition, nutritional value and antioxidant properties of Mediterranean okra genotypes in relation to harvest stage.

    Science.gov (United States)

    Petropoulos, Spyridon; Fernandes, Ângela; Barros, Lillian; Ferreira, Isabel C F R

    2018-03-01

    The aim of the present study was to determine the effect of fruit size on nutritional value, chemical composition and antioxidant properties of Mediterranean okra genotypes. For this purpose, pods from four okra cultivars and local landraces commonly cultivated in Greece, as well as pods from four commercial cultivars from North America were collected at two sizes (3-5 and>7cm). Significant differences were observed between the studied genotypes for both nutritional value and chemical composition parameters. Small fruit had a higher nutritional value, whereas chemical composition differed in a genotype dependent manner with most of the studied cultivars showing better results when harvested in small size. In conclusion, fruit size has a genotype dependent impact on chemical composition and nutritional value of okra pods and the common practice of harvesting okra fruit while they still have a small size helps to increase nutritional value for most of the studied genotypes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Clinical value of natriuretic peptides in chronic kidney disease.

    Science.gov (United States)

    Santos-Araújo, Carla; Leite-Moreira, Adelino; Pestana, Manuel

    2015-01-01

    According to several lines of evidence, natriuretic peptides (NP) are the main components of a cardiac-renal axis that operate in clinical conditions of decreased cardiac hemodynamic tolerance to regulate sodium homeostasis, blood pressure and vascular function. Even though it is reasonable to assume that NP may exert a relevant role in the adaptive response to renal mass ablation, evidence gathered so far suggest that this contribution is probably complex and dependent on the type and degree of the functional mass loss. In the last years NP have been increasingly used to diagnose, monitor treatment and define the prognosis of several cardiovascular (CV) diseases. However, in many clinical settings, like chronic kidney disease (CKD), the predictive value of these biomarkers has been questioned. In fact, it is now well established that renal function significantly affects the plasmatic levels of NP and that renal failure is the clinical condition associated with the highest plasmatic levels of these peptides. The complexity of the relation between NP plasmatic levels and CV and renal functions has obvious consequences, as it may limit the predictive value of NP in CV assessment of CKD patients and be a demanding exercise for clinicians involved in the daily management of these patients. This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

  3. Clinical impact and value of workstation single sign-on.

    Science.gov (United States)

    Gellert, George A; Crouch, John F; Gibson, Lynn A; Conklin, George S; Webster, S Luke; Gillean, John A

    2017-05-01

    CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges. To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. Following implementation of SSO, a total of 65,202 logins were sampled systematically during a 7day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers. The reduction of total clinician login time over the 7day period showed a net gain of 168.3h per week of clinician time - 28.1h (2.3 shifts) per facility per week. Annualized, 1461.2h of mixed physician and nursing time is liberated per facility per annum (121.8 shifts of 12h per year). The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per annum and $1,658,745 per annum in the first phase implementation of 18 hospitals. Computer hardware equipment savings due to desktop virtualization increases annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO are discussed. SSO had a positive impact on clinician efficiency and productivity in the 6 hospitals evaluated, and is an effective and cost-effective method to liberate clinician time from repetitive and time consuming logins to clinical software applications. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Value chain management for commodities: a case study from the chemical industry

    NARCIS (Netherlands)

    Kannegiesser, M.; Günther, H.O.; Beek, van P.; Grunow, M.; Habla, C.

    2009-01-01

    We present a planning model for chemical commodities related to an industry case. Commodities are standard chemicals characterized by sales and supply volatility in volume and value. Increasing and volatile prices of crude oil-dependent raw materials require coordination of sales and supply

  5. Reference values for rotational thromboelastometry (ROTEM) in clinically healthy cats.

    Science.gov (United States)

    Marly-Voquer, Charlotte; Riond, Barbara; Jud Schefer, Rahel; Kutter, Annette P N

    2017-03-01

    To establish reference intervals for rotational thromboelastometry (ROTEM) using feline blood. Prospective study. University teaching hospital. Twenty-three clinically healthy cats between 1 and 15 years. For each cat, whole blood was collected via jugular or medial saphenous venipuncture, and blood was placed into a serum tube, a tube containing potassium-EDTA, and tubes containing 3.2% sodium citrate. The tubes were maintained at 37°C for a maximum of 30 minutes before coagulation testing. ROTEM tests included the EXTEM, INTEM, FIBTEM, and APTEM assays. In addition, prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen concentration (Clauss method) were analyzed for each cat. Reference intervals for ROTEM were calculated using the 2.5-97.5 th percentile for each parameter, and correlation with the standard coagulation profile was performed. Compared to people, clinically healthy cats had similar values for the EXTEM and INTEM assays, but had lower plasma fibrinogen concentrations (0.9-2.2 g/L), resulting in weaker maximum clot firmness (MCF, 3-10 mm) in the FIBTEM test. In 18 cats, maximum lysis (ML) values in the APTEM test were higher than in the EXTEM test, which seems unlikely to have occurred in the presence of aprotinin. It is possible that the observed high maximum lysis values were due to clot retraction rather than true clot lysis. Further studies will be required to test this hypothesis. Cats have a weaker clot in the FIBTEM test, but have a similar clot strength to human blood in the other ROTEM assays, which may be due to a stronger contribution of platelets compared to that found in people. In cats, careful interpretation of the results to diagnose hyperfibrinolysis is advised, especially with the APTEM test, until further data are available. © Veterinary Emergency and Critical Care Society 2017.

  6. Clinical value of ambulatory blood pressure: evidence and limits.

    Science.gov (United States)

    Mancia, Giuseppe; Verdecchia, Paolo

    2015-03-13

    This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ

  7. CLINICAL VALUE OF CHROMOGRANIN A IN GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS

    Directory of Open Access Journals (Sweden)

    N. V. Lyubimova

    2015-01-01

    Full Text Available Background: Neuroendocrine tumors (NET is a heterogeneous group of neoplasms characterized by hypersecretion of biologically active sub- stances that manifests by specific syndromes and determines the clinical course of the disease. The most common NET types are those of gastrointestinal tract. The obligatory biochemical marker used in the examination of NET patients is chromogranin A (CgA.Aim: Evaluation of the CgA value for diagnostics and monitoring of gastrointestinal NETs.Materials and methods: A comparative study of plasma CgA levels was performed in 146 patients with gastroenteropancreatic neuroendocrine tu- mors and 66 healthy individuals using the enzyme immunoassay “Chromogranin A ELISA kit” (Dako A/S, Denmark.Results: CgA levels were significantly higher in patients with NETs of all localizations, such as pancreas, stomach, gut, small and large bowel, than in the healthy subjects (р < 0.000001. In NET patients, CgA secretion was highly variable, with the highest value in the group of patients with gastric NETs (102000 U/l. The highest CgA medians were detected in patients with small intestinal (183.9 U/l, colon (148.4 U/l and pancreatic (135.9 U/l NETs. There was an association between CgA secretion and extension or activity of NETs, with the highest median values in patients with hepatic metastases (395 U/l and those with carcinoid syndrome (352 U/l. The clinical significance of CgA as a NET marker was assessed using the cut-off value of 33 U/l, calculated according to the results in the control group. Overall diagnostic sensitivity of CgA in NET patients was high (85.8% with a specificity of 98.5%. Conclusion: The results obtained confirm a high sensitivity of CgA as a NET marker whose determination helps to improve accuracy of diagnostics and to assess NET prevalence.

  8. The use of reference change values in clinical laboratories.

    Science.gov (United States)

    Bugdayci, Guler; Oguzman, Hamdi; Arattan, Havva Yasemin; Sasmaz, Guler

    2015-01-01

    The use of Reference Change Values (RCV) has been advocated as very useful for monitoring individuals. Most of these are performed for monitoring individuals in acute situations and for following up the improvement or deterioration of chronic diseases. In our study, we aimed at evaluating the RCV calculation for 24 clinical chemistry analytes widely used in clinical laboratories and the utilization of this data. Twenty-four serum samples were analyzed with Abbott kits (Abbott Laboratories, Abbott Park, IL, USA), manufactured for use with the Architect c8000 (Abbott Laboratories, Abbott Park, IL, USA) auto-analyzer. We calculated RCV using the following formula: RCV = Z x 2 1/2x (CVA2 + CVw2)1/2. Four reference change values (RCV) were calculated for each analyte using four statistical probabilities (0.95, and 0.99, unidirectional and bidirectional). Moreover, by providing an interval after identifying upper and lower limits with the Reference Change Factor (RCF), serially measured tests were calculated by using two formulas: exp (Z x 2 1/2 x (CV(A)2 + CVw2)½/100) for RCF(UP) and (1/RCF(UP)) for RCF(DOWN). RCVs of these analytes were calculated as 14.63% for glucose, 29.88% for urea, 17.75% for ALP, 53.39% for CK, 46.98% for CK-MB, 21.00% amylase, 8.00% for total protein, 8.70% for albumin, 51.08% for total bilirubin, 86.34% for direct bilirubin, 6.40% for calcium, 15.03% for creatinine, 21.47% for urate, 14.19% for total cholesterol, 46.62% for triglyceride, 20.51% for HDL-cholesterol, 29.59% for AST, 46.31% for ALT, 31.54% for GGT, 20.92% for LDH, 19.75% for inorganic phosphate, 3.05% for sodium, 11.75% for potassium, 4.44% for chloride (RCV, p laboratories. RCV could be available as a tool for making clinical decision, especially when monitoring individuals.

  9. Chemical compound-based direct reprogramming for future clinical applications

    Science.gov (United States)

    Takeda, Yukimasa; Harada, Yoshinori; Yoshikawa, Toshikazu; Dai, Ping

    2018-01-01

    Recent studies have revealed that a combination of chemical compounds enables direct reprogramming from one somatic cell type into another without the use of transgenes by regulating cellular signaling pathways and epigenetic modifications. The generation of induced pluripotent stem (iPS) cells generally requires virus vector-mediated expression of multiple transcription factors, which might disrupt genomic integrity and proper cell functions. The direct reprogramming is a promising alternative to rapidly prepare different cell types by bypassing the pluripotent state. Because the strategy also depends on forced expression of exogenous lineage-specific transcription factors, the direct reprogramming in a chemical compound-based manner is an ideal approach to further reduce the risk for tumorigenesis. So far, a number of reported research efforts have revealed that combinations of chemical compounds and cell-type specific medium transdifferentiate somatic cells into desired cell types including neuronal cells, glial cells, neural stem cells, brown adipocytes, cardiomyocytes, somatic progenitor cells, and pluripotent stem cells. These desired cells rapidly converted from patient-derived autologous fibroblasts can be applied for their own transplantation therapy to avoid immune rejection. However, complete chemical compound-induced conversions remain challenging particularly in adult human-derived fibroblasts compared with mouse embryonic fibroblasts (MEFs). This review summarizes up-to-date progress in each specific cell type and discusses prospects for future clinical application toward cell transplantation therapy. PMID:29739872

  10. [The clinical value of urinary antigen detection of Legionella pneumonia].

    Science.gov (United States)

    Jiang, Luxi; Chen, Yu; Xia, Shuyue; Ma, Jiangwei; Zhao, Hongwen; Lu, Ye; Tao, Sixu; Zhao, Li

    2015-01-01

    To investigate the clinical value of urinary antigen detection of Legionella, and to describe the clinical characteristics of Legionella pneumonia. Patients with suspected Legionella pneumonia were enrolled from the Respiratory departments of 3 tertiary hospitals in Shenyang during May 2011 to November 2013. Urinary Legionella antigen was detected for all the enrolled patients. Bacterial culture, polymerase chain reaction (PCR) for Legionella, and double Legionella antibody detection in sera were performed for each patient whose urinary antigen was positive. Patients confirmed to have Legionella pneumonia were pooled and analyzed. Totally 13 cases presenting with pneumonia were positive for Legionella by the urinary antigen method, and in one of them Legionella strain was isolated from the secretion of lower respiratory tract. PCR detection was performed in 8 patients, and 4 of them were positive. Legionella antibody detection was performed in 12 patients, and 7 of them were positive. Nine patients had a history of exposure to Legionella high-risk environments. The characteristics of the cases with Legionella pneumonia were as follows: characteristic orange sputum in 4 patients, digestive symptoms in 6, neurologic disorders in 8, hyponatremia in 10, hypoxia with oxygenation index 130) in 8 patients . Chest CT scan showed bilateral involvement in 6, ground-glass opacity combined with consolidation in 11, and moderate pleural effusion in 11 patients. Cavity and reversed halo sign were found in one case, respectively. All of the patients received fluoroquinolone treatment, and 11 patients recovered completely while 2 died of multiple organ dysfunction syndrome, one of them was complicated with secondary infection. Detection of urinary antigen of Legionella is very useful in the diagnosis of Legionella pneumonia. Attention should be paid to exposure history to the high-risk environments and multiple organ impairment when Legionella infection is suspected. Orange sputum

  11. The value of pathogen information in treating clinical mastitis.

    Science.gov (United States)

    Cha, Elva; Smith, Rebecca L; Kristensen, Anders R; Hertl, Julia A; Schukken, Ynte H; Tauer, Loren W; Welcome, Frank L; Gröhn, Yrjö T

    2016-11-01

    The objective of this study was to determine the economic value of obtaining timely and more accurate clinical mastitis (CM) test results for optimal treatment of cows. Typically CM is first identified when the farmer observes recognisable outward signs. Further information of whether the pathogen causing CM is Gram-positive, Gram-negative or other (including no growth) can be determined by using on-farm culture methods. The most detailed level of information for mastitis diagnostics is obtainable by sending milk samples for culture to an external laboratory. Knowing the exact pathogen permits the treatment method to be specifically targeted to the causation pathogen, resulting in less discarded milk. The disadvantages are the additional waiting time to receive test results, which delays treating cows, and the cost of the culture test. Net returns per year (NR) for various levels of information were estimated using a dynamic programming model. The Value of Information (VOI) was then calculated as the difference in NR using a specific level of information as compared to more detailed information on the CM causative agent. The highest VOI was observed where the farmer assumed the pathogen causing CM was the one with the highest incidence in the herd and no pathogen specific CM information was obtained. The VOI of pathogen specific information, compared with non-optimal treatment of Staphylococcus aureus where recurrence and spread occurred due to lack of treatment efficacy, was $20.43 when the same incorrect treatment was applied to recurrent cases, and $30.52 when recurrent cases were assumed to be the next highest incidence pathogen and treated accordingly. This indicates that negative consequences associated with choosing the wrong CM treatment can make additional information cost-effective if pathogen identification is assessed at the generic information level and if the pathogen can spread to other cows if not treated appropriately.

  12. Methods for conversion of carbohydrates in ionic liquids to value-added chemicals

    Science.gov (United States)

    Zhao, Haibo [The Woodlands, TX; Holladay, Johnathan E [Kennewick, WA; Zhang, Zongchao C [Norwood, NJ

    2011-05-10

    Methods are described for converting carbohydrates including, e.g., monosaccharides, disaccharides, and polysaccharides in ionic liquids to value-added chemicals including furans, useful as chemical intermediates and/or feedstocks. Fructose is converted to 5-hydroxylmethylfurfural (HMF) in the presence of metal halide and acid catalysts. Glucose is effectively converted to HMF in the presence of chromium chloride catalysts. Yields of up to about 70% are achieved with low levels of impurities such as levulinic acid.

  13. Added clinical value of the inferior temporal EEG electrode chain.

    Science.gov (United States)

    Bach Justesen, Anders; Eskelund Johansen, Ann Berit; Martinussen, Noomi Ida; Wasserman, Danielle; Terney, Daniella; Meritam, Pirgit; Gardella, Elena; Beniczky, Sándor

    2018-01-01

    To investigate the diagnostic added value of supplementing the 10-20 EEG array with six electrodes in the inferior temporal chain. EEGs were recorded with 25 electrodes: 19 positions of the 10-20 system, and six additional electrodes in the inferior temporal chain (F9/10, T9/10, P9/10). Five-hundred consecutive standard and sleep EEG recordings were reviewed using the 10-20 array and the extended array. We identified the recordings with EEG abnormalities that had peak negativities at the inferior temporal electrodes, and those that only were visible at the inferior temporal electrodes. From the 286 abnormal recordings, the peak negativity was at the inferior temporal electrodes in 81 cases (28.3%) and only visible at the inferior temporal electrodes in eight cases (2.8%). In the sub-group of patients with temporal abnormalities (n = 134), these represented 59% (peak in the inferior chain) and 6% (only seen at the inferior chain). Adding six electrodes in the inferior temporal electrode chain to the 10-20 array improves the localization and identification of EEG abnormalities, especially those located in the temporal region. Our results suggest that inferior temporal electrodes should be added to the EEG array, to increase the diagnostic yield of the recordings. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  14. Clinical values of CT and dynamic CT in brain infarction

    International Nuclear Information System (INIS)

    Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul

    1985-01-01

    scan had a marked difference in CT (HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. The clinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation of effectiveness of medical or surgical treatment

  15. Clinical value of colonic irrigation in patients with continence disturbances.

    Science.gov (United States)

    Briel, J W; Schouten, W R; Vlot, E A; Smits, S; van Kessel, I

    1997-07-01

    Continence disturbances, especially fecal soiling, are difficult to treat. Irrigation of the distal part of the large bowel might be considered as a nonsurgical alternative for patients with impaired continence. This study is aimed at evaluating the clinical value of colonic irrigation. Thirty-two patients (16 females; median age, 47 (range, 23-72) years) were offered colonic irrigation on an ambulatory basis. Sixteen patients suffered from fecal soiling (Group I), whereas the other 16 patients were treated for fecal incontinence (Group II). Patients were instructed by enterostomal therapists how to use a conventional colostomy irrigation set to obtain sufficient irrigation of the distal part of their large bowel. Patients with continence disturbances during the daytime were instructed to introduce 500 to 1,000 ml of warm (38 degrees C) water within 5 to 10 minutes after they passed their first stool. In addition, they were advised to wait until the urge to defecate was felt. Patients with soiling during overnight sleep were advised to irrigate during the evening. To determine clinical outcome, a detailed questionnaire was used. Median duration of follow-up was 18 months. Ten patients discontinued irrigation within the first month of treatment. Symptoms resolved completely in two patients. They believed that there was no need to continue treatment any longer. Irrigation had no effect in two patients. Despite the fact that symptoms resolved, six patients discontinued treatment because they experienced pain (n = 2) or they considered the irrigation to be too time-consuming (n = 4). Twenty-two patients are still performing irrigations. Most patients irrigated the colon in the morning after the first stool was passed. Time needed for washout varied between 10 and 90 minutes. Frequency of irrigations varied from two times per day to two times per week. In Group I, irrigation was found to be beneficial in 92 percent of patients, whereas 60 percent of patients in Group II

  16. Clinical values of CT and dynamic CT in brain infarction

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Il; Jang, Do; Seo, Eun Joo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University College of Medicine, Jeonju (Korea, Republic of)

    1985-04-15

    -and postcontrast CT scan had a marked difference in CT (HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. The clinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation of effectiveness of medical or surgical treatment.

  17. Value chain management for commodities: a case study from the chemical industry

    DEFF Research Database (Denmark)

    Kannegiesser, M.; Gunther, H.O.; van Beek, P.

    2009-01-01

    decisions by volume and value throughout the value chain to ensure profitability. Contract and spot demand differentiation with volatile and uncertain spot prices, spot sales quantity flexibility, spot sales price-quantity functions and variable raw material consumption rates in production are problem...... quantity, price and supply decisions throughout the value chain. A two-phase optimization approach supports robust planning ensuring minimum profitability even in case of worst-case spot sales price scenarios. Model evaluations with industry case data demonstrate the impact of elasticities, variable raw......We present a planning model for chemical commodities related to an industry case. Commodities are standard chemicals characterized by sales and supply volatility in volume and value. Increasing and volatile prices of crude oil-dependent raw materials require coordination of sales and supply...

  18. Ecotoxicological assessments and the setting of limit values for chemicals in the environment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The Committee on the Setting of Limit Values for Chemicals held its first open conference in Denmark in March 1992 at Mogenstrup Kro, Zealand. The conference proceedings were entitled `Risk Management and Risk Assessment in Different Sectors in Denmark`. The conference focused on risk assessment and the setting of limit values for chemicals in connection with human exposure to chemicals. The conference held in January 1996, which is covered by the present proceedings, dealt with the exposure of the environment to chemicals and the state-of-the-art as well as perspectives of ecotoxicological research. Special emphasis was placed on the illustration and discussion of the problems that have to be solved in order to secure satisfactory levels of protection of soil and aquatic environments in connection with exposure to chemicals. Also, problems connected with exposure through the atmosphere were discussed and exemplified by the work on the setting of limit values for tropospheric ozone. Furthermore, the global problems pertaining to what is believed to be the greenhouse effect and the degradation of the stratospheric ozone layer as well as the damage to crops caused by ozone were mentioned. (au)

  19. Digestibility and energetic value of agricultural wastes as affected by gamma irradiation and chemical treatments

    International Nuclear Information System (INIS)

    Al-Masri, M.R.

    2002-01-01

    Experiments were carried out to study the changes in the values of in-vitro apparent organic matter digestibility (IVOMD), metabolizable energy (ME) and net energy lactation (NEL) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after spraying with different concentrations of hydrobromic acid (HBr) and sodium hydroxide (NaOH) (0,3,6 ml HBr and 3,6 g NaOH/25 ml water/100 g Dm) or after exposure to various doses of gamma radiation (0, 20, 40, 60 kGy). Results indicated that, except for the date palm seeds, the chemical treatments with either HBr or NaOH significantly (P<0.05) increased IVOMD, Me and NEL values for all treated samples. The experimental agricultural wastes did not respond equally to the chemical treatments investigated, i.e. they differ in the induced increases pertaining to their IVOMD, ME and NEL. The highest changes in the studied parameters due to chemical treatments were obtained when applying the 6% concentration. There was no significant effect (P<0.05) of irradiation on IVOMD, ME and NEL values for all treated samples. Moreover, the combined treatments of irradiation and hydrobromic acid or sodium hydroxide were found to have no significant affects on the IVOMD, ME and NEL values compared to the individual chemical treatments. (author)

  20. Digestibility and energetic value of some agricultural wastes as affected by gamma irradiation and chemical treatments

    International Nuclear Information System (INIS)

    Al-Masri, M.R.

    2001-08-01

    Experiments were carried out to study the changes in the values of in-vitro apparent organic matter digestibility (IVOMD), metabolizable energy (ME) and net energy lactation (NEL) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after spraying with different concentrations of hydrobromic acid (HBr) and sodium hydroxide (NaOH) (0,3,6 ml HBr and 3,6 g NaOH/25 ml water/100 g DM) or after exposure to various doses of gamma radiation (0, 20, 40, 60 kGy). Results indicated that, except for the date palm seeds, the chemical treatments with either HBr or NaOH significantly (P<0.05) increased IVOMD, Me and NEL values for all treated samples. The experimental agricultural wastes did not respond equally to the chemical treatments investigated, i.e. they differ in the induced increases pertaining to their IVOMD, ME and NEL. The highest changes in the studied parameters due to chemical treatments were obtained when applying the 6% concentration. There was no significant effect (P<0.05) of irradiation on IVOMD, ME and NEL values for all treated samples. Moreover, the combined treatments of irradiation and hydrobromic acid or sodium hydroxide were found to have no significant affects on the IVOMD, ME and NEL values compared to the individual chemical treatments. (author)

  1. Classified study and clinical value of the phase imaging features

    International Nuclear Information System (INIS)

    Dang Yaping; Ma Aiqun; Zheng Xiaopu; Yang Aimin; Xiao Jiang; Gao Xinyao

    2000-01-01

    445 patients with various heart diseases were examined by the gated cardiac blood pool imaging, and the phase was classified. The relationship between the seven types with left ventricular function index, clinical heart function, different heart diseases as well as electrocardiograph was studied. The results showed that the phase image classification could match with the clinical heart function. It can visually, directly and accurately indicate clinical heart function and can be used to identify diagnosis of heart disease

  2. Chemicals to enhance microalgal growth and accumulation of high-value bioproducts

    Directory of Open Access Journals (Sweden)

    Xinheng eYu

    2015-02-01

    Full Text Available Photosynthetic microalgae have attracted significant attention as they can serve as important sources for cosmetic, food and pharmaceutical products, industrial materials and even biofuel biodiesels. However, current productivity of microalga-based processes is still very low, which has restricted their scale-up application. In addition to various efforts in strain improvement and cultivation optimization, it was proposed that the productivity of microalga-based processes can also be increased using various chemicals to trigger or enhance cell growth and accumulation of bioproducts. Herein, we summarized recent progresses in applying chemical triggers or enhancers to improve cell growth and accumulation of bioproducts in algal cultures. Based on their enhancing mechanisms, these chemicals can be classified into four categories:chemicals regulating biosynthetic pathways, chemicals inducing oxidative stress responses, phytohormones and analogues regulating multiple aspects of microalgal metabolism, and chemicals directly as metabolic precursors. Taken together, the early researches demonstrated that the use of chemical stimulants could be a very effective and economical way to improve cell growth and accumulation of high-value bioproducts in large-scale cultivation of microalgae.

  3. Clinical value of natriuretic peptides in chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Carla Santos-Araújo

    2015-05-01

    This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure.

  4. Coronary CT angiography: Diagnostic value and clinical challenges.

    Science.gov (United States)

    Sabarudin, Akmal; Sun, Zhonghua

    2013-12-26

    Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

  5. Consistency between Self-Reported and Recorded Values for Clinical Measures

    OpenAIRE

    III, Joseph Thomas; Paulet, Mindy; Rajpura, Jigar R.

    2016-01-01

    Objectives. This study evaluated consistency between self-reported values for clinical measures and recorded clinical measures. Methods. Self-reported values were collected for the clinical measures: systolic blood pressure, diastolic blood pressure, glucose level, height, weight, and cholesterol from health risk assessments completed by enrollees in a privately insured cohort. Body mass index (BMI) was computed from reported height and weight. Practitioner recorded values for the clinical me...

  6. Exploring the value of qualitative research films in clinical education.

    Science.gov (United States)

    Toye, Fran; Jenkins, Sue; Seers, Kate; Barker, Karen

    2015-11-27

    Many healthcare professionals use both quantitative and qualitative research to inform their practice. The usual way to access research findings is through peer-reviewed publications. This study aimed to understand the impact on healthcare professionals of watching and discussing a short research based film. The film, 'Struggling to be me' portrays findings from a qualitative synthesis exploring people's experiences of chronic pain, and was delivered as part of an inter-professional postgraduate e-learning module. The innovation of our study is to be the first to explore the impact of qualitative research portrayed through the medium of film in clinical education. All nineteen healthcare professionals enrolled on the course in December 2013 took part in on-line interviews or focus groups. We recorded and transcribed the interviews verbatim and used the methods of Grounded Theory to analyse the interview transcripts. Watching and discussing the film became a stimulus for learning : (a) A glimpse beneath the surface explored a pro-active way of seeing the person behind the pain (b) Pitfalls of the Medical Model recognised the challenge, for both patient and clinician, of 'sitting with' rather than 'fixing' an ill person; (c) Feeling bombarded by despair acknowledged the intense emotions that the clinicians brings to the clinical encounter; (d) Reconstructing the clinical encounter as a shared journey reconstructed the time-constrained clinical encounter as a single step on a shared journey towards healing, rather than fixing. Films portraying qualitative research findings can stimulate a pro-active and dialectic form of knowing. Research-based qualitative films can make qualitative findings accessible and can be a useful resource in clinical training. Our research presents, for the first time, specific learning themes for clinical education.

  7. The adenoid-nasopharynx ratio. Its clinical value in children

    International Nuclear Information System (INIS)

    Zou Mingshun

    1997-01-01

    To evaluate the clinical usefulness of adenoid-nasopharynx ratio (A/N ratio) measured on nasopharyngeal lateral plain film, 106 clinical cases of secretory otitis media were selected to measure the A/N ratio before treatment. For patients with A/N ratio of 0.50-0.70, the symptoms improved distinctly after conservative treatment, but one half of patients with A/N ratio ≥ 0.71 required adenoidectomy. A/N ratio is a practical and convenient method for evaluation of the adenoid. A/N ratio ≥ 0.71 indicates pathological enlarged adenoid

  8. Distribution of haematological and chemical pathology values among infants in Malawi and Uganda

    Science.gov (United States)

    Kumwenda, Newton I.; Khonje, Tiwonge; Mipando, Linda; Nkanaunena, Kondwani; Katundu, Pauline; Lubega, Irene; Elbireer, Ali; Bolton, Steve; Bagenda, Danstan; Mubiru, Michael; Fowler, Mary Glenn; Taha, Taha E.

    2013-01-01

    Background Data on paediatric reference laboratory values are limited for sub-Saharan Africa. Objective To describe the distribution of haematological and chemical pathology values among healthy infants from Malawi and Uganda. Methods A cross-sectional study was conducted among healthy infants, 0–6 months old, born to HIV-uninfected mothers recruited from two settings in Blantyre, Malawi and Kampala, Uganda. Chemical pathology and haematology parameters were determined using standard methods on blood samples. Descriptive analyses by age-group were performed based on 2004 Division of AIDS Toxicity Table age categories. Mean values and interquartile ranges were compared by site and age-group. Results A total of 541 infants were included altogether, 294 from Malawi and 247 from Uganda. Overall, the mean laboratory values were comparable between the two sites. Mean alkaline phosphatase levels were lower among infants aged ≤21 days while aspartate aminotransferase, creatinine, total bilirubin and gamma-glutamyl transferase were higher in those aged 0–7 days than in older infants. Mean haematocrit, haemoglobin and neutrophil counts were higher in the younger age-groups (<35 days) and overall were lower than US norms. Red and white blood cell counts tended to decrease after birth but increased after ~2 months of age. Mean basophil counts were higher in Malawi than in Uganda in infants aged 0–1 and 2–7 days; mean counts for eosinophils (for age groups 8–21 or older) and platelets (for all age groups) were higher in Ugandan than in Malawian infants. Absolute lymphocyte counts increased with infant age. Conclusion The chemical pathology and haematological values in healthy infants born to HIV-uninfected mothers were comparable in Malawi and Uganda and can serve as useful reference values in these settings. PMID:23164296

  9. Cyanobacteria as a Platform for the High-Value Chemicals Production

    DEFF Research Database (Denmark)

    Wlodarczyk, Artur Jacek

    and cheap fertilizer as a medium for the cultivation of engineered cyanobacterial strains is shown. Alternative strategy to engineer Synechocystis sp. PCC 6803 as a universal platform for the sustainable production of diverse range high-value phenylpropanoids which find use as pharmaceuticals, cosmetics......Emerging problems like increasing global warming and depletion of fossil fuels bring serious concerns regarding production of food and various chemicals in the future. Clearly, there is a need for finding alternative and more sustainable ways of producing chemicals in order to satisfy increasing...... consumer demands of an ever growing population. Considering the ability to convert solar energy and carbon dioxide into biomass, cyanobacteria and microalgae have potential for becoming such alternative in the future. Biosynthesis of a great number of plant high-value secondary metabolites requires...

  10. The Value of Clinical Teachers for EMR Implementations and Conversions

    Science.gov (United States)

    Pantaleoni, J.L.; Longhurst, C.A.

    2015-01-01

    Summary Effective physician training is an essential aspect of EMR implementation. However, it can be challenging to find instructors who can present the material in a clinically relevant manner. The authors describe a unique physician-training program, utilizing medical students as course instructors. This approach resulted in high learner satisfaction rates and provided significant cost-savings compared to alternative options. PMID:25848414

  11. Nutritional value and chemical composition of Cichorium spinosum L. under saline conditions

    OpenAIRE

    Petropoulos, Spyridon Α.; Vasilios, Antoniadis; Efi, Levizou; Fernandes, Ângela; Barros, Lillian; Ferreira, Isabel C.F.R.

    2016-01-01

    Soil salinity is an ever‐growing problem that hinders vegetable cultivation in many areas within the Mediterranean basin. Cichorium spinosum is native to the Mediterranean basin and is usually found in coastal areas and plateaus. In the present study, C. spinosum plants were grown under saline conditions (1.8, 4 and 8 dS/m), in order to evaluate the effect of salinity on their nutritional value and chemical composition. From the results it was observed that high salinity levels...

  12. Method for conversion of carbohydrate polymers to value-added chemical products

    Science.gov (United States)

    Zhang, Zongchao C [Norwood, NJ; Brown, Heather M [Kennewick, WA; Su, Yu [Richland, WA

    2012-02-07

    Methods are described for conversion of carbohydrate polymers in ionic liquids, including cellulose, that yield value-added chemicals including, e.g., glucose and 5-hydroxylmethylfurfural (HMF) at temperatures below 120.degree. C. Catalyst compositions that include various mixed metal halides are described that are selective for specified products with yields, e.g., of up to about 56% in a single step process.

  13. Clinical value of different detection methods in blunt ocular trauma

    Directory of Open Access Journals (Sweden)

    Yang Li

    2018-02-01

    Full Text Available Blunt ocular can cause persistent change of eye structure and function, the method of detection which is closely related to eye injury including B-can ultrasonography, UBM, OCT, FFA, scanning laser polarimetry, fundus autofluorescence, each examination with particular emphasis. This paper aims to review the advantages and disadvantages of different inspection methods in order to provide reference for clinical diagnosis and treatment of blunt ocular trauma.

  14. Role and Value of Clinical Pharmacy in Heart Failure Management.

    Science.gov (United States)

    Stough, W G; Patterson, J H

    2017-08-01

    Effectively managing heart failure requires a multidisciplinary, holistic approach attuned to many factors: diagnosis of structural and functional cardiac abnormalities; medication, device, or surgical management; concomitant treatment of comorbidities; physical rehabilitation; dietary considerations; and social factors. This practice paper highlights the pharmacist's role in the management of patients with heart failure, the evidence supporting their functions, and steps to ensure the pharmacist resource is available to the broad population of patients with heart failure. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  15. Genetic variability of genital mycoplasmas and its clinical value

    Directory of Open Access Journals (Sweden)

    K. I. Plakhova

    2015-01-01

    Full Text Available The article presents data on genetic variability of genital mycoplasmas. The author presents the results of genetic variability studies for M. hominis, gene vaa, U. parvum, gene mba, and M. genitalium, gene mg192, sampled from women with different clinical manifestations of inflammatory diseases of the urogenital system. Based on the molecular typing results for 138 samples of genital mycoplasmas, the author revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars as well as different genetic variations of M. hominis.Infection with 6 U. parvum serovar results in the development of inflammatory diseases of the urogenital tract accompanied by subjective manifestations (р < 0.05. Genetic variant II of М. hominis was revealed more often in patients with clinical manifestations of inflammatory diseases while variant I was revealed more often in patients infected with М. hominis without any signs of inflammation (р < 0.05. Genetic variants of M. genitalium were determined; no significant differences in terms of their prevalence in the examined patients were revealed.

  16. Clinical value of renal images obtained incidentally to bone scintigraphy

    International Nuclear Information System (INIS)

    Ohishi, Y.; Machida, T.; Miki, M.; Kido, A.; Tanaka, A.

    1982-01-01

    Various studies were made on 400 renal (including 325 clinical cases) observed during whole-body bone scintigraphy using 99mTc-MDP. Asymmetrical renal images in bone scintigrams were obtained from 40% of the urologic patients and 7.5% of the nonurologic patients. Out of the asymmetrical images of the urologic patients, 50% provided nonvisualized kidneys and 35% showed unilateral renal high accumulation. It can be said from the above that renal images incidentally obtained during whole-body bone scintigraphy should not be overlooked

  17. Added clinical value of the inferior temporal EEG electrode chain

    DEFF Research Database (Denmark)

    Bach Justesen, Anders; Eskelund Johansen, Ann Berit; Martinussen, Noomi Ida

    2018-01-01

    Objective To investigate the diagnostic added value of supplementing the 10–20 EEG array with six electrodes in the inferior temporal chain. Methods EEGs were recorded with 25 electrodes: 19 positions of the 10–20 system, and six additional electrodes in the inferior temporal chain (F9/10, T9/10, P...... in the inferior chain) and 6% (only seen at the inferior chain). Conclusions Adding six electrodes in the inferior temporal electrode chain to the 10–20 array improves the localization and identification of EEG abnormalities, especially those located in the temporal region. Significance Our results suggest...

  18. Value and limitations of clinical practice guidelines in neonatology.

    Science.gov (United States)

    Polin, Richard A; Lorenz, John M

    2015-12-01

    Given the overwhelming size of the neonatal literature, clinicians must rely upon expert panels such as the Committee on Fetus and Newborn in the USA and the National Institute for Healthcare and Excellence in the UK for guidance. Guidelines developed by expert panels are not equivalent to evidence-based medicine and are not rules, but do provide evidence-based recommendations (when possible) and at minimum expert consensus reports. The standards used to develop evidence-based guidelines differ among expert panels. Clinicians must be able judge the quality of evidence from an expert panel, and decide whether a recommendation applies to their neonatal intensive care unit or infant under their care. Furthermore, guidelines become outdated within a few years and must be revised or discarded. Clinical practice guidelines should not always be equated with standard of care. However, they do provide a framework for determining acceptable care. Clinicians do not need to follow guidelines if the recommendations are not applicable to their population or infant. However, if a plan of care is not consistent with apparently applicable clinical practice guidelines, the medical record should include an explanation for the deviation from the relevant practice guideline. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Chemical composition, nutritional value and in vitro starch digestibility of roasted chickpeas.

    Science.gov (United States)

    Simsek, Senay; Herken, Emine Nur; Ovando-Martinez, Maribel

    2016-06-01

    Chickpea is considered a wholesome and nutritious food due to its nutritional properties and glycemic response. Such properties can be influenced by the thermal treatment used to cook this legume and produce a snack named leblebi. From the consumers' point of view, it is desirable to improve texture and palatability of the chickpea by the processing steps used to make leblebi. However, consumers are increasingly concerned with the nutritional value of snack foods. Nutritional components and digestibility properties of single and double heat-treated chickpea, single and double roasted leblebi and white leblebi were studied. High sodium, starch damage and soluble dietary fiber content were observed in white leblebi; while the other samples showed significantly (P good nutritional quality and low glycemic response. White leblebi had relatively high sodium content and glycemic response. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

  20. Opportunity for high value-added chemicals from food supply chain wastes.

    Science.gov (United States)

    Matharu, Avtar S; de Melo, Eduardo M; Houghton, Joseph A

    2016-09-01

    With approximately 1.3 billion tonnes of food wasted per annum, food supply chain wastes (FSCWs) may be viewed as the contemporary Periodic Table of biobased feedstock chemicals (platform molecules) and functional materials. Herein, the global drivers and case for food waste valorisation within the context of global sustainability, sustainable development goals and the bioeconomy are discussed. The emerging potential of high value added chemicals from certain tropical FSCW is considered as these are grown in three major geographical areas: Brazil, India and China, and likely to increase in volume. FSCW in the context of biorefineries is discussed and two case studies are reported, namely: waste potato, and; orange peel waste. Interestingly, both waste feedstocks, like many others, produce proteins and with the global demand for vegetable proteins on the rise then proteins from FSCW may become a dominant area. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Mammary neoplasm inflammatory: clinic presentation: combined treatment value

    International Nuclear Information System (INIS)

    Viola Alles, A.; Sabini Gaye, G.; Barrios Herrera, E.; Muse Sevrini, I.

    1995-01-01

    On a total of 1152 patients bearing of cancer of she suckles tried in the period 1978-1988, 41 of she(3.5% )corresponding to the variety inflamatory. Her ages was understood between 26 and 73 years , was been 15(63,5% )postmenopause. Clinically they presented commitment mammary exclusive 34,1%, invasion ganglionar lorregional 48,7% and 17% was disseminated remaining. The initial treatment bases on 3-4 cycles of chemotherapy type FCA, safe in patient with more years that they received the association CMF. All then were irradiated with dose of 5000-6000 cGy on she suckles and territories ganglionares. Finish the treatment with 6 to 8 additional cycles of the patients' chemotherapy. Nobody it was subjected to surgical. The middle survive of the population's total it was of 22 meses, has been of 26 for the premenopause and 15 for the posmenopause. The percentage of relapses arrive to 30% and 45% in the located ways they were disseminated during its evolution. It highlights that the therapeutic strategy you bases on the association open chemotherapy, radiotherapy remaining the possibility of the handling of high citostatics dose with or without transplants of osseous medulla osea (Author) [es

  2. Clinical value of MRI on wrists with arthritis

    International Nuclear Information System (INIS)

    Ma Qiang; Ma Daqing; He Wen; Le Erhu; Ma Xinfa; Wang Jun; Zuo Zhaoyong

    2006-01-01

    Objective: To study the appearances of various kinds of arthritis on MRI, and to assess and evaluate the role of MRI on diagnosing various kinds of arthritis. Methods: One hundred and fifty-one patients with medical history of wrist pain entered the study. T 1 -weighted spin echo, STIR (short time inversion recovery) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were examined in the coronal planes. MRl, plain wrist radiographs, clinical data including swollen joint and patient global assessment (AIMS), and laboratory, examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score (HAQ). According to 1987 American Rheumatism Association (ARA) revised criteria, in 151 patients, 80 patients were diagnosed as rheumatoid arthritis, 29 patients as undifferentiated spondyloarthropathy, 20 patients as seronegative spondyloarthropathy, and 22 as other kinds of connective tissue diseases. Results: All 80 patients diagnosed with rheumatoid arthritis had bilateral pannus. Among 29 patients diagnosed with undifferentiated spondyloanthropathy, 3 cases had bilateral pannus, 24 had lateral pannus. Among 20 patients diagnosed with seronegative spondyloanthropathy, 4 cases had bilateral pannus, 15 had lateral pannus. Among 22 patients diagnosed with other kinds of connective tissue disease, 21 had lateral pannus. Bilateral pannus on bilateral wrists occured in 87 patients. There were not significant difference in the unilateral pannus among patients with various arthritis (χ 2 =6.157; P>0.05). But there were significant difference in the bilateral pannus among patients with various arthritis (χ 2 =126.882, P 2 =94.192, P 2 =70.354, P 2 =96.174, P<0.001). Conclusion: MRI can show the pathologic changes of wrists with various kinds of arthritis. MRI plays an important role in the differential diagnosis of various kinds of arthritis

  3. Clinical value of computerized tomography scanning in severe head injury

    International Nuclear Information System (INIS)

    Kobayashi, Shiro; Yano, Masami; Otsuka, Toshibumi; Nakazawa, Shozo

    1982-01-01

    Serial computerized tomography (SCT) was performed on 138 patients suffering from severe head injuries (8 or less on the Glasgow Coma Scale). Standard practice called for scans to be done upon admission (within hours of the injury), and after 1, 3, 7 days and 1 month. Subsequent CT's depended on the patient's condition. Clinical results at the time of discharge were graded according to the Glasgow Outcome Scale. Patients who died, were in a persistent vegetative state, or were severely disabled were considered to have a ''bad outcome''. On the other hand, patients who were somewhat disabled or made good recoveries were considered to have a ''good outcome''. During the serial CT scan, there were new findings (not visualized on the initial CT but appearing on subsequent ones) in 91 of the 138 patients. These new findings were classified as follows; 1) decreased density collection in the subdural space (DDC), 2) ventricular dilation (VD), 3) intracerebral hematoma (ICH), 4) intraventricular hemorrhage (IVH), 5) extracerebral hematoma (ECH), 6) edema (E), 7) infarction (I). We defined ICH, IVH, ECH, E and I as new lesions. Of the 60 patients with new lesions 12 had good outcomes and 48 had poor outcomes. There were 78 patients who did not have any new lesions, 60 with good outcomes and 18 with poor outcomes. A significant correlation was found between good outcomes and the absence of new lesions, and between bad outcomes and the development of new lesions (p 2 = 44.038). We conclude that SCT can help predict the outcome with severe head injury patients and may be very important in their examination and care. (J.P.N.)

  4. Expression and clinical value of EGFR in human meningiomas

    Directory of Open Access Journals (Sweden)

    Magnus B. Arnli

    2017-03-01

    Full Text Available Background Meningiomas are common intracranial tumors in humans that frequently recur despite having a predominantly benign nature. Even though these tumors have been shown to commonly express EGFR/c-erbB1 (epidermal growth factor receptor, results from previous studies are uncertain regarding the expression of either intracellular or extracellular domains, cellular localization, activation state, relations to malignancy grade, and prognosis. Aims This study was designed to investigate the expression of the intracellular and extracellular domains of EGFR and of the activated receptor as well as its ligands EGF and TGFα in a large series of meningiomas with long follow-up data, and investigate if there exists an association between antibody expression and clinical and histological data. Methods A series of 186 meningiomas consecutively operated within a 10-year period was included. Tissue microarrays were constructed and immunohistochemically analyzed with antibodies targeting intracellular and extracellular domains of EGFR, phosphorylated receptor, and EGF and TGFα. Expression levels were recorded as a staining index (SI. Results Positive immunoreactivity was observed for all antibodies in most cases. There was in general high SIs for the intracellular domain of EGFR, phosphorylated EGFR, EGF, and TGFα but lower for the extracellular domain. Normal meninges were negative for all antibodies. Higher SIs for the phosphorylated EGFR were observed in grade II tumors compared with grade I (p = 0.018. Survival or recurrence was significantly decreased in the time to recurrence analysis (TTR with high SI-scores of the extracellular domain in a univariable survival analysis (HR 1.152, CI (1.036–1.280, p = 0.009. This was not significant in a multivariable analysis. Expression of the other antigens did not affect survival. Conclusion EGFR is overexpressed and in an activated state in human meningiomas. High levels of ligands also support this

  5. Top value platform chemicals: bio-based production of organic acids.

    Science.gov (United States)

    Becker, Judith; Lange, Anna; Fabarius, Jonathan; Wittmann, Christoph

    2015-12-01

    Driven by the quest for sustainability, recent years have seen a tremendous progress in bio-based production routes from renewable raw materials to commercial goods. Particularly, the production of organic acids has crystallized as a competitive and fast-evolving field, related to the broad applicability of organic acids for direct use, as polymer building blocks, and as commodity chemicals. Here, we review recent advances in metabolic engineering and industrial market scenarios with focus on organic acids as top value products from biomass, accessible through fermentation and biotransformation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Chemical Composition, Physicochemical Characteristics, and Nutritional Value of Lannea kerstingii Seeds and Seed Oil

    Directory of Open Access Journals (Sweden)

    Judicaël Thomas Ouilly

    2017-01-01

    Full Text Available The chemical composition, main physicochemical properties, and nutritional value of seed flour and seed oil of Lannea kerstingii were studied. The results indicated that seeds contained 3.61% moisture, 57.85% fat, 26.39% protein, 10.07% carbohydrates, and 2.08% ash. Potassium was the predominant mineral, followed by magnesium and calcium. The essential amino acids were at higher levels than the estimated amino acid requirements of FAO/WHO/UNU except for lysine. Fatty acid composition showed that oleic acid was the major fatty acid, followed by palmitic, linoleic, and stearic acids. Physicochemical properties of the seed oil were melting point, 19.67°C; refractive index (25°C, 1.47; iodine value, 60.72/100 g of oil; peroxide value, 0.99 meq. O2/kg of oil; p-anisidine value, 0.08; total oxidation (TOTOX value, 2.06; oxidative stability index (120°C, 52.53 h; free fatty acids, 0.39%; acid value, 0.64 mg of KOH/g of oil; saponification value, 189.73. Total amount of tocopherols, carotenoids, and sterols was 578.60, 4.60, and 929.50 mg/kg of oil, respectively. γ-Tocopherol (82%, lutein (80%, and β-sitosterol (93% were the most abundant forms of tocopherols, carotenoids, and sterols, respectively. Seeds of L. kerstingii constitute an alternative source of stable vegetable oil and protein for nutritional and industrial applications.

  7. Screening values for Non-Carcinogenic Hanford Waste Tank Vapor Chemicals that Lack Established Occupational Exposure Limits

    Energy Technology Data Exchange (ETDEWEB)

    Poet, Torka S.; Mast, Terryl J.; Huckaby, James L.

    2006-02-06

    Over 1,500 different volatile chemicals have been reported in the headspaces of tanks used to store high-level radioactive waste at the U.S. Department of Energy's Hanford Site. Concern about potential exposure of tank farm workers to these chemicals has prompted efforts to evaluate their toxicity, identify chemicals that pose the greatest risk, and incorporate that information into the tank farms industrial hygiene worker protection program. Established occupation exposure limits for individual chemicals and petroleum hydrocarbon mixtures have been used elsewhere to evaluate about 900 of the chemicals. In this report headspace concentration screening values were established for the remaining 600 chemicals using available industrial hygiene and toxicological data. Screening values were intended to be more than an order of magnitude below concentrations that may cause adverse health effects in workers, assuming a 40-hour/week occupational exposure. Screening values were compared to the maximum reported headspace concentrations.

  8. Economic Evaluations for the Carbon Dioxide-involved Production of High-value Chemicals

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Lee, Dong Woog; Jang, Se Gyu; Kwak, No-Sang; Lee, In Young; Jang, Kyung Ryoung; Shim, Jae-Goo [KEPCO Research Institute, Daejon (Korea, Republic of); Choi, Jong Shin [Korea East-West Power Co. LTD, Seoul (Korea, Republic of)

    2014-06-15

    Economic evaluation of the manufacturing technology of high-value chemicals through the carbonation reaction of carbon dioxide contained in the flue gas was performed, and analysis of the IRR (Internal Rate of Return) and whole profit along the production plan of the final product was conducted. Through a carbonation reaction with sodium hydroxide that is generated from electrolysis and by using carbon dioxide in the combustion gas that is generated in the power plant, it is possible to get a high value products such as sodium bicarbonate compound and also to reduce the carbon dioxide emission simultaneously. The IRR (Internal Rate of Return) and NPV (Net Present Value) methods were used for the economic evaluation of the process which could handle carbon dioxide of 100 tons per day in the period of the 20 years of plant operation. The results of economic evaluation showed that the IRR of baseline case of technology was 67.2% and the profit that obtained during the whole operation period (20 years) was 346,922 million won based on NPV value. When considering ETS due to the emissions trading enforcement that will be activated in 2015, the NPV was improved to a 6,000 million won. Based on this results, it could be concluded that this CO2 carbonation technology is an cost-effective technology option for the reduction of greenhouse gas.

  9. Economic Evaluations for the Carbon Dioxide-involved Production of High-value Chemicals

    International Nuclear Information System (INIS)

    Lee, Ji Hyun; Lee, Dong Woog; Jang, Se Gyu; Kwak, No-Sang; Lee, In Young; Jang, Kyung Ryoung; Shim, Jae-Goo; Choi, Jong Shin

    2014-01-01

    Economic evaluation of the manufacturing technology of high-value chemicals through the carbonation reaction of carbon dioxide contained in the flue gas was performed, and analysis of the IRR (Internal Rate of Return) and whole profit along the production plan of the final product was conducted. Through a carbonation reaction with sodium hydroxide that is generated from electrolysis and by using carbon dioxide in the combustion gas that is generated in the power plant, it is possible to get a high value products such as sodium bicarbonate compound and also to reduce the carbon dioxide emission simultaneously. The IRR (Internal Rate of Return) and NPV (Net Present Value) methods were used for the economic evaluation of the process which could handle carbon dioxide of 100 tons per day in the period of the 20 years of plant operation. The results of economic evaluation showed that the IRR of baseline case of technology was 67.2% and the profit that obtained during the whole operation period (20 years) was 346,922 million won based on NPV value. When considering ETS due to the emissions trading enforcement that will be activated in 2015, the NPV was improved to a 6,000 million won. Based on this results, it could be concluded that this CO2 carbonation technology is an cost-effective technology option for the reduction of greenhouse gas

  10. Correlations between the 1H NMR chemical shieldings and the pKa values of organic acids and amines.

    Science.gov (United States)

    Lu, Juanfeng; Lu, Tingting; Zhao, Xinyun; Chen, Xi; Zhan, Chang-Guo

    2018-06-01

    The acid dissociation constants and 1 H NMR chemical shieldings of organic compounds are important properties that have attracted much research interest. However, few studies have explored the relationship between these two properties. In this work, we theoretically studied the NMR chemical shifts of a series of carboxylic acids and amines in the gas phase and in aqueous solution. It was found that the negative logarithms of the experimental acid dissociation constants (i.e., the pK a values) of the organic acids and amines in aqueous solution correlate almost linearly with the corresponding calculated NMR chemical shieldings. Key factors that affect the theoretically predicted pK a values are discussed in this paper. The present work provides a new way to predict the pK a values of organic/biochemical compounds. Graphical abstract The chemical shielding values of organic acids and amines correlate near linearly with their corresponding pK a values.

  11. Economic Value Approach to Industrial Water Demand Management, A Case Study of Chemical Plants

    Directory of Open Access Journals (Sweden)

    morteza tahami pour zarandi

    2017-03-01

    Full Text Available Limitations in water supply to meet the increasing demand have encouraged both planners and researchers to focus attention on water demand management, in which such economic tools as the water pricing system play a major role. A fundamental component of the pricing system is the estimation of the economic value of water, which reflects a firm’s maximum affordable water price or the ultimate elasticity of industrial water. The present study was conducted to estimate the economic value of water for basic chemical plants, excluding fertilizers and nitrogen compounds (code 2411, representing the four-digit ISIC industrial codes which account for about 14% of the total industrial water consumption. The econometric method of production function within the framework of panel data and the residual method were used. Data were collected from the Census of medium-sized businesses carried out by the Statistical Center of Iran over the period 1997–2013.  Results showed that one cubic meter of water allocated to the plants surveyed creates a value of 3,7071 Rials, which shows a large gap with the current purchase price of 5685 Rials. Moreover, it was found that the present water prices account for only about 1.3 percent of the total production cost of basic chemicals, excluding fertilizers and nitrogen compounds. It may, thus, be concluded that it is reasonable to increase the present water tariffs and discriminate among the various manufacturing codes by differences in tariffs in order to achieve water demand management goals. Finally, the information emerging from the study may be exploited to improve the revenues earned by water authorities or to carry out feasibility studies of industrial water development projects.

  12. Prediction of pKa Values for Druglike Molecules Using Semiempirical Quantum Chemical Methods.

    Science.gov (United States)

    Jensen, Jan H; Swain, Christopher J; Olsen, Lars

    2017-01-26

    Rapid yet accurate pK a prediction for druglike molecules is a key challenge in computational chemistry. This study uses PM6-DH+/COSMO, PM6/COSMO, PM7/COSMO, PM3/COSMO, AM1/COSMO, PM3/SMD, AM1/SMD, and DFTB3/SMD to predict the pK a values of 53 amine groups in 48 druglike compounds. The approach uses an isodesmic reaction where the pK a value is computed relative to a chemically related reference compound for which the pK a value has been measured experimentally or estimated using a standard empirical approach. The AM1- and PM3-based methods perform best with RMSE values of 1.4-1.6 pH units that have uncertainties of ±0.2-0.3 pH units, which make them statistically equivalent. However, for all but PM3/SMD and AM1/SMD the RMSEs are dominated by a single outlier, cefadroxil, caused by proton transfer in the zwitterionic protonation state. If this outlier is removed, the RMSE values for PM3/COSMO and AM1/COSMO drop to 1.0 ± 0.2 and 1.1 ± 0.3, whereas PM3/SMD and AM1/SMD remain at 1.5 ± 0.3 and 1.6 ± 0.3/0.4 pH units, making the COSMO-based predictions statistically better than the SMD-based predictions. For pK a calculations where a zwitterionic state is not involved or proton transfer in a zwitterionic state is not observed, PM3/COSMO or AM1/COSMO is the best pK a prediction method; otherwise PM3/SMD or AM1/SMD should be used. Thus, fast and relatively accurate pK a prediction for 100-1000s of druglike amines is feasible with the current setup and relatively modest computational resources.

  13. Calorific Value and Chemical Composition of Five Semi-Arid Mexican Tree Species

    Directory of Open Access Journals (Sweden)

    Maginot Ngangyo-Heya

    2016-03-01

    Full Text Available The current global energy crisis has generated growing interest in looking for alternatives to traditional fossil fuels, presenting lignocellulosic materials as a promising resource for sustainable energy production. In this paper, the calorific values and chemical composition of the trunks, branches, twigs and leaves of five timber species of the semi-arid land of Mexico (Helietta parvifolia (Gray Benth., Ebenopsis ebano (Berl. Barneby, Acacia berlandieri (Benth., Havardia pallens (Benth. Britton & Rose and Acacia wrightii (Benth. were determined according to international standards. The results highlighted the calorific value ranges of 17.56 to 18.61 MJ kg−1 in trunks, 17.15 to 18.45 MJ kg−1 in branches, 17.29 to 17.92 MJ kg−1 in twigs, and 17.35to 19.36 MJ kg−1 in leaves. The pH presented an acidic trend (3.95–5.64. The content of mineral elements varied in trunks (1.09%–2.29%, branches (0.86%–2.75%, twigs (4.26%–6.76% and leaves (5.77%–11.79%, showing the higher proportion in Ca (57.03%–95.53%, followed by K (0.95%–19.21% and Mg (0.88%–13.47%. The highest amount of extractives was obtained in the methanolic solvent (3.96%–17.03%. The lignin recorded values of 28.78%–35.84% for trunks, 17.14%–31.39% for branches and 20.61%–29.92% for twigs. Lignin showed a moderately strong correlation (r = 0.66 with calorific value, but the best mathematical model was registered with the calorific value depending on the pH and lignin (R2 = 58.86%.

  14. The major differences in chemical composition and antibacterial activity of two closely related Leonotis species (Lamiaceae may have taxonomic value

    Directory of Open Access Journals (Sweden)

    J.N. Eloff

    2010-01-01

    Full Text Available Several Leonotis species are used widely for medicinal purposes in Africa. There have been drastic changes in the taxonomic treatment of Leonotis species during the past decade. Two species, L. dysophylla and L. microphylla occurring in Pretoria have been considered as varieties of the same species and as different species by different authors. Because Leonotis species are used widely as medicinal plants inter alia against bacterial infections, we decided to compare the chemical composition and antibacterial activity of four plants from each of two populations of the species. The chemical composition of acetone extracts of finely ground leaves was determined by thin layer chromatography followed by spraying with vanillin-sulphuric acid. There were hardly any differences between plants from the same population. There were major differences between the two species in the composition of pigments separated by thin layer chromatography and for compounds visualized with the vanillin-sulphuric acid spray reagent. This supported the viewpoint that the two species should not be considered as varieties. The major differences found in chemical composition indicate that chemical parameters may play an important role in resolving taxonomic differences. Because such a small quantity of material is needed, it may be feasible to analyze one or two leaves obtained from herbarium sheets as an additional taxonomic parameter. The antibacterial activity of the acetone extracts was determined using a two-fold serial dilution microplate method with tetrazolium violet as indicator of growth. The specific strains of the four most important nosocomial bacterial pathogens suggested by the United States National Committee for Clinical Laboratory Standards were used: Staphylococcus aureus (American Type Culture Collection 29213, Pseudomonas aeruginosa (ATCC 27853, Escherichia coli (ATCC 25922 and Enterococcus faecalis (ATCC 21212. The minimum inhibitory activity of the

  15. Upgrading of lignocellulosic biorefinery to value-added chemicals: Sustainability and economics of bioethanol-derivatives

    DEFF Research Database (Denmark)

    Cheali, Peam; Posada, John A.; Gernaey, Krist

    2015-01-01

    with a sustainability assessment method is used as evaluation tool. First, an existing superstructure representing the lignocellulosic biorefinery design network is extended to include the options for catalytic conversion of bioethanol to value-added derivatives. Second, the optimization problem for process upgrade...... of operating profit for biorefineries producing bioethanol-derived chemicals (247 MM$/a and 241 MM$/a for diethyl ether and 1,3-butadiene, respectively). Second, the optimal designs for upgrading bioethanol (i.e. production of 1,3-butadiene and diethyl ether) performed also better with respect...... to sustainability compared with the petroleum-based processes. In both cases, the effects of the market price uncertainties were also analyzed by performing quantitative economic risk analysis and presented a significant risk of investment for a lignocellulosic biorefinery (12 MM$/a and 92 MM$/a for diethyl ether...

  16. Determination of reference values for intraocular pressure and Schirmer tear test results in clinically normal domestic donkeys (Equus asinus).

    Science.gov (United States)

    Selk Ghaffari, Masoud; Sabzevari, Amin; Ghamsari, SeyedMehdi; Shad, Hussein

    2017-11-25

    This study was conducted to establish normal reference range for the Schirmer tear test (STT) and intraocular pressure (IOP) in clinically normal donkeys for use in clinical practice. Sixteen adult Ethiopian domestic donkeys were used in this study. Complete ophthalmic examinations were performed without chemical restraint. STT values were evaluated in both eyes of all donkeys using a commercial STT strip. IOP was measured in both eyes with a Tono-Pen Vet (Reichert. USA) without using regional nerve blocks. STT values for all eyes (n=32) were 22.1±6.9 mm/minute with a range of 13-35 mm/minute. Comparison of mean STT values between right (n=16) and left eyes (n=16) showed no differences (P=0.6). Mean ±sd IOP values by applanation tonometry were 17.8±3.7 mmHg (range 13.5-24.5 mmHg). Comparison of mean IOP values between right (n=16) and left eyes (n=16) showed no differences (P=0.7). This initial survey provides means and ranges for IOP and STT values in donkeys. These data will assist veterinary ophthalmologists in more accurate diagnosis and management of ophthalmic diseases in donkeys, including keratoconjunctivitis sicca and glaucoma. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Production of bioelectricity, bio-hydrogen, high value chemicals and bioinspired nanomaterials by electrochemically active biofilms.

    Science.gov (United States)

    Kalathil, Shafeer; Khan, Mohammad Mansoob; Lee, Jintae; Cho, Moo Hwan

    2013-11-01

    Microorganisms naturally form biofilms on solid surfaces for their mutual benefits including protection from environmental stresses caused by contaminants, nutritional depletion or imbalances. The biofilms are normally dangerous to human health due to their inherited robustness. On the other hand, a recent study suggested that electrochemically active biofilms (EABs) generated by electrically active microorganisms have properties that can be used to catalyze or control the electrochemical reactions in a range of fields, such as bioenergy production, bioremediation, chemical/biological synthesis, bio-corrosion mitigation and biosensor development. EABs have attracted considerable attraction in bioelectrochemical systems (BESs), such as microbial fuel cells and microbial electrolysis cells, where they act as living bioanode or biocathode catalysts. Recently, it was reported that EABs can be used to synthesize metal nanoparticles and metal nanocomposites. The EAB-mediated synthesis of metal and metal-semiconductor nanocomposites is expected to provide a new avenue for the greener synthesis of nanomaterials with high efficiency and speed than other synthetic methods. This review covers the general introduction of EABs, as well as the applications of EABs in BESs, and the production of bio-hydrogen, high value chemicals and bio-inspired nanomaterials. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. The calculation of the chemical exergies of coal-based fuels by using the higher heating values

    International Nuclear Information System (INIS)

    Bilgen, Selcuk; Kaygusuz, Kamil

    2008-01-01

    This paper demonstrates the application of exergy to gain a better understanding of coal properties, especially chemical exergy and specific chemical exergy. In this study, a BASIC computer program was used to calculation of the chemical exergies of the coal-based fuels. Calculations showed that the chemical composition of the coal influences strongly the values of the chemical exergy. The exergy value of a coal is closely related to the H:C and O:C ratios. High proportions of hydrogen and/or oxygen, compared to carbon, generally reduce the exergy value of the coal. High contents of the moisture and/or the ash cause to low values of the chemical exergy. The aim of this paper is to calculate the chemical exergy of coals by using equations given in the literature and to detect and to evaluate quantitatively the effect of irreversible phenomena increased the thermodynamic imperfection of the processes. In this paper, the calculated exergy values of the fuels will be useful for energy experts studied in the coal mining area and coal-fired powerplants

  19. CHEMICAL COMPOSITION AND ENERGY VALUE IN THE MEAT OF THE MACEDONIAN AND OHRID TROUT

    Directory of Open Access Journals (Sweden)

    Aleksandar SAVESKI

    2017-03-01

    Full Text Available The aim of this research is to conduct a comparative analysis and to verify the quality properties of meat of the Macedonian trout (Salmo macedonicus and the Ohrid trout (Salmo letnica, from aquaculture production, bred on a fish farm under controlled conditions. In order to determine the quality of meat of the Macedonian and Ohrid trout, analyses of the chemical composition have been conducted: the amount of proteins, fat, water, minerals, as well as a determination of the energy value of the meat. The analyses have been made on samples from Macedonian and Ohrid trout, with size of consumption between 200g and 300g. By these analyses, it has been confirmed that in the meat of the Macedonian trout, the amount of water is 77.122%, 17.800% proteins, 3.333% fat and 1.667% minerals, whereas in the meat of the Ohrid trout 75.923% water, 16.783% proteins, 5.403% fat and 1.080% minerals. Though the established difference in the amount of water and fat is not significant, the differences determined in the contents of proteins and minerals are significant on a level p>0,05. The energy value of Macedonian trout meat is 435.29 KJ/100gm, i.e. and 498.49 KJ/100gm in the Ohrid trout meat.

  20. Nutritive value and chemical composition of prickly pear seeds (Opuntia ficus indica L.) growing in Turkey.

    Science.gov (United States)

    Özcan, Mehmet Musa; Al Juhaimi, Fahad Y

    2011-08-01

    The proximate composition and physico-chemical properties (moisture, crude lipid, crude protein, ash, and crude fiber, peroxide value, saponification value, acidity, relative density and refractive index) of prickly pear seed and corresponding oil were determined. The mineral contents (Ca, Cu, Fe, K, Mg, Na, P, Mn and Zn) of samples were analyzed by inductively coupled plasma atomic emission spectrometry. Minerals determined were: calcium 471.2 mg/kg, potassium 532.7 mg/kg, magnesium 117.3 mg/kg, phosphorus 1,627.5 mg/kg and natrium 71.3 mg/kg. The fatty acid profiles of seed oil from the Opuntia ficus indica were analyzed by gas chromatography. Linoleic acid was established as the major fatty acid (61.01%), followed by oleic (25.52%) and palmitic (12.23%) acids. Both myristic, stearic and arachidonic acids were detected in O. ficus indica seed oil in low amounts. As a result, O. ficus indica seeds are an important source of natural fiber and, given its high linoleic acid content, its oil can be used as a nutraceutic agent.

  1. The value of iodide as a parameter in the chemical characterisation of groundwaters

    Science.gov (United States)

    Lloyd, J. W.; Howard, K. W. F.; Pacey, N. R.; Tellam, J. H.

    1982-06-01

    Brackish and saline groundwaters can severely constrain the use of fresh groundwaters. Their chemical characterisation is important in understanding the hydraulic conditions controlling their presence in an aquifer. Major ions are frequently of limited value but minor ions can be used. Iodide in groundwater is particularly significant in many environments due to the presence of soluble iodine in aquifer matrix materials. Iodide is found in groundwaters in parts of the English Chalk aquifer in concentrations higher than are present in modern seawater. Its presence is considered as a indication of groundwater residence and is of use in the characterisation of fresh as well as saline waters. Under certain circumstances modern seawater intrusion into aquifers along English estuaries produces groundwaters which are easily identified due to iodide enrichment from estuarine muds. In other environments iodide concentrations are of value in distinguishing between groundwaters in limestones and shaly gypsiferous rocks as shown by a study in Qatar, while in an alluvial aquifer study in Peru iodide has been used to identify groundwaters entering the aquifer from adjacent granodiorites.

  2. Top Value Added Chemicals from Biomass: Volume I -- Results of Screening for Potential Candidates from Sugars and Synthesis Gas

    Energy Technology Data Exchange (ETDEWEB)

    Werpy, T.; Petersen, G.

    2004-08-01

    This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol.

  3. Top Value Added Chemicals from Biomass - Volume I, Results of Screening for Potential Candidates from Sugars and Synthesis Gas

    Energy Technology Data Exchange (ETDEWEB)

    None

    2004-08-01

    This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol.

  4. Effect of mentoring on professional values in model C clinical nurse leader graduates.

    Science.gov (United States)

    Gazaway, Shena B; Anderson, Lori; Schumacher, Autumn; Alichnie, Chris

    2018-04-19

    Nursing graduates acquire their nursing values by professional socialization. Mentoring is a crucial support mechanism for these novice nurses, yet little is known about the model C clinical nurse leader graduate and the effects of mentoring. This investigation examined how mentoring affected the development of professional nursing values in the model C clinical nurse leader graduate. A longitudinal design was used to survey model C clinical nurse leader graduates before and after graduation to determine how different types of mentoring relationships influenced professional values. Demographic surveys documented participant characteristics and the Nurses Professional Values Scale - Revised (NPVS-R) assessed professional nursing values. Mean NPVS-R scores increased after graduation for the formally mentored participants, while the NPVS-R scores decreased or remained unchanged for the other mentoring groups. However, no significant difference was found in NPVS-R scores over time (p = .092) or an interaction between the NPVS-R scores and type of mentoring relationships (p = .09). These results suggest that model C clinical nurse leader graduate participants experiencing formal mentoring may develop professional nursing values more than their colleagues. Formal mentoring relationships are powerful and should be used to promote professional values for model C clinical nurse leader graduates. © 2018 John Wiley & Sons Ltd.

  5. Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care.

    Science.gov (United States)

    Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S

    2017-01-01

    The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.

  6. The Emerging Business Models and Value Proposition of Mobile Health Clinics.

    Science.gov (United States)

    Aung, Khin-Kyemon; Hill, Caterina; Bennet, Jennifer; Song, Zirui; Oriol, Nancy E

    2015-12-01

    Mobile health clinics are increasingly used to deliver healthcare to urban and rural populations. An estimated 2000 vehicles in the United States are now delivering between 5 and 6 million visits annually; however, despite this growth, mobile health clinics represent an underutilized resource that could transform the way healthcare is delivered, especially in underserved areas. Preliminary research has shown that mobile health clinics have the potential to reduce costs and improve health outcomes. Their value lies primarily in their mobility, their ability to be flexibly deployed and customized to fit the evolving needs of populations and health systems, and their ability to link clinical and community settings. Few studies have identified how mobile health clinics can be sustainably utilized. We discuss the value proposition of mobile health clinics and propose 3 potential business models for them-adoption by accountable care organizations, payers, and employers.

  7. The Value of Laboratory Tests in Diagnosing Secondary Osteoporosis at a Fracture and Osteoporosis Outpatient Clinic

    NARCIS (Netherlands)

    de Klerk, Gijs; Hegeman, J. Han; van der Velde, Detlef; van der Palen, Jacobus Adrianus Maria; ten Duis, Henk J.

    2013-01-01

    Background: As more and more patients meeting the criteria for osteoporosis are referred to a fracture and osteoporosis outpatient clinic (FO clinic), the laboratory costs to screen for secondary osteoporosis also increases. This study was conducted to determine the value of screening on underlying

  8. Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

    NARCIS (Netherlands)

    Heymans, R.; van der Helm, J. J.; de Vries, H. J. C.; Fennema, H. S. A.; Coutinho, R. A.; Bruisten, S. M.

    2010-01-01

    The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary

  9. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

    NARCIS (Netherlands)

    van Kampen, D.A.; van den Berg, T.; van der Woude, H.J.; Castelein, R.M.; Terwee, C.B.; Willems, W.J.

    2013-01-01

    Background: It is unknown which combination of patient information and clinical tests might beoptimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determinethe diagnostic value of individual clinical tests and to develop a prediction model that combined patient

  10. Faithful but Different: Clinical Social Workers Speak Out about Career Motivation and Professional Values

    Science.gov (United States)

    Bradley, Carolyn; Maschi, Tina; O'Brien, Helen; Morgen, Keith; Ward, Kelly

    2012-01-01

    The purpose of this study was to describe licensed clinical social workers' (LCSWs) professional motivation to pursue a social work career and the decision to enter clinical practice. It used a probability sample of 245 New Jersey LCSWs and the Social Work Values Survey as part of an anonymous self-administered mail survey. Descriptive analyses…

  11. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    Science.gov (United States)

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

  12. A national survey on pediatric critical values used in clinical laboratories across Canada.

    Science.gov (United States)

    Gong, Yanping; Adeli, Khosrow

    2009-11-01

    Notification of critical values to clinical staff is an important post-analytical process in all acute care clinical laboratories. No data are available however on how laboratories obtain or establish critical values, particularly in pediatric settings. This study was designed to examine and compare critical values used for pediatric patients in biochemistry laboratories in Canada and assess potential interlaboratory variability. Fourteen clinical laboratories, including two in pediatric hospitals and twelve in hospitals caring for both children and adults, participated in a survey that included 14 pre-selected STAT chemistry tests and 19 pre-selected therapeutic drug monitoring (TDM) tests. Among fourteen chemistry tests, good agreement was observed for critical values used for sodium and pH at both low and high levels within 14 participant laboratories. Significant interlaboratory variability existed for glucose critical values at the high end, magnesium at high end, and PO2 at the low end. For 19 TDM tests, the majority of laboratories did not have alert values to report values over the therapeutic level but not toxic. For critical values greater than the toxic range, significant variability existed at both trough and peak levels among laboratories surveyed. When asked to provide the source for critical values established at each site, only a limited number of laboratories identified their sources as either internal decision or published references. Although all laboratories have established and routinely use critical values to alert clinical staff, considerable variability exists in both the critical limits reported as well as the source of such values. There is a clear need for new national efforts to standardize pediatric critical value reporting and establish evidence-based critical limits for all medical laboratories across Canada.

  13. Evaluating Business Value of IT in Healthcare: Three Clinical Practices from Australia and the US.

    Science.gov (United States)

    Haddad, Peter; Schaffer, Jonathan L; Wickramasinghe, Nilmini

    2015-01-01

    Exponentially increasing costs in healthcare coupled with poor quality and limited access have motivated the healthcare industry to turn to IS/IT solutions to overcome these issues and facilitate superior healthcare delivery. In an environment of rapid development of new clinical informatics solutions claiming to provide better healthcare delivery, there is a paucity of systematic frameworks to robustly measure the actual value of these systems. The promised business value of these solutions has been elusive; hence, this study offers an approach for the evaluation of the business value of health IS/IT solutions based on a conceptual model, which has been validated using three clinical case studies.

  14. Effect of white striping on chemical composition and nutritional value of chicken breast meat

    Directory of Open Access Journals (Sweden)

    Massimiliano Petracci

    2014-03-01

    Full Text Available White striping defect (appearance of white striations parallel to muscle fiber on surface of breast is considered an emerging issue in chicken breast meat which is related to increasing growth rate of modern hybrid birds. This study was aimed at evaluating the effect of white striping on chemical composition and nutritional value of chicken breast meat. During three replications, a total of 108 Pectoralis major muscles representing three degrees of white striping (absence=normal; presence classified in 2 levels as moderate or severe were selected to determine proximate composition (moisture, protein, lipid and collagen as well as sarcoplasmic and myofibrillar protein profile by sodium dodecyl sulphatepolyacrylamide gel electrophoresis analysis. The results showed that both severe and moderate white-striped fillets had higher fat content (2.53 vs 1.46 vs 0.78%; P<0.001, lower protein level (20.9 vs 22.2 vs 22.9%; P<0.001, decreased quality of protein as proven by higher collagen content (1.30 vs 1.37 vs 1.43%; P<0.001, and different pattern on myofibrillar and sarcoplasmic fractions when compared to normal fillets. Moreover, severe white-striped fillets exhibited higher energy content (450.7 vs 421.1 kJ/100g; P<0.01 with respect to normal meat. In conclusion, there was a large worsening of nutritional value of chicken breast meat following occurrence of white striping and this might impair consumer attitude towards poultry meat.

  15. Therapeutic values, chemical constituents and toxicity of Taiwanese Dysosma pleiantha--a review.

    Science.gov (United States)

    Karuppaiya, Palaniyandi; Tsay, Hsin Sheng

    2015-07-16

    Dysosma pleiantha (Hance) Woodson also called as Bajiaolian belongs to the family Berberidaceae, is widely used in Taiwan as traditional Chinese herbal medicine for more than thousands of years. It is usually recommended by various traditional Chinese medical doctors and herbal pharmacies for general remedies including postpartum recovery, treatment of weakness, neck mass, acne, hepatoma, lumbago, snakebite, tumor growth and dysmenorrhea. In the textbooks of traditional Chinese medicine, there is limited information about the toxicity of Bajiaolian. Podophyllotoxin, a lignan is the main toxic ingredient of Bajiaolian rhizome. Therefore, Bajiaolian is documented as the fifth highest cause of poisoning among the herbal medicine in Taiwan. Since the therapeutic and toxic doses are very close, Bajiaolian poisoning cases are frequently reported in Taiwan. Moreover, Dysosma poisoning cases are difficult to diagnosis because physicians are unfamiliar with this medicine's multiple clinical presentations in different stages of intoxication. Therefore, the objective of this review is to represent the collective information available in literatures regarding D. pleiantha, a cytotoxic lignan containing medicinal plant. Specifically, the literatures have been reviewed for articles pertaining to chemical constituents, properties, therapeutical benefits, toxicity, poisoning symptoms, toxic as well as therapeutic dose and medical management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Chemical composition and nutritional value of unripe banana flour (Musa acuminata, var. Nanicão).

    Science.gov (United States)

    Menezes, Elizabete Wenzel; Tadini, Carmen Cecília; Tribess, Tatiana Beatris; Zuleta, Angela; Binaghi, Julieta; Pak, Nelly; Vera, Gloria; Dan, Milana Cara Tanasov; Bertolini, Andréa C; Cordenunsi, Beatriz Rosana; Lajolo, Franco M

    2011-09-01

    Banana flour obtained from unripe banana (Musa acuminata, var. Nanicão) under specific drying conditions was evaluated regarding its chemical composition and nutritional value. Results are expressed in dry weight (dw). The unripe banana flour (UBF) presented a high amount of total dietary fiber (DF) (56.24 g/100 g), which consisted of resistant starch (RS) (48.99 g/100 g), fructans (0.05 g/100 g) and DF without RS or fructans (7.2 g/100 g). The contents of available starch (AS) (27.78 g/100 g) and soluble sugars (1.81 g/100 g) were low. The main phytosterols found were campesterol (4.1 mg/100 g), stigmasterol (2.5 mg/100 g) and β-sitosterol (6.2 mg/100 g). The total polyphenol content was 50.65 mg GAE/100 g. Antioxidant activity, by the FRAP and ORAC methods, was moderated, being 358.67 and 261.00 μmol of Trolox equivalent/100 g, respectively. The content of Zn, Ca and Fe and mineral dialyzability were low. The procedure used to obtain UBF resulted in the recovery of undamaged starch granules and in a low-energy product (597 kJ/100 g).

  17. On the clinical value of roentgenological observation of the clinical course of renal osteopathy

    International Nuclear Information System (INIS)

    Fritsch, R.; Freyschmidt, J.; Lustenberger, N.; Hesch, R.D.; Medizinische Hochschule Hannover

    1980-01-01

    Basing on radiological observation of the course of renal osteopathy confirmed both clinically and by bone biopsy in 96 patients - the X-ray examination comprising primarily the entire axial skeleton including the proximal extremities and hands - 60% of the patients showed mineralisation in their hands. The rest of the skeleton was affected only if there were identifiable alterations at the hands, although the affection of the axial skeleton was definitely lower in terms of percentage. Hence, radiological observation of renal osteopathy based on X-ray films of both hands with additional magnification technique appears both possible and meaningful. (orig.) [de

  18. Critical value reporting: a survey of 36 clinical laboratories in South Africa.

    Science.gov (United States)

    Schapkaitz, Elise; Mafika, Zipho

    2013-10-11

    Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin 20 g/dl, platelet count 1 000 ×10(9)/l, white cell count 46 ×10(9)/l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient's care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory's critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies.

  19. Melatonin: a chemical photoperiodic signal with clinical significance in humans.

    Science.gov (United States)

    Pang, S F; Pang, C S; Poon, A M; Lee, P P; Liu, Z M; Shiu, S Y

    1998-03-01

    Secretion of pineal melatonin exhibits a diumal rhythm and a seasonal rhythm in humans. Night-time melatonin is high at 3-5 year-old and decreases with age. Many drugs and pathological conditions also change melatonin levels in the circulation. Melatonin has a mild sedative effect and has been used effectively in synchronizing the sleep-wake cycle of patients with sleep disorders. Immunoenhancing, anti-cancer, anti-aging and anti-oxidant effects of melatonin have been proposed. Recent studies suggest that melatonin receptors are present in central and peripheral tissues. The importance of melatonin receptors on the nervous, reproductive, immune and renal functions is implicated. Studies on the molecular biology, physiology and pathology of melatonin receptors in different tissues are progressing rapidly. The physiological and pathological changes in melatonin secretion, multifarious melatonin actions, and diverse melatonin receptors reported suggest that melatonin is a photoperiodic signal with clinical significance in humans.

  20. Top Value Added Chemicals From Biomass: I. Results of Screening for Potential Candidates from Sugars and Synthesis Gas

    Energy Technology Data Exchange (ETDEWEB)

    Werpy, Todd A.; Holladay, John E.; White, James F.

    2004-11-01

    This report identifies twelve building block chemicals that can be produced from sugars via biological or chemical conversions. The twelve building blocks can be subsequently converted to a number of high-value bio-based chemicals or materials. Building block chemicals, as considered for this analysis, are molecules with multiple functional groups that possess the potential to be transformed into new families of useful molecules. The twelve sugar-based building blocks are 1,4-diacids (succinic, fumaric and malic), 2,5-furan dicarboxylic acid, 3-hydroxy propionic acid, aspartic acid, glucaric acid, glutamic acid, itaconic acid, levulinic acid, 3-hydroxybutyrolactone, glycerol, sorbitol, and xylitol/arabinitol. In addition to building blocks, the report outlines the central technical barriers that are preventing the widespread use of biomass for products and chemicals.

  1. Collaborative partnership and the social value of clinical research: a qualitative secondary analysis.

    Science.gov (United States)

    Nurmi, Sanna-Maria; Halkoaho, Arja; Kangasniemi, Mari; Pietilä, Anna-Maija

    2017-10-25

    Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders' perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for

  2. Mephedrone (4-methylmethcathinone; 'meow meow'): chemical, pharmacological and clinical issues.

    Science.gov (United States)

    Schifano, Fabrizio; Albanese, Antonio; Fergus, Suzanne; Stair, Jackie L; Deluca, Paolo; Corazza, Ornella; Davey, Zoe; Corkery, John; Siemann, Holger; Scherbaum, Norbert; Farre', Magi'; Torrens, Marta; Demetrovics, Zsolt; Ghodse, A Hamid

    2011-04-01

    Recently, those substances deriving from the active ingredient of the Khat plant, cathinone, have been rising in popularity. Indeed, 4-methylmethcathinone (mephedrone; 'meow meow' and others) has been seen by some as a cheaper alternative to other classified recreational drugs. We aimed here at providing a state-of-the-art review on mephedrone history and prevalence of misuse, chemistry, pharmacology, legal status, product market appearance, clinical/management and related fatalities. Because of the limited evidence, some of the information here presented has been obtained from user reports/drug user-orientated web sites. The most common routes for mephedrone recreational use include insufflation and oral ingestion. It elicits stimulant and empathogenic effects similar to amphetamine, methylamphetamine, cocaine and MDMA. Due to its sympathomimetic actions, mephedrone may be associated with a number of both physical and psychopathological side effects. Recent preliminary analysis of recent UK data carried out in 48 related cases have provided positive results for the presence of mephedrone at postmortem. Within the UK, diffusion of mephedrone may have been associated with an unprecedented combination of a particularly aggressive online marketing policy and a decreasing availability/purity of both ecstasy and cocaine. Mephedrone has been recently classified in both the UK and in a number of other countries as a measure to control its availability. Following this, a few other research psychoactives have recently entered the online market as yet unregulated substances that may substitute for mephedrone. Only international collaborative efforts may be able to tackle the phenomenon of the regular offer of novel psychoactive drugs.

  3. Reference values of clinical chemistry and hematology parameters in rhesus monkeys (Macaca mulatta).

    Science.gov (United States)

    Chen, Younan; Qin, Shengfang; Ding, Yang; Wei, Lingling; Zhang, Jie; Li, Hongxia; Bu, Hong; Lu, Yanrong; Cheng, Jingqiu

    2009-01-01

    Rhesus monkey models are valuable to the studies of human biology. Reference values for clinical chemistry and hematology parameters of rhesus monkeys are required for proper data interpretation. Whole blood was collected from 36 healthy Chinese rhesus monkeys (Macaca mulatta) of either sex, 3 to 5 yr old. Routine chemistry and hematology parameters, and some special coagulation parameters including thromboelastograph and activities of coagulation factors were tested. We presented here the baseline values of clinical chemistry and hematology parameters in normal Chinese rhesus monkeys. These data may provide valuable information for veterinarians and investigators using rhesus monkeys in experimental studies.

  4. The clinical value of detection of serum TGAb and TPOAb level in autoimmune thyroid diseases

    International Nuclear Information System (INIS)

    Min Xiaoxia; Huang Xingming

    2008-01-01

    To study the clinical value of serum TGAb and TPOAb levels in the diagnosis of patients with autoimmune thyroid diseases (AITD), the serum levels of TGAb and TPOAb in 175 patients with AITD and 64 non-AITD patients and 57 health controls were measured by RIA. The results showed that the serum levels of TGAb and TPOAb in AITD patients with GD and HT were significantly higher than that of control group (P 0.05). The detection of serum TGAb and TPOAb levels may have clinical value in the diagnosis, treatment and prognosis of autoimmune thyroid diseases. (authors)

  5. Driving out waste: a framework to enhance value in clinical care.

    Science.gov (United States)

    Burton, David A

    2013-06-01

    Many healthcare providers today are seeking to improve the value of the care they deliver by implementing standardized clinical practice guidelines aimed at reducing variations in care, avoiding complications, and lowering costs. To succeed, such an initiative requires the full support and participation of the clinicians who will use the guidelines. Providers also should have a fully developed infrastructure consisting of a clinical content system, an analytics system, and a deployment system.

  6. DWI of Prostate Cancer: Optimal b-Value in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Guglielmo Manenti

    2014-01-01

    Full Text Available Aim. To compare the diagnostic performance of diffusion weighted imaging (DWI using b-values of 1000 s/mm2 and 2000 s/mm2 at 3 Tesla (T for the evaluation of clinically significant prostate cancer. Matherials and Methods. Seventy-eight prostate cancer patients underwent a 3T MRI scan followed by radical prostatectomy. DWI was performed using b-values of 0, 1000, and 2000 s/mm2 and qualitatively analysed by two radiologists. ADC maps were obtained at b-values of 1000 and 2000 s/mm2 and quantitatively analyzed in consensus. Results. For diagnosis of 78 prostate cancers the accuracy of DWI for the young reader was significantly greater at b = 2000 s/mm2 for the peripheral zone (PZ but not for the transitional zone (TZ. For the experienced reader, DWI did not show significant differences in accuracy between b-values of 1000 and 2000 s/mm2. The quantitative analysis in the PZ and TZ was substantially superimposable between the two b-values, albeit with a higher accuracy with a b-value of 2000 s/mm2. Conclusions. With a b-value of 2000 s/mm2 at 3T both readers differentiated clinical significant cancer from benign tissue; higher b-values can be helpful for the less experienced readers.

  7. Chemical Information Literacy: pK[subscript a] Values--Where Do Students Go Wrong?

    Science.gov (United States)

    Flynn, Alison B.; Amellal, Delphine G.

    2016-01-01

    Chemical information literacy is an essential skillset for navigating, evaluating, and using the wealth of print and online information. Accordingly, efforts are underway to improve students' acquisition and mastery of this skillset. However, less is known about students' abilities related to finding and using chemical information to solve…

  8. Medicine, methodology, and values: trade-offs in clinical science and practice.

    Science.gov (United States)

    Ho, Vincent K Y

    2011-01-01

    The current guidelines of evidence-based medicine (EBM) presuppose that clinical research and clinical practice should advance from rigorous scientific tests as they generate reliable, value-free knowledge. Under this presupposition, hypotheses postulated by doctors and patients in the process of their decision making are preferably tested in randomized clinical trials (RCTs), and in systematic reviews and meta-analyses summarizing outcomes from multiple RCTs. Since testing under this scheme is predominantly focused on the criteria of generality and precision achieved through methodological rigor, at the cost of the criterion of realism, translating test results to clinical practice is often problematic. Choices concerning which methodological criteria should have priority are inevitable, however, as clinical trials, and scientific research in general, cannot meet all relevant criteria at the same time. Since these choices may be informed by considerations external to science, we must acknowledge that science cannot be value-free in a strict sense, and this invites a more prominent role for value-laden considerations in evaluating clinical research. The urgency for this becomes even more apparent when we consider the important yet implicit role of scientific theories in EBM, which may also be subjected to methodological evaluation and for which selectiveness in methodological focus is likewise inevitable.

  9. Advancing medicine one research note at a time: the educational value in clinical case reports

    Directory of Open Access Journals (Sweden)

    Cabán-Martinez Alberto J

    2012-07-01

    Full Text Available Abstract A case report—a brief written note that describes unique aspects of a clinical case—provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new “case reports” section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science — one research note at a time.

  10. Advancing medicine one research note at a time: the educational value in clinical case reports.

    Science.gov (United States)

    Cabán-Martinez, Alberto J; Beltrán, Wilfredo F García

    2012-07-06

    A case report--a brief written note that describes unique aspects of a clinical case--provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new "case reports" section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science--one research note at a time.

  11. Don't just do something, stand there! The value and art of deliberate clinical inertia.

    Science.gov (United States)

    Keijzers, Gerben; Cullen, Louise; Egerton-Warburton, Diana; Fatovich, Daniel M

    2018-04-01

    It can be difficult to avoid unnecessary investigations and treatments, which are a form of low-value care. Yet every intervention in medicine has potential harms, which may outweigh the potential benefits. Deliberate clinical inertia is the art of doing nothing as a positive response. This paper provides suggestions on how to incorporate deliberate clinical inertia into our daily clinical practice, and gives an overview of current initiatives such as 'Choosing Wisely' and the 'Right Care Alliance'. The decision to 'do nothing' can be complex due to competing factors, and barriers to implementation are highlighted. Several strategies to promote deliberate clinical inertia are outlined, with an emphasis on shared decision-making. Preventing medical harm must become one of the pillars of modern health care and the art of not intervening, that is, deliberate clinical inertia, can be a novel patient-centred quality indicator to promote harm reduction. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Biological and chemical weapons of mass destruction: updated clinical therapeutic countermeasures since 2003.

    Science.gov (United States)

    Pettineo, Christopher; Aitchison, Robert; Leikin, Scott M; Vogel, Stephen N; Leikin, Jerrold B

    2009-01-01

    The objective of this article is to provide updated treatment options for bioterrorism agents. This updated synopsis includes recent clinical cases and treatment recommendations that have arisen in the last 5 years. The decontamination, treatment, and disposition of these biologic and chemical agents are presented alphabetically by agent type: biologic, chemical, and radiologic/nuclear. The information provided outlines only new treatment options since 2003.

  13. Reference values for 27 clinical chemistry tests in 70-year-old males and females.

    Science.gov (United States)

    Carlsson, Lena; Lind, Lars; Larsson, Anders

    2010-01-01

    Reference values are usually defined based on blood samples from healthy men or nonpregnant women in the age range of 20-50 years. These values are not optimal for elderly patients, as many biological markers change over time and adequate reference values are important for correct clinical decisions. To validate NORIP (Nordic Reference Interval Project) reference values in a 70-year-old population. We studied 27 frequently used laboratory tests. The 2.5th and 97.5th percentiles for these markers were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values. Reference values are reported for plasma alanine aminotransferase, albumin, alkaline phosphatase, pancreas amylase, apolipoprotein A1, apolipoprotein B, aspartate aminotransferase, bilirubin, calcium, chloride, cholesterol, creatinine, creatine kinase, C-reactive protein, glucose, gamma-glutamyltransferase, HDL-cholesterol, iron, lactate dehydrogenase, LDL-cholesterol, magnesium, phosphate, potassium, sodium, transferrin, triglycerides, urate and urea. Reference values calculated from the whole population and a subpopulation without cardiovascular disease showed strong concordance. Several of the reference interval limits were outside the 90% CI of a Scandinavian population (NORIP). 2009 S. Karger AG, Basel.

  14. Top Value Added Chemicals From Biomass. Volume 1 - Results of Screening for Potential Candidates From Sugars and Synthesis Gas

    Science.gov (United States)

    2004-08-01

    UsesIntermediatesBiomass Feedstocks Sugars Glucose Fructose Xylose Arabinose Lactose Sucrose Starch Starch Cellulose Lignin Oil Protein Hemicellulose...these goals, the Program supports the integrated biorefinery, a processing facility that extracts carbohydrates, oils, lignin , and other materials from...biomass, converts them into multiple products including fuels and high value chemicals and materials. Already today, corn wet and dry mills, and

  15. Assessment of the nutritive value of cereal and legume straws based on chemical composition and in vitro digestibility

    NARCIS (Netherlands)

    Lopez, S.; Davies, D.; Dhanoa, M.S.; Dijkstra, J.; France, J.

    2005-01-01

    The nutritive value of 17 straws was determined on the basis of their chemical composition, in vitro dry matter (DM) digestibility and rumen fermentation kinetics (from gas production curves measured in vitro). Five roughages were from the cereal species Avena sativa (oat), Hordeum vulgare (barley),

  16. The value of clinical tests in acute full-thickness tears of the supraspinatus tendon

    DEFF Research Database (Denmark)

    Bak, Klaus; Sørensen, Anne Kathrine Belling; Jørgensen, Uffe Viegh

    2010-01-01

    Early repair of rotator cuff tears leads to superior results. To detect symptomatic full-thickness tears of the supraspinatus tendon at an early stage, we conducted a prospective study to evaluate the value of clinical examination with and without subacromial lidocaine within the first weeks after...

  17. The cultural shaping of alexithymia: values and externally oriented thinking in a Chinese clinical sample.

    Science.gov (United States)

    Dere, Jessica; Tang, Qiuping; Zhu, Xiongzhao; Cai, Lin; Yao, Shuqiao; Ryder, Andrew G

    2013-05-01

    Alexithymia is a multi-faceted personality construct characterized by difficulties in identifying and describing emotional states. Originally based on observations of American psychosomatic patients, the construct is now studied in a variety of cultural contexts. However, few studies have critically examined alexithymia from a cultural perspective. Dere et al. [1] recently found support for the hypothesis that one alexithymia component - externally oriented thinking (EOT) - is linked to cultural values, among Euro-Canadian and Chinese-Canadian students. The current study examines this association in a Chinese clinical sample. Outpatients presenting at three hospital-based psychology clinics in Hunan province, China (N=268) completed a structured clinical interview and self-report measures of alexithymia and cultural values. All participants endorsed clinically significant levels of depressed mood, anhedonia, and/or fatigue. As expected, EOT was negatively predicted by Modernization and Euro-American values. Two other alexithymia components, difficulty identifying feelings and difficulty describing feelings, were unrelated to cultural values. These findings suggest that cultural variations in the importance placed on emotional experience must be taken into account in cross-cultural alexithymia research. Such studies should also consider separately the specific components of alexithymia; failure to do so can lead to overestimation of alexithymia in groups where scores are driven by culturally-promoted EOT. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Clinical Correlates and Prognostic Value of Proenkephalin in Acute and Chronic Heart Failure

    NARCIS (Netherlands)

    Matsue, Yuya; ter Maaten, Jozine M.; Struck, Joachim; Metra, Marco; O'Connor, Christopher M.; Ponikowski, Piotr; Teerlink, John R.; Cotter, Gad; Davison, Beth; Cleland, John G.; Givertz, Michael M.; Bloomfield, Daniel M.; Dittrich, Howard C.; van Veldhuisen, Dirk J.; van der Meer, Peter; Damman, Kevin; Voors, Adriaan A.

    Background: Proenkephalin (pro-ENK) has emerged as a novel biomarker associated with both renal function and cardiac function. However, its clinical and prognostic value have not been well evaluated in symptomatic patients with heart failure. Methods and Results: The association between pro-ENK and

  19. Personal values and self-esteem in general and clinical population

    Directory of Open Access Journals (Sweden)

    Vanesa C. Góngora

    2015-09-01

    Full Text Available The aim of this study is to investigate the association between personal values and self-esteem in general population and clinical population. The sample was composed of a group of patients with a diagnosis of anxiety disorders and/or depression (n = 60 and a comparison group, paired by sex and age, of general population (n = 60. The Portrait Values Questionnaire of Schwartz (PVQ and the Autoe Self-esteem Scale were used. T-tests were performed to compare the scores of both instruments between the two groups. The clinical sample scored significantly lower in Self-esteem, Self- direction, Hedonism, and Openness to Change. For this reason, Pearson correlations were calculated in differential groups (clinical and general between the PVQ and the Self-esteem Scale. In the general population group self-esteem was associated to one value: Self-direction. In the clinical group, self-esteem was associated mainly to Self- direction, but also to Hedonism, Power and Security; and to the axis Self-promotion and Openness to Change. Both in the clinical and general population samples it was found a significant association between the interest in having independent thought, freedom of action and exploring with higher levels of self-esteem. 

  20. The Value of Clinical Jazz: Teaching Critical Reflection on, in, and Toward Action.

    Science.gov (United States)

    Casapulla, Sharon; Longenecker, Randall; Beverly, Elizabeth A

    2016-05-01

    Clinical Jazz is a small-group strategy in medical education designed to develop interpersonal skills and improve doctor-patient and interprofessional relationships. The purpose of this study was to explore medical students' and faculty facilitators' perceived value of Clinical Jazz. We conducted a modified Nominal Group Process with participating medical students (n=21), faculty facilitators (n=5), and research team members (n=3). Students and faculty facilitators independently answered the question, "What do you value about Clinical Jazz?" We then conducted content and thematic analyses on the resulting data. Three themes emerged during analysis: (1) students and faculty appreciated the opportunity to learn and practice a thoughtful and structured process for problem solving, (2) students and faculty valued the safety of the group process in sharing a diversity of perspectives on topics in medicine, and (3) students and faculty acknowledged the importance of addressing real and challenging problems that are rarely addressed in formal lectures and other planned small-group settings. Clinical Jazz provides students and faculty with the opportunity to address the hidden and/or informal curriculum in medical education, while providing a safe space and time to solve important clinical and interprofessional problems.

  1. Novel catalysts for valorization of biomass to value-added chemicals ...

    Indian Academy of Sciences (India)

    charides have attracted greater attention as a promis- ing carbon-based ... extensively studied due to importance of HMF as a plat- form chemical.4 Potential applications of HMF includes its selective oxidation to FDCA,5,6 hydrogenolysis to.

  2. The clinical value of serum PSA and PAP determinations in prostate cancer patients

    International Nuclear Information System (INIS)

    Zeng Lei; Yu Renbo; Du Guowei; Pang Baozhong

    2001-01-01

    Objective: To investigate the clinical value of serum PSA and PAP determinations in diagnosis of prostate cancer patients. Methods: The serum PSA and PAP levels of 98 prostate cancer patients, 45 prostate benign disease patients and 40 normal subjects were tested by IRMA. Results: The serum PSA and PAP levels of prostate cancer patients were significantly higher than those in prostate benign disease patients and normal controls (P < 0.01). The diagnostic sensitivity and specificity of serum PSA for prostate cancer were 93.9% and 93.3% respectively. The diagnostic sensitivity and specificity of serum PAP for prostate cancer were 71.4% and 91.1% respectively. Conclusion: The determination of serum PSA and PAP was of high clinical value for diagnosis of early prostate cancer. It could be used as an important reference parameter for the clinical staging, follow-up of treatment result and prediction of prognosis

  3. Clinical value of component-resolved diagnostics in peanut-allergic patients

    DEFF Research Database (Denmark)

    Eller, E; Bindslev-Jensen, C

    2013-01-01

    As replacement for the oral food challenge, decision-points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported to be of v......As replacement for the oral food challenge, decision-points for sensitization test have been established, but suboptimal sensitivity and/or specificity, as well as regional differences, have reduced the clinical usability. IgE toward specific peanut protein components has been reported...... to be of value, but data on correlation with clinical data are sparse. Our aim was to correlate IgE values with the outcome of peanut challenges....

  4. Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

    International Nuclear Information System (INIS)

    Liu Xiao; Wang Guiqi; He Shun

    2014-01-01

    Objective: To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC). Methods: A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS), esophagoscopy, thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed. The disease free survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings. Results: The median follow-up was 47 months.A total of 305 (85.2%) of all patients were analyzed by clinical stage based on EUS + CT.Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6%, highest (88.6%) for T1 stage and lowest for T4 stage. The predictive value of clinical N stage (N 0 /N1) was 62.5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P=0.000 and 0.000). There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted (P=0.000 and 0.000). Conclusions: Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients

  5. Clinical implications in laboratory parameter values in acute Kawasaki disease for early diagnosis and proper treatment.

    Science.gov (United States)

    Seo, Yu-Mi; Kang, Hyun-Mi; Lee, Sung-Churl; Yu, Jae-Won; Kil, Hong-Ryang; Rhim, Jung-Woo; Han, Ji-Whan; Lee, Kyung-Yil

    2018-05-01

    This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.

  6. The clinical value of Huangqi injection in the treatment of leucopenia: a meta-analysis of clinical controlled trials.

    Directory of Open Access Journals (Sweden)

    Changsong Zhang

    Full Text Available BACKGROUND: Huangqi injection is derived from Astragalus membranaceus root. In China, recent reports of Huangqi injection for the treatment of leucopenia have emerged. However, a systematic review of these reports has not been performed. Thus, we conducted a meta-analysis of clinical controlled trials to assess the clinical value of Huangqi injection in the treatment of leucopenia. METHODS: We searched the Chinese Biomedical Literature Database (CBM, Wanfang Database, China National Knowledge Infrastructure (CNKI, Chinese Scientific Journals Full-text Database (VIP, as well as PubMed and EMBASE to collect the data about trials of Huangqi injection for treating leucopenia. A meta-analysis was performed using RevMan 5.2 software. RESULTS: A total of 13 studies involving 841 patients were included in this study. The overall study quality was lower according to the Jadad scale. The meta-analysis showed that experimentally treated patients experienced greater therapeutic efficacy and lower white blood cell counts than control groups treated with Western medicine (P < 0.05. No publication bias was evident, according to Egger's test. CONCLUSIONS: The validity of this meta-analysis was limited by the overall poor quality of the included studies. Huangqi injection may have potential clinical value in the treatment of leucopenia, but confirmation with rigorously well-designed multi-center trials is needed.

  7. Economics evaluation for on-site pyrolysis of kraft lignin to value-added chemicals.

    Science.gov (United States)

    Farag, Sherif; Chaouki, Jamal

    2015-01-01

    This work is part of a series of investigations on pyrolysis of lignin. After obtaining the necessary information regarding the quantity and quality of the obtained products, a first step economics evaluation for converting lignin into chemicals was essential. To accomplish this aim, a pyrolysis plant with a 50t/d capacity was designed, and the total capital investment and operating costs were estimated. Next, the minimal selling price of the obtained dry oil was calculated and the effect of crucial variables on the estimated price was examined. The key result indicates the estimated selling price would not compete with the price of the chemicals that are fossil fuel based, which is primarily due to the high cost of the feedstock. To overcome this challenge, different scenarios for reducing the selling price of the obtained oil, which consequently is helping by taking a place among the fossil fuel based chemicals, were discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. The 5 Clinical Pillars of Value for Total Joint Arthroplasty in a Bundled Payment Paradigm.

    Science.gov (United States)

    Kim, Kelvin; Iorio, Richard

    2017-06-01

    Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms. We summarize a number of experiences and lessons learned since the implementation of Bundled Payments for Care Improvement at our institution. Our experience has led to the development of more refined clinical pathways and coordination of care through evidence-based approaches. We have established that the success of the bundled payment program rests on the following 5 main clinical pillars: (1) optimizing patient selection and comorbidities; (2) optimizing care coordination, patient education, shared decision making, and patient expectations; (3) using a multimodal pain management protocol and minimizing narcotic use to facilitate rapid rehabilitation; (4) optimizing blood management, and standardizing venous thromboembolic disease prophylaxis treatment by risk standardizing patients and minimizing the use of aggressive anticoagulation; and (5) minimizing post-acute facility and resource utilization, and maximizing home resources for patient recovery. From our extensive experience with bundled payment models, we have established 5 clinical pillars of value for bundled payments. Our hope is that these principles will help ease the transition to value-based care for less-experienced healthcare systems. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Utility of repeat testing of critical values: a Q-probes analysis of 86 clinical laboratories.

    Science.gov (United States)

    Lehman, Christopher M; Howanitz, Peter J; Souers, Rhona; Karcher, Donald S

    2014-06-01

    A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result. To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test. Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing. Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care. Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.

  10. Threshold of toxicological concern values for non-genotoxic effects in industrial chemicals: re-evaluation of the Cramer classification.

    Science.gov (United States)

    Kalkhof, H; Herzler, M; Stahlmann, R; Gundert-Remy, U

    2012-01-01

    The TTC concept employs available data from animal testing to derive a distribution of NOAELs. Taking a probabilistic view, the 5th percentile of the distribution is taken as a threshold value for toxicity. In this paper, we use 824 NOAELs from repeated dose toxicity studies of industrial chemicals to re-evaluate the currently employed TTC values, which have been derived for substances grouped according to the Cramer scheme (Cramer et al. in Food Cosm Toxicol 16:255-276, 1978) by Munro et al. (Food Chem Toxicol 34:829-867, 1996) and refined by Kroes and Kozianowski (Toxicol Lett 127:43-46, 2002), Kroes et al. 2000. In our data set, consisting of 756 NOAELs from 28-day repeated dose testing and 57 NOAELs from 90-days repeated dose testing, the experimental NOAEL had to be extrapolated to chronic TTC using regulatory accepted extrapolation factors. The TTC values derived from our data set were higher than the currently used TTC values confirming the safety of the latter. We analysed the prediction of the Cramer classification by comparing the classification by this tool with the guidance values for classification according to the Globally Harmonised System of classification and labelling of the United Nations (GHS). Nearly 90% of the chemicals were in Cramer class 3 and assumed as highly toxic compared to 22% according to the GHS. The Cramer classification does underestimate the toxicity of chemicals only in 4.6% of the cases. Hence, from a regulatory perspective, the Cramer classification scheme might be applied as it overestimates hazard of a chemical.

  11. Novel catalysts for valorization of biomass to value-added chemicals ...

    Indian Academy of Sciences (India)

    The catalysts used for each transformation were subjected to detailed characterization using XRD, BET surface area, temperature-programmed desorption and transmission electron microscopy. The effect of various reaction parameters was also investigated for obtaining high yields of desired chemical intermediates.

  12. Further Relationships Between Blood Chemical Values and College Student Performance and Attitudes.

    Science.gov (United States)

    Lindeman, Richard H.; And Others

    Blood serum uric acid and cholesterol levels in the blood were studied in relation to inner drive and external pressures of college students in the U.S.A. and in Sweden. Subjects for the study included 210 American and 78 Swedish male and female college students and 138 college football players. The blood chemicals were measured by Technicon…

  13. Determining utility values in patients with anterior cruciate ligament tears using clinical scoring systems

    Directory of Open Access Journals (Sweden)

    Szucs Thomas

    2011-08-01

    Full Text Available Abstract Background Several instruments and clinical scoring systems have been established to evaluate patients with ligamentous knee injuries. A comparison of individual articles in the literature is challenging, not only because of heterogeneity in methodology, but also due to the variety of the scoring systems used to document clinical outcomes. There is limited information about the correlation between used scores and quality of life with no information being available on the impact of each score on the utility values. The aim of this study was to compare the most commonly used scores for evaluating patients with anterior cruciate ligament (ACL injuries, and to establish corresponding utility values. These values will be used for the interpretation and comparison of outcome results in the currently available literature for different treatment options. Methods Four hypothetical vignettes were defined, based on different levels of activities after rupture of the ACL to simulate typical situations seen in daily practice. A questionnaire, including the Health Utility Index (HUI for utility values, the IKDC subjective score, the Lysholm and the Tegner score, was created and 25 orthopedic surgeons were asked to fill the questionnaire for each hypothetical patient as proxies for all patients they had treated and who would fit in that hypothetical vignette. Results The utility value as an indicator for quality of life increased with the level of activity. Having discomforts already during normal activities of daily living was rated with a mean utility value of 0.37 ± 0.19, half of that of a situation where mild sport activity was possible without discomfort (0.78 ± 0.11. All investigated scores were able to distinguish clearly (p Conclusions Here we report the correlation between the most commonly used scores for the assessment of patients with a ruptured ACL and utility values as an indicator of quality of life. Assumptions were based on expert

  14. Are exposure index values consistent in clinical practice? A multi-manufacturer investigation

    International Nuclear Information System (INIS)

    Butler, M. L.; Rainford, L.; Last, J.; Brennan, P. C.

    2010-01-01

    The advent of digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers have responded to this by offering an exposure index (EI) value to the clinician. Whilst the EI value is a measure of the air kerma at the detector surface, it has been recommended by international agencies as a method of monitoring radiation dose to the patient. Recent studies by the group have shown that EI values are being used in clinical practice to monitor radiation dose and assess image quality. This study aims to compare the clinical consistency of the EI value in computed radiography (CR) and direct digital radiography (DR) systems. An anthropomorphic phantom was used to simulate four common radiographic examinations: skull, pelvis, chest and hand. These examinations were chosen as they provide contrasting exposure parameters, image detail and radiation dose measurements. Four manufacturers were used for comparison: Agfa Gaevert CR, Carestream CR, Philips Digital Diagnost DR and Siemens DR. For each examination, the phantom was placed in the optimal position and exposure parameters were chosen in accordance with European guidelines and clinical practice. Multiple exposures were taken and the EI recorded. All exposure parameters and clinical conditions remained constant throughout. For both DR systems, the EI values remained consistent throughout. No significant change was noted in any examination. In both CR systems, there were noteworthy fluctuations in the EI values for all examinations. The largest for the Agfa system was a variation of 1.88-2.21 for the skull examination. This represents to the clinician a doubling of detector dose, despite all exposure parameters remaining constant. In the Kodak system, the largest fluctuation was seen for the chest examination where the EI ranged from 2560 to 2660, representing approximately an increase of 30% in radiation dose, despite consistent parameters. The fluctuations seen with the CR systems are most likely

  15. The role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease

    International Nuclear Information System (INIS)

    Shimada, Tomoyoshi; Nakamori, Hisato; Kurimoto, Toru; Karakawa, Masahiro; Matsuura, Takashi; Iwasaka, Toshiji; Inada, Mitsuo; Nishiyama, Yutaka

    1990-01-01

    To define the role and clinical value of thallium-201 myocardial scintigraphy in ischemic heart disease, 967 consecutive patients refered to our laboratory since 1985 were studied. The purpose of scintigraphy have changed from diagnosing of myocardial ischemia to assessing myocardial viability with the progress of coronary angioplasty. At present, thallium-201 myocardial scintigraphy have become indispensable noninvasive method for the management of patients with ischemic heart disease. (author)

  16. ERP in chronic pancreatitis - ductal morphology, relation to exocrine function and pain - clinical value

    International Nuclear Information System (INIS)

    Norup Lauridsen, K.; Raahede, J.; Kruse, A.; Thommesen, P.; Aarhus Univ.

    1985-01-01

    ERP was analyzed in 87 patients with chronic pancreatitis with special reference to its clinical value in management of pain, the dominating symptom in uncomplicated chronic pancreatitis. A significant correlation was found between ductal changes due to pancreatitis and decrease in pancreatic function. However, no association was found between severe pancreatic pain and pancreatic function or pancreatic morphology. The significance of ERP in management of patients with persistent severe pancreatic pain is discussed. (orig.) [de

  17. Early pleural fluid dynamics following video-assisted thoracoscopic lobectomy has limited clinical value

    DEFF Research Database (Denmark)

    Holbek, Bo Laksáfoss; Petersen, René Horsleben; Kehlet, Henrik

    2017-01-01

    The objective of this study was to evaluate the potential of predicting the pleural fluid output in patients after video-assisted thoracoscopic lobectomy of the lung. Detailed measurements of continuous fluid output were obtained prospectively using an electronic thoracic drainage device (Thopaz...... and 48 hours. Assessment of initial fluid production may predict high 24-hour fluid output (≥500 mL) but seems to lack clinical value in drain removal criteria....

  18. Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia

    OpenAIRE

    GONG, LIANG; ZHANG, CHONG-LIN; ZHEN, QING

    2016-01-01

    Pneumonia is an infectious disease of the lung causing mortality. Mycoplasma pneumonia (MP) is an atypical bacterial pneumonia that damages several organs. Lung computed tomography (CT) has been utilized in its identification. The aim of the present study was to examine the value of computed tomography diagnosis for pediatric MP. The present study prospectively analyzed the clinical and imaging data of 1,280 cases of pediatric MP in the out- and inpatient departments from March, 2010 to March...

  19. Groundwater chemical baseline values to assess the Recovery Plan in the Matanza-Riachuelo River basin, Argentina.

    Science.gov (United States)

    Zabala, M E; Martínez, S; Manzano, M; Vives, L

    2016-01-15

    The two most exploited aquifers in the Matanza-Riachuelo River basin are being monitored in the framework of the Integrated Environmental Sanitation Plan that implements the Basin Authority, Autoridad de Cuenca Matanza Riachuelo. In this context, this work identifies the groundwater chemical types and the natural processes behind them; determines spatial and temporal changes; establishes ranges of variation for chemical components, and proposes concentration values for the upper limit of the natural chemical background. A total of 1007 samples from three aquifer-layers (Upper Aquifer, top and bottom of Puelche Aquifer) have been studied. As concrete guidelines for practical determination of baseline values are not available in the region, the methodology used follows the proposals of European projects which assessed European water directives. The groundwater composition is very stable in terms of both chemical facies and mineralization degree, and the changes observed in the dry and wet periods analysed are subtle in general. Most of the groundwater is Na-HCO3 type, except a few samples that are Ca-HCO3, Na-ClSO4 and Na-Cl types. The Ca-HCO3 waters are the result of calcium carbonate dissolution, Na-HCO3 waters result from cation exchange and carbonate dissolution, while in the Na-ClSO4 and Na-Cl waters, mixing with connate and with encroached old marine water from the underlying and overlying sediments are the most relevant processes. The proposed values for the upper limit of the natural background consider the influence of geology and Holocene marine ingressions in the baseline of coastal groundwater. This study allowed to know the initial chemical conditions of the groundwater system of the Matanza-Riachuelo River basin and to establish the reference from which Basin Authority can start to evaluate trends and monitor the recovery plan. At the same time, it sets a precedent for future studies in the region. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Optimising the clinical strategy for autoimmune liver diseases: Principles of value-based medicine.

    Science.gov (United States)

    Carbone, Marco; Cristoferi, Laura; Cortesi, Paolo Angelo; Rota, Matteo; Ciaccio, Antonio; Okolicsanyi, Stefano; Gemma, Marta; Scalone, Luciana; Cesana, Giancarlo; Fabris, Luca; Colledan, Michele; Fagiuoli, Stefano; Ideo, Gaetano; Belli, Luca Saverio; Munari, Luca Maria; Mantovani, Lorenzo; Strazzabosco, Mario

    2018-04-01

    Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy. In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset. Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies. We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017. Published by Elsevier B.V.

  1. CHEMICAL COMPOSITION AND NUTRITIVE VALUE OF MAIZE STEMS DEPENDING ON THE CUTTING HEIGHT OF PLANTS AT HARVEST

    Directory of Open Access Journals (Sweden)

    Ireneus KOWALIK

    2013-12-01

    Full Text Available Studies were carried out in the two years in Trzcianka near Nowy Tomyśl, on brown soil, IIIa – IVa with pH 7.1 – 7.2. Plants of five maize cultivars were cut at the height of 15 cm and 55 cm. The lower parts of stems with leaves which remain on the field in case of high cutting, were characterized by a smaller content of protein and by a greater content of fibre, in comparison with the higher parts of plants. The energetic value of 1 kg of dry matter of the lower 40 cm part with leaves expressed in MJ NEL, in spite of significant differences in the chemical composition, was only insignificantly lower than the upper part. The content of dry matter, the chemical composition and the energetic value of both parts differed, depending on the cultivar.

  2. Clinical value of Tei index in pediatric patients with repaired tetralogy of Fallot.

    Science.gov (United States)

    Song, Bing; Qi, Quan; Liu, Ruisheng; Xing, Wang; Tang, Hanbo; Li, Yuanmin

    2015-01-01

    Tetralogy of Fallot is a congenital heart disease characterized by underdevelopment of the right ventricular infundibulum. Present study aimed to explore the clinic value of Tei index in assessing right ventricular function of pediatric patients with repaired Tetralogy of Fallot. A total of 45 pediatric patients with repaired Tetralogy of Fallot were recruited and classified into: group A (Tei index 0.7; n=13, aging 4-14 years). The right ventricular Tei index value was related to the clinical characteristics of Tetralogy of Fallot repair patients. Right ventricular Tei index was positively correlated with ventilation time, drainage volumes, and negatively with drug assistance and Intensive Care Unit (ICU) stay, although time for drug assistance and ICU stay were not statically different between group B and group C. There was no significant difference in left ventricular ejection fraction. Tei index is a sensitive indicator of right ventricular dysfunction, and has important clinical value to better our understanding of right ventricular function after tetralogy of Fallot repair.

  3. Computational chemical analysis of unconjugated bilirubin anions and insights into pKa values clarification

    Science.gov (United States)

    Vega-Hissi, Esteban G.; Estrada, Mario R.; Lavecchia, Martín J.; Pis Diez, Reinaldo

    2013-01-01

    The pKa, the negative logarithm of the acid dissociation equilibrium constant, of the carboxylic acid groups of unconjugated bilirubin in water is a discussed issue because there are quite different experimental values reported. Using quantum mechanical calculations we have studied the conformational behavior of unconjugated bilirubin species (in gas phase and in solution modeled implicitly and explicitly) to provide evidence that may clarify pKa values because of its pathophysiological relevance. Our results show that rotation of carboxylate group, which is not restricted, settles it in a suitable place to establish stronger interactions that stabilizes the monoanion and the dianion to be properly solvated, demonstrating that the rationalization used to justify the high pKa values of unconjugated bilirubin is inappropriate. Furthermore, low unconjugated bilirubin (UCB) pKa values were estimated from a linear regression analysis.

  4. Clinical value of homodynamic numerical simulation applied in the treatment of cerebral aneurysm.

    Science.gov (United States)

    Zhang, Hailin; Li, Li; Cheng, Chongjie; Sun, Xiaochuan

    2017-12-01

    Our objective was to evaluate the clinical value of numerical simulation in diagnosing cerebral aneurysm based on the analysis of numerical simulation of hemodynamic model. The experimental method used was the numerical model of cerebral aneurysm hemodynamic, and the numerical value of blood flow at each point was analyzed. The results showed that, the wall shear stress (WSS) value on the top of CA1 was significantly lower than that of the top (Pvalue of each point on the CA2 tumor was significantly lower than that of tumor neck (Pvalue on the tumor top and tumor neck between CA1 and CA2 had no significant difference (P>0.05); the unsteady index of shear (UIS) value at the points of 20 had distinctly changed, the wave range was 0.6-1.5; the unsteady index of pressure value of every point was significantly lower than UIS value, the wave range was 0.25-0.40. In conclusion, the application of cerebral aneurysm hemodynamic research can help doctors to diagnose cerebral aneurysm more precisely and to grasp the opportunity of treatment during the formulating of the treatment strategies.

  5. The value of case-based teaching vignettes in clinical microbiology rounds.

    Science.gov (United States)

    Spicer, Jennifer O; Kraft, Colleen S; Burd, Eileen M; Armstrong, Wendy S; Guarner, Jeannette

    2014-03-01

    To describe the implementation and evaluation of a case-based microbiology curriculum during daily microbiology rounds. Vignettes consist of short cases with images and questions that facilitate discussion among microbiologists, pathologists, infectious disease physicians, and trainees (residents and fellows). We performed a survey to assess the value of these vignettes to trainees. Motivation to come to rounds on time increased from 60% to 100%. Trainees attending rounds after implementation of the vignettes perceived the value of microbiology rounds to be significantly higher compared with those who attended rounds before implementation (P = .04). Pathology residents found that vignettes were helpful for retaining knowledge (8.3 of 10 points). The vignettes have enhanced the value of microbiology rounds by serving as a formalized curriculum exposing trainees from multiple specialties to various microbiology topics. Emphasis on interdisciplinary interactions between clinical and laboratory personnel was highlighted with this case-based curriculum.

  6. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    Science.gov (United States)

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

  7. [A study of work values, professional commitment, turnover intention and related factors among clinical nurses].

    Science.gov (United States)

    Wang, Kuei-Ying; Chou, Chuan-Chiang; Huang, Jui-Lan

    2010-02-01

    The high rate of turnover in nursing positions is a global problem. There have been few studies done addressing the relationship between work values and nurse turnover intention. The purpose of this study was to explore the relationship between work values, professional commitment and turnover intention among clinical nurses. A cross-sectional survey was conducted between February 1st to March 10th, 2008 on a convenience sample of nurses, all of whom had at least a half year of work experience at one of four teaching hospitals in Taiwan. A total of 289 valid responses were received, with a response rate of 96.3%. Major findings included: (1) Nurses who were older, had more years of school, had worked more years, held specific job duties, earned a higher salary, held Buddhist beliefs, or were married with two or more children presented higher work values and professional commitment and lower turnover intention; (2) As a group, total work values and professional commitment scores corresponded negatively with turnover intention scores; (3) Significant factors affecting turnover intent in clinical nurses included professional commitment, institution characteristics, Buddhist beliefs and salary. These four variables accounted for 52.2% of the variation in turnover intention. This study indicated that nurses with higher work values and professional commitment tend to exhibit less turnover intention. It is highly recommended to develop strategies to bolster the teaching of altruistic values and professional commitment in nursing education in order to reduce turnover intent. Also, further studies on the influence of religious beliefs and organizational attributes on nurse turnover intentions are also suggested.

  8. Clinical value of positron emission tomography (PET) in oncology: Results of an interdisciplinary consensus conference

    International Nuclear Information System (INIS)

    Reske, S.N.; Bares, R.; Buell, U.; Guhlmann, A.; Moser, E.; Wannenmacher, M.F.

    1996-01-01

    Clinical value of PET in oncology was evaluated by a panel of recognized experts in the framework of an interdisciplinary consensus conference. On the basis of PET studies, well documented in the international literature, the value of PET for solving clinical questions was classified according to the following categories 'appropriate' (1a), 'mostly acceptable' (1b), 'helpful' (2a), 'value as yet unknown' (2b), 'useless' (3). 2-fluorodeoxyglucose (FDG) acts as the radiopharmaceutical of choice for PET in clinical oncology. PET is indicated (1a) for diagnosing relapse in high grade glioma (FDG) or low grade glioma (C-11 methionine or F-18 fluorotyrosine), differential diagnosis of solitary peripheral pulponary nodules in high risk patients and for diagnosis of pancreatic carcinoma. PET may be clinically used (1b): In 'low-grade' glioma, search for unknown primary in head and neck tumors, suspicion of relapse in nonsmall cell bronchial carcinoma (NSCBC) and colorectal carcinoma, lymphnode staging in NSCBC, pancreatic carcinoma, muscle invasive bladder carcinoma and testicular cancer. Staging of Hodgkin's disease (HD, stage I/II vs III), early therapy control in patients with a residual mass or suspicion of relapse in HD and in high grade NHL, lymph node staging and search for distant metastases in malignant melanoma (Breslow>1,5 mm), search for lymph node or distant metastases in differentiated thyroid cancer with elevated hTG and a negative radioiodide whole body scan. Many further indications are emerging, but are not yet sufficiently well documented in the literature. For most indications beside scientific studies, an individual cost benefit utility evaluation by the responsible physician is recommended. (orig./MG) [de

  9. Lignocellulosic Biomass Transformations via Greener Oxidative Pretreatment Processes: Access to Energy and Value-Added Chemicals

    Directory of Open Access Journals (Sweden)

    Walter Den

    2018-04-01

    Full Text Available Anthropogenic climate change, principally induced by the large volume of carbon dioxide emission from the global economy driven by fossil fuels, has been observed and scientifically proven as a major threat to civilization. Meanwhile, fossil fuel depletion has been identified as a future challenge. Lignocellulosic biomass in the form of organic residues appears to be the most promising option as renewable feedstock for the generation of energy and platform chemicals. As of today, relatively little bioenergy comes from lignocellulosic biomass as compared to feedstock such as starch and sugarcane, primarily due to high cost of production involving pretreatment steps required to fragment biomass components via disruption of the natural recalcitrant structure of these rigid polymers; low efficiency of enzymatic hydrolysis of refractory feedstock presents a major challenge. The valorization of lignin and cellulose into energy products or chemical products is contingent on the effectiveness of selective depolymerization of the pretreatment regime which typically involve harsh pyrolytic and solvothermal processes assisted by corrosive acids or alkaline reagents. These unselective methods decompose lignin into many products that may not be energetically or chemically valuable, or even biologically inhibitory. Exploring milder, selective and greener processes, therefore, has become a critical subject of study for the valorization of these materials in the last decade. Efficient alternative activation processes such as microwave- and ultrasound irradiation are being explored as replacements for pyrolysis and hydrothermolysis, while milder options such as advanced oxidative and catalytic processes should be considered as choices to harsher acid and alkaline processes. Herein, we critically abridge the research on chemical oxidative techniques for the pretreatment of lignocellulosics with the explicit aim to rationalize the objectives of the biomass

  10. Lignocellulosic Biomass Transformations via Greener Oxidative Pretreatment Processes: Access to Energy and Value-Added Chemicals

    Science.gov (United States)

    Den, Walter; Sharma, Virender K.; Lee, Mengshan; Nadadur, Govind; Varma, Rajender S.

    2018-01-01

    Anthropogenic climate change, principally induced by the large volume of carbon dioxide emission from the global economy driven by fossil fuels, has been observed and scientifically proven as a major threat to civilization. Meanwhile, fossil fuel depletion has been identified as a future challenge. Lignocellulosic biomass in the form of organic residues appears to be the most promising option as renewable feedstock for the generation of energy and platform chemicals. As of today, relatively little bioenergy comes from lignocellulosic biomass as compared to feedstock such as starch and sugarcane, primarily due to high cost of production involving pretreatment steps required to fragment biomass components via disruption of the natural recalcitrant structure of these rigid polymers; low efficiency of enzymatic hydrolysis of refractory feedstock presents a major challenge. The valorization of lignin and cellulose into energy products or chemical products is contingent on the effectiveness of selective depolymerization of the pretreatment regime which typically involve harsh pyrolytic and solvothermal processes assisted by corrosive acids or alkaline reagents. These unselective methods decompose lignin into many products that may not be energetically or chemically valuable, or even biologically inhibitory. Exploring milder, selective and greener processes, therefore, has become a critical subject of study for the valorization of these materials in the last decade. Efficient alternative activation processes such as microwave- and ultrasound irradiation are being explored as replacements for pyrolysis and hydrothermolysis, while milder options such as advanced oxidative and catalytic processes should be considered as choices to harsher acid and alkaline processes. Herein, we critically abridge the research on chemical oxidative techniques for the pretreatment of lignocellulosics with the explicit aim to rationalize the objectives of the biomass pretreatment step and the

  11. Chemical analysis and full value of albumens of meat of pork

    OpenAIRE

    BIRTA G.O.

    2011-01-01

    Quality of meat has a genetic conditionality and changes depending on external factors. The pedigree differences of quality of pork are based on quantitative correlation the degree of forming of muscular and fatty fabric. Meat of pigs of greasy and meat breeds already on a 5-6 monthly age has a complex of chemical and фізико-біологічних properties which determine his maturity, and meat and bacon to 6-7 monthly, that is why the animals of different directions of the productivity in a the same ...

  12. Lignocellulosic Biomass Transformations via Greener Oxidative Pretreatment Processes: Access to Energy and Value-Added Chemicals.

    Science.gov (United States)

    Den, Walter; Sharma, Virender K; Lee, Mengshan; Nadadur, Govind; Varma, Rajender S

    2018-01-01

    Anthropogenic climate change, principally induced by the large volume of carbon dioxide emission from the global economy driven by fossil fuels, has been observed and scientifically proven as a major threat to civilization. Meanwhile, fossil fuel depletion has been identified as a future challenge. Lignocellulosic biomass in the form of organic residues appears to be the most promising option as renewable feedstock for the generation of energy and platform chemicals. As of today, relatively little bioenergy comes from lignocellulosic biomass as compared to feedstock such as starch and sugarcane, primarily due to high cost of production involving pretreatment steps required to fragment biomass components via disruption of the natural recalcitrant structure of these rigid polymers; low efficiency of enzymatic hydrolysis of refractory feedstock presents a major challenge. The valorization of lignin and cellulose into energy products or chemical products is contingent on the effectiveness of selective depolymerization of the pretreatment regime which typically involve harsh pyrolytic and solvothermal processes assisted by corrosive acids or alkaline reagents. These unselective methods decompose lignin into many products that may not be energetically or chemically valuable, or even biologically inhibitory. Exploring milder, selective and greener processes, therefore, has become a critical subject of study for the valorization of these materials in the last decade. Efficient alternative activation processes such as microwave- and ultrasound irradiation are being explored as replacements for pyrolysis and hydrothermolysis, while milder options such as advanced oxidative and catalytic processes should be considered as choices to harsher acid and alkaline processes. Herein, we critically abridge the research on chemical oxidative techniques for the pretreatment of lignocellulosics with the explicit aim to rationalize the objectives of the biomass pretreatment step and the

  13. Clinical chemistry reference values for 75-year-old apparently healthy persons.

    Science.gov (United States)

    Huber, Klaus Roland; Mostafaie, Nazanin; Stangl, Gerhard; Worofka, Brigitte; Kittl, Eva; Hofmann, Jörg; Hejtman, Milos; Michael, Rainer; Weissgram, Silvia; Leitha, Thomas; Jungwirth, Susanne; Fischer, Peter; Tragl, Karl-Heinz; Bauer, Kurt

    2006-01-01

    Clinical chemistry reference values for elderly persons are sparse and mostly intermixed with those for younger subjects. To understand the links between metabolism and aging, it is paramount to differentiate between "normal" physiological processes in apparently healthy elderly subjects and metabolic changes due to long-lasting diseases. The Vienna Transdanube Aging (VITA) study, which began in 2000 and is continuing, will allow us to do just that, because more than 600 male and female volunteers aged exactly 75 years (to exclude any influence of the "aging" factor in this cohort) are participating in this study. Extensive clinical, neurological, biochemical, psychological, genetic, and radiological analyses, with a special emphasis on consumption of medication and abuse of drugs, were performed on each of the probands. The multitude of data and questionnaires obtained made possible an a posteriori approach to select individuals fulfilling criteria for a reference sample group of apparently healthy 75-year-old subjects for our study. Specific analytes were quantified on automated clinical analyzers, while manual methods were used for hormonal analytes. All clinical chemistry analytes were evaluated using in-depth statistical analyses with SPSS for Windows. In all, reference intervals for 45 analytes could be established. These include routine parameters for the assessment of organ functions, as well as hormone concentrations and hematological appraisals. Because all patients were reevaluated after exactly 30 months in the course of this study, we had the opportunity to reassess their health status at the age of 77.5 years. This was very useful for validation of the first round data set. Data of the second round evaluation corroborate the reference limits of the baseline analysis and further confirm our inclusion and exclusion criteria. In summary, we have established a reliable set of reference data for hormonal, hematological, and clinical chemistry analytes for

  14. Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: proven clinical value?

    International Nuclear Information System (INIS)

    Pinna, Gian Domenico; Maestri, Roberto; La Rovere, Maria Teresa

    2015-01-01

    The baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) is a key mechanism contributing to the neural regulation of the cardiovascular system. Several methods have been proposed so far to assess BRS by analyzing the spontaneous beat-to-beat fluctuations of arterial blood pressure and heart rate. These methods are inherently simple, non-invasive and low-cost. This study is an attempt to address the question of whether spontaneous baroreflex methods have proven to be of value in the clinical setting. In the first part of this article, we critically review most representative clinical studies using spontaneous BRS techniques either for risk stratification or treatment evaluation, these being major issues in the clinical management of the patients. In the second part, we address two important aspects of spontaneous BRS measurements: measurability and reliability. Estimation of BRS in the studies selected for the review was performed according to the sequence, transfer function, alpha-index and phase-rectified signal averaging method. Arterial blood pressure was recorded non-invasively during supine, short-term (<30 min) laboratory recordings. The conclusion from this review is that spontaneous BRS techniques have been shown to be of great value in clinical practice but further work is needed to confirm the validity of previous findings and to widen the field of clinical applications. Measurability and reliability can be a major issue in the measurement of spontaneous BRS, particularly in some patient populations like post-myocardial infarction and heart failure patents. Main causes of poor measurability are: non-sinus rhythm, a high rate of ectopic beats and the need for recorded time series of RR interval and arterial blood pressure to satisfy the constraints of the different BRS estimation algorithms. As for reliability, within-subject variability is rather high in the measurements of spontaneous BRS and, therefore, should be carefully taken into account

  15. Anorectal physiology measurements are of no value in clinical practice. True or false?

    Science.gov (United States)

    Carty, N. J.; Moran, B.; Johnson, C. D.

    1994-01-01

    This article examines whether there is any clinical value in anorectal physiology measurements. The function of the human rectum is poorly understood and the factors which affect function of the anal sphincters are complex. Several laboratories have reported results of anorectal physiology measurements, but there is extensive variation between normal values in different laboratories. It is argued that anorectal physiology measurements fail to meet the criteria of a useful clinical test: 1. It is not widely available to clinicians; 2. It is not possible to establish a reproducible normal range; 3. Abnormal measurements do not correlate with disease entities or explain symptoms; 4. The results are often unhelpful in diagnosis and management; 5. Clinical outcome after intervention does not correlate with alteration in the measurements obtained. On the other hand it can be argued that anorectal physiology measurements do provide information that assists in the management of conditions such as constipation, anismus, Hirschsprung's disease, faecal incontinence and tenesmus. Management based on biofeedback modification of physiological responses requires these techniques as part of the biofeedback system. There is evidence that this may be appropriate in anismus and solitary rectal ulcer syndrome. However, the assessment of these difficult conditions and the interpretation of the results are probably at present best confined to specialist units. PMID:8074392

  16. Searching for neurodegeneration in multiple sclerosis at clinical onset: Diagnostic value of biomarkers.

    Science.gov (United States)

    Novakova, Lenka; Axelsson, Markus; Malmeström, Clas; Imberg, Henrik; Elias, Olle; Zetterberg, Henrik; Nerman, Olle; Lycke, Jan

    2018-01-01

    Neurodegeneration occurs during the early stages of multiple sclerosis. It is an essential, devastating part of the pathophysiology. Tools for measuring the degree of neurodegeneration could improve diagnostics and patient characterization. This study aimed to determine the diagnostic value of biomarkers of degeneration in patients with recent clinical onset of suspected multiple sclerosis, and to evaluate these biomarkers for characterizing disease course. This cross-sectional study included 271 patients with clinical features of suspected multiple sclerosis onset and was the baseline of a prospective study. After diagnostic investigations, the patients were classified into the following disease groups: patients with clinically isolated syndrome (n = 4) or early relapsing remitting multiple sclerosis (early RRMS; n = 93); patients with relapsing remitting multiple sclerosis with disease durations ≥2 years (established RRMS; n = 39); patients without multiple sclerosis, but showing symptoms (symptomatic controls; n = 89); and patients diagnosed with other diseases (n = 46). In addition, we included healthy controls (n = 51) and patients with progressive multiple sclerosis (n = 23). We analyzed six biomarkers of neurodegeneration: cerebrospinal fluid neurofilament light chain levels; cerebral spinal fluid glial fibrillary acidic protein; cerebral spinal fluid tau; retinal nerve fiber layer thickness; macula volume; and the brain parenchymal fraction. Except for increased cerebral spinal fluid neurofilament light chain levels, median 670 ng/L (IQR 400-2110), we could not find signs of early degeneration in the early disease group with recent clinical onset. However, the intrathecal immunoglobin G production and cerebral spinal fluid neurofilament light chain levels showed diagnostic value. Moreover, elevated levels of cerebral spinal fluid glial fibrillary acidic protein, thin retinal nerve fiber layers, and low brain parenchymal fractions were associated with

  17. Nutritive value of some agricultural wastes as affected by relatively low gamma irradiation levels and chemical treatments

    International Nuclear Information System (INIS)

    Al-Masri, M. R.

    2006-01-01

    An experiment was carried out to study the changes in the values of in-vitro organic matter digestibility (IVOMD) and metabolizable energy (ME) of wheat straw, sunflower seed shell, olive cake wood, date palm seeds and peanut shell after irradiation by various levels of gamma radiation (0, 20, 40, 60 kGy) or after spraying with different amounts of hydrobromic acid (HBr; 47%) and sodium hydroxide (NaOH): 0, 3, 6 ml HBr and 3, 6 g NaOH in 25 ml water/100 g DM. The results indicated that chemical treatments increased the IVOMD and ME values significantly for all samples treated except the date palm seeds. There was no significant effect of irradiation on IVOMD and ME. Combined treatments of irradiation and HBr or NaOH were also found to be ineffective in increasing the IVOMD and ME values. (Author)

  18. Chemical process for recovery of uranium values contained in phosphoric mineral lixivia

    International Nuclear Information System (INIS)

    Conceicao, E.L.H. da; Awwal, M.A.; Coelho, S. V.

    1980-01-01

    A recovery process of uranium values from phosporic mineral lixivia for obtaining uranio oxide concentrate adjusted to specifications of purity for its commercialization the process consists of the adjustment of electromotive force of lixiviem to suitable values for uranium extraction, extraction with organic solvent containing phosphoric acid ester and oxidant reextraction from this solvent with phosphoric acid solution, suggesting a new solvent extraction containing synergetic mixture of di-2-ethyl hexyl phosphoric acid and tri-octyl phosphine, leaching this solvent with water and re-extraction/precipitation with ammonium carbonate solution, resulting in the formation of uranyl tricarbonate and ammonium, that by drying and calcination gives the uranium oxide with purity degree for commercialization. (M.C.K.) [pt

  19. Analysis of the Chemical, Pharmacological and Clinical Applications of Polygonum Cuspidatum

    Science.gov (United States)

    Guo, Chenyang; Bai, Ming; Miao, Mingsan; Miao, Yanyan

    2018-01-01

    Traditional Chinese medicine Polygonum cuspidatum widely used, the larger production, and in the clinical application of more, but the role played by the role of different roles are also different. By reviewing the relevant literatures in recent years, the chemical constituents and pharmacological effects of Polygonum cuspidatum were sorted and summarized, and the role of Polygonum cuspidatum was analyzed, and the function of Polygonum cuspidatum was explored to find out the role of Polygonum cuspidatum in compatibility. Application law. Which can not only study the medicinal mechanism of Polygonum cuspidatum, but also provide the theoretical basis for the medicinal development, clinical treatment and comprehensive utilization of Polygonum cuspidatum.

  20. Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism.

    Science.gov (United States)

    Swearingen, Andrew J; Kahramangil, Bora; Monteiro, Rosebel; Krishnamurthy, Vikram; Jin, Judy; Shin, Joyce; Siperstein, Allan; Berber, Eren

    2018-04-01

    Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure. A retrospective analysis of patients who underwent adrenalectomy for primary aldosteronism from 2010 to 2016 was performed, analyzing preoperative and postoperative plasma aldosterone, plasma renin activity, hypertension, and hypokalemia. The utility of postoperative testing was assessed. Clinical cure was defined as improved hypertension control and resolution of potassium loss. Biochemical cure was defined as aldosterone renin ratio reduction to <23.6. Forty-four patients were included; 20 had plasma aldosterone and plasma renin activity checked on postoperative day 1. In the study, 40/44 (91%) were clinically cured. All clinical failures had of biochemical failure at follow-up. Postoperative day 1aldosterone renin ratio <23.6 had PPV of 95% for clinical cure. Cured patients had mean plasma aldosterone drop of 33.1 ng/dL on postoperative day 1; noncured patient experienced 3.9 ng/dL increase. A cutoff of plasma aldosterone decrease of 10 ng/dL had high positive predictive value for clinical cure. Changes in plasma aldosterone and plasma renin activity after adrenalectomy correlate with improved hypertension and hypokalemia. The biochemical impact of adrenalectomy manifests as early as postoperative day 1. We propose a plasma aldosterone decrease of 10 ng/dL as a criterion to predict clinical cure. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Clinical value of prognosis gene expression signatures in colorectal cancer: a systematic review.

    Directory of Open Access Journals (Sweden)

    Rebeca Sanz-Pamplona

    Full Text Available INTRODUCTION: The traditional staging system is inadequate to identify those patients with stage II colorectal cancer (CRC at high risk of recurrence or with stage III CRC at low risk. A number of gene expression signatures to predict CRC prognosis have been proposed, but none is routinely used in the clinic. The aim of this work was to assess the prediction ability and potential clinical usefulness of these signatures in a series of independent datasets. METHODS: A literature review identified 31 gene expression signatures that used gene expression data to predict prognosis in CRC tissue. The search was based on the PubMed database and was restricted to papers published from January 2004 to December 2011. Eleven CRC gene expression datasets with outcome information were identified and downloaded from public repositories. Random Forest classifier was used to build predictors from the gene lists. Matthews correlation coefficient was chosen as a measure of classification accuracy and its associated p-value was used to assess association with prognosis. For clinical usefulness evaluation, positive and negative post-tests probabilities were computed in stage II and III samples. RESULTS: Five gene signatures showed significant association with prognosis and provided reasonable prediction accuracy in their own training datasets. Nevertheless, all signatures showed low reproducibility in independent data. Stratified analyses by stage or microsatellite instability status showed significant association but limited discrimination ability, especially in stage II tumors. From a clinical perspective, the most predictive signatures showed a minor but significant improvement over the classical staging system. CONCLUSIONS: The published signatures show low prediction accuracy but moderate clinical usefulness. Although gene expression data may inform prognosis, better strategies for signature validation are needed to encourage their widespread use in the clinic.

  2. Chemical restraint in routine clinical practice: a report from a general hospital psychiatric ward in Greece

    Directory of Open Access Journals (Sweden)

    Papamichael Georgios

    2011-02-01

    Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.

  3. The cost and value of pre-registration clinical placements for Project 2000 students.

    Science.gov (United States)

    Jones, M L; Akehurst, R

    1999-07-01

    The research outlined in this article was commissioned by the Sheffield and North Trent College of Nursing and Midwifery to explore the cost implications of pre-registration clinical placements in the context of Project 2000. The authors outline the methodology and findings of an exercise designed to collect relevant cost information which was not readily available. On the basis of these findings, they suggest that: at 1995/1996 pay and prices, clinical placements cost the education provider approximately pound 890 per student per annum; in terms of real resources, the value to service providers of the service contribution made by second- and third-year nursing and midwifery students on ward-based placements outweighs the value of the time spent by qualified staff on their supervision and education. Once the funding assumptions underlying the introduction of Project 2000 have been taken into account, second- and third-year nursing and midwifery students benefit the service provider by on average pound 3.46 for every hour they spend in an unrostered ward-based placement. The service contribution made by students in community-based clinical placements cannot free staff time in the same way as on the wards and, because qualified staff in these areas are generally more highly graded, the value of the time they spend on the supervision and education of students on placement is higher than in ward-based placements. Second- and third-year students therefore appear to cost the service provider on average pound 0.48 for each hour they spend in a community-based placement. It was not possible to determine whether this cost translates into a reduction in patient contacts.

  4. The clinical value of pulmonary perfusion imaging complicated with pulmonary embolism in children of nephrotic syndrome

    International Nuclear Information System (INIS)

    Lin Jun; Chen Ning; Miao Weibing; Peng Jiequan; Jiang Zhihong; Wu Jing

    2001-01-01

    To investigate the clinical features of complicated with pulmonary embolism nephrotic syndrome in children. 99m Tc-MAA pulmonary perfusion imaging was performed on 30 nephrotic syndrome in children with elevated plasma D-dimer. Results shown that 14 of 30 patients were found to have pulmonary embolism (46.7%). Pulmonary perfusion imaging showed an involvement of 1 pulmonary segment in 3 cases, 2 segments in 2 cases and over 3 segments in other 9 cases. Among them, there were 7 segments involved in one case. After two weeks of heparin anti-coagulative therapy, most cases showed a recovery. The result of this study suggested that pulmonary embolism is a common complication of nephrotic syndrome. Pulmonary perfusion imaging is simple, effective and accurate method for the diagnosis of pulmonary embolism, and it also can help to assess the value of clinical therapy

  5. Health-related physical fitness measures: reference values and reference equations for use in clinical practice.

    Science.gov (United States)

    Tveter, Anne Therese; Dagfinrud, Hanne; Moseng, Tuva; Holm, Inger

    2014-07-01

    To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice. Cross-sectional design. General community. Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway. Not applicable. The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test). The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants clinical practice. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. [Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia].

    Science.gov (United States)

    Guo, Xiao-Hui; Sun, Yan-Feng; Wang, Jiang-Bo; Han, Shu-Zhen; Miao, Jing; Cui, Min

    2017-03-01

    To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes. According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded. Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (Prisk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.

  7. Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates.

    Science.gov (United States)

    Reisler, Ronald B; Yu, Chenggang; Donofrio, Michael J; Warren, Travis K; Wells, Jay B; Stuthman, Kelly S; Garza, Nicole L; Vantongeren, Sean A; Donnelly, Ginger C; Kane, Christopher D; Kortepeter, Mark G; Bavari, Sina; Cardile, Anthony P

    2017-08-01

    The Ebola virus (EBOV) outbreak in West Africa during 2013-2016 demonstrated the need to improve Ebola virus disease (EVD) diagnostics and standards of care. This retrospective study compared laboratory values and clinical features of 3 nonhuman primate models of lethal EVD to assess associations with improved survival time. In addition, the study identified laboratory values useful as predictors of survival, surrogates for EBOV viral loads, and triggers for initiation of therapeutic interventions in these nonhuman primate models. Furthermore, the data support that, in nonhuman primates, the Makona strain of EBOV may be less virulent than the Kikwit strain of EBOV. The applicability of these findings as potential diagnostic and management tools for EVD in humans warrants further investigation.

  8. The clinical value of angiography in diseases of the epigastric organs

    International Nuclear Information System (INIS)

    Mertens, A.W.

    1981-01-01

    76 cases in which in the time between 1969 and 1974 coeliacographies were carried out and the diagnoses are clinically manifested were retrospectively analysed. The angiographic symptoms and the diagnostic results are compared to the literature. Following this, the diagnostic and therapeutic value in liver processes, paucreas processes, stomach tumours, gastrointestinal bleedings, traumas of the epigastric organs, catheter embolisation and stopping of acute, severe gastrointestinal bleedings are discussed. The value of angiography in comparison to laparoscopy, ERCP, sonography, and computerized tomography is discussed. At the end, the indication of angiography in diseases of the epigastric organs is summarized in two tables, distinguishing between absolute, relative, strongly restricted indications and no indication at all. (orig./MG) [de

  9. Sensitivity, specificity and predictive value of blood cultures from cattle clinically suspected of bacterial endocarditis

    DEFF Research Database (Denmark)

    Houe, Hans; Eriksen, L.; Jungersen, Gregers

    1993-01-01

    This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis...... of the isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied...... the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases....

  10. Clinical value of serum vitamin B12 and folate in cerebrovascular disease

    International Nuclear Information System (INIS)

    Zhan Hao; Zhang Yongxue

    2002-01-01

    To study the clinical value of serum vitamin B 12 and folate in cerebrovascular disease, the concentration of serum vitamin B 12 and folate in 32 patients with cerebrovascular disease was measured by radioimmunoassay. The results showed that the changes in folate in all groups were not significant. The content of vitamin B 12 in multi-infarct dementia was markedly lower than that in cerebral infarction and cerebral hemorrhage. Moreover, the level of vitamin B 12 was lower in paralytic patients with muscular strength of grade 0-III. It can be concluded that serum vitamin B 12 level had association with intelligent disorder and paralytic degree

  11. Clinical value of CD133 and nestin in patients with glioma

    DEFF Research Database (Denmark)

    Dahlrot, Rikke H; Hansen, Steinbjørn; Jensen, Stine S

    2014-01-01

    Cancer stem cell-related (CSC) markers have been suggested to have promising potentials as novel types of prognostic and predictive markers in gliomas. However no single CSC-related marker is currently used in clinical decisions. The aim of this study was to investigate the prognostic value of CD......133 and nestin separately and in combination using a novel quantitative approach in a well-characterized population-based cohort of glioma patients. The expression of CD133 and nestin was measured by systematic random sampling in stained paraffin sections from 239 glioma patients diagnosed between...

  12. Histological evaluation of the human testis--approaches to optimizing the clinical value of the assessment

    DEFF Research Database (Denmark)

    McLachlan, R I; Rajpert-De Meyts, E; Hoei-Hansen, C E

    2007-01-01

    on genotype-phenotype relationships. The rising incidence of testis cancer and carcinoma in situ (CIS), especially in infertile populations, requires that every effort be made for its early detection. We provide a systematic approach to the histological classification of spermatogenic disorders and detection...... within the hypospermatogenesis classification, that helps account for reported success of TESE. We propose a new diagnosis code for testicular biopsies that addresses the needs of ART clinicians and allows data storage and retrieval of value in clinical practice and research....

  13. Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries.

    Directory of Open Access Journals (Sweden)

    Xin Wang

    Full Text Available BACKGROUND: The Ottawa ankle rules (OAR are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. OBJECTIVES: The purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures. METHODS: In this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT. RESULTS: 183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus. CONCLUSIONS: The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on

  14. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

    Science.gov (United States)

    Johnson, Nils P; Tóth, Gábor G; Lai, Dejian; Zhu, Hongjian; Açar, Göksel; Agostoni, Pierfrancesco; Appelman, Yolande; Arslan, Fatih; Barbato, Emanuele; Chen, Shao-Liang; Di Serafino, Luigi; Domínguez-Franco, Antonio J; Dupouy, Patrick; Esen, Ali M; Esen, Ozlem B; Hamilos, Michalis; Iwasaki, Kohichiro; Jensen, Lisette O; Jiménez-Navarro, Manuel F; Katritsis, Demosthenes G; Kocaman, Sinan A; Koo, Bon-Kwon; López-Palop, Ramón; Lorin, Jeffrey D; Miller, Louis H; Muller, Olivier; Nam, Chang-Wook; Oud, Niels; Puymirat, Etienne; Rieber, Johannes; Rioufol, Gilles; Rodés-Cabau, Josep; Sedlis, Steven P; Takeishi, Yasuchika; Tonino, Pim A L; Van Belle, Eric; Verna, Edoardo; Werner, Gerald S; Fearon, William F; Pijls, Nico H J; De Bruyne, Bernard; Gould, K Lance

    2014-10-21

    Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold. A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy. Copyright © 2014. Published by Elsevier Inc.

  15. System visualization of integrated biofuels and high value chemicals developed within the MacroAlgaeBiorefinery (MAB3) project

    DEFF Research Database (Denmark)

    Seghetta, Michele; Hasler, Berit; Bastianoni, Simone

    MacroAlgaeBiorefinery (MAB3) may functions as production platform and raw material supplier for future sustainable production chains of biofuels and high value chemicals. Biofuels are interesting energy source but challenges in terms of the composition of the biomass and resulting energy...... efficiencies has to be compensated for to make the biofuel prices competitive in replacing fossil fuel. Since it is difficult to increase the yield of the single biorefinery, the overall system productivity can be improved integrating different sub-systems. In this study, macroalgae cultivation in Denmark...... is integrated with a biogas biorefinery, a bioethanol biorefinery and a fish feed industry. The modeled system is able to adapt itself to different amount and quality of feedstock and to maximize valuable outputs (e.g. bio-fuels and chemical). Macroalgae are harvested and utilized as feedstock in bioethanol...

  16. Comparison of the chemical compositions and nutritive values of various pumpkin (Cucurbitaceae) species and parts

    Science.gov (United States)

    Kim, Mi Young; Kim, Eun Jin; Kim, Young-Nam; Choi, Changsun

    2012-01-01

    Pumpkins have considerable variation in nutrient contents depending on the cultivation environment, species, or part. In this study, the general chemical compositions and some bioactive components, such as tocopherols, carotenoids, and β-sitosterol, were analyzed in three major species of pumpkin (Cucurbitaceae pepo, C. moschata, and C. maxima) grown in Korea and also in three parts (peel, flesh, and seed) of each pumpkin species. C. maxima had significantly more carbohydrate, protein, fat, and fiber than C. pepo or C. moschata (P pumpkin was highest in C. pepo. The major fatty acids in the seeds were palmitic, stearic, oleic, and linoleic acids. C. pepo and C. moschata seeds had significantly more γ-tocopherol than C. maxima, whose seeds had the highest β-carotene content. C. pepo seeds had significantly more β-sitosterol than the others. Nutrient compositions differed considerably among the pumpkin species and parts. These results will be useful in updating the nutrient compositions of pumpkin in the Korean food composition database. Additional analyses of various pumpkins grown in different years and in different areas of Korea are needed. PMID:22413037

  17. Process Design for the Biocatalysis of Value-Added Chemicals from Carbon Dioxide

    Energy Technology Data Exchange (ETDEWEB)

    Mark Eiteman

    2007-07-31

    This report describes results toward developing a process to sequester CO{sub 2} centered on the enzymes PEP carboxylase and pyruvate carboxylase. The process involves the use of bacteria to convert CO{sub 2} and glucose as a co-substrate and generates succinic acid as a commodity chemical product. The study reports on strain development and process development. In the area of strain development, knockouts in genes which divert carbon from the enzymatic steps involved in CO{sub 2} consumption were completed, and were shown not to affect significantly the rate of CO{sub 2} sequestration and succinic acid generation. Furthermore, the pyc gene encoding for pyruvate carboxylase proved to be unstable when integrated onto the chromosome. In the area of process development, an optimal medium, pH and base counterion were obtained, leading to a sequestration rate as great as 800 mg/Lh. Detailed studies of gas phase composition demonstrated that CO{sub 2} composition has a significant affect on CO{sub 2} sequestration, while the presence of 'toxic' compounds in the gas, including NO{sub 2}, CO and SO{sub 2} did not have a detrimental effect on sequestration. Some results on prolonging the rate of sequestration indicate that enzyme activities decrease with time, suggesting methods to prolong enzyme activity may benefit the overall process.

  18. Clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries

    Directory of Open Access Journals (Sweden)

    Fen-Dui Zhang

    2015-11-01

    Full Text Available AIM: To evaluate the clinical effect of vitamin A palmitate eye gel on early ocular surface reconstruction after thermal or chemical injuries. METHODS: Seventy-eight cases with thermal or chemical injuries to eyes were selected and divided into two groups by randomized, double-blind, positive drug parallel controlled method: group A(40 cases were treated with vitamin A palmitate eye geland group B \\〖38 cases were treated with basic fibroblast growth factor(bFGF\\〗. The bFGF and vitamin A palmitate eye gel were used 4 times a day. The treatment course was 14d. Restoration of epithelial defect, Schirmer's test values, tear break-up time(BUT, and subjective assessment of symptoms and signs were observed on D1, D3, D5, D7, D10 and D14.RESULTS: In group A, 31 cases were cured, 5 cases were effective, with the cure rate of 76% and efficiency 90%. In group B, 32 cases were cured, 3 cases were effective, with the cure rate of 84% and efficiency 92%. There were no significant differences between the two groups(P>0.05. However, there were significant differences on the results of Schirmer's test and BUT(PPCONCLUSION: Vitamin A palmitate eye gel is valuable and safe on early ocular surface reconstruction of the eyes suffered from thermal or chemical injuries.

  19. Determination of decimal reduction time (D value) of chemical agents used in hospitals for disinfection purposes

    Science.gov (United States)

    Mazzola, Priscila Gava; Penna, Thereza Christina Vessoni; da S Martins, Alzira M

    2003-01-01

    Background Prior to the selection of disinfectants for low, intermediate and high (sterilizing) levels, the decimal reduction time, D-value, for the most common and persistent bacteria identified at a health care facility should be determined. Methods The D-value was determined by inoculating 100 mL of disinfecting solution with 1 mL of a bacterial suspension (104 – 105 CFU/mL for vegetative and spore forms). At regular intervals, 1 mL aliquots of this mixture were transferred to 8 mL of growth media containing a neutralizing agent, and incubated at optimal conditions for the microorganism. Results The highest D-values for various bacteria were determined for the following solutions: (i) 0.1% sodium dichloroisocyanurate (pH 7.0) – E. coli and A. calcoaceticus (D = 5.9 min); (ii) sodium hypochlorite (pH 7.0) at 0.025% for B. stearothermophilus (D = 24 min), E. coli and E. cloacae (D = 7.5 min); at 0.05% for B. stearothermophilus (D = 9.4 min) and E. coli (D = 6.1 min) and 0.1% for B. stearothermophilus (D = 3.5 min) and B. subtilis (D = 3.2 min); (iii) 2.0% glutaraldehyde (pH 7.4) – B. stearothermophilus, B. subtilis (D = 25 min) and E. coli (D = 7.1 min); (iv) 0.5% formaldehyde (pH 6.5) – B. subtilis (D = 11.8 min), B. stearothermophilus (D = 10.9 min) and A. calcoaceticus (D = 5.2 min); (v) 2.0% chlorhexidine (pH 6.2) – B. stearothermophilus (D = 9.1 min), and at 0.4% for E. cloacae (D = 8.3 min); (vi) 1.0% Minncare® (peracetic acid and hydrogen peroxide, pH 2.3) – B. stearothermophilus (D = 9.1 min) and E. coli (D = 6.7 min). Conclusions The suspension studies were an indication of the disinfectant efficacy on a surface. The data in this study reflect the formulations used and may vary from product to product. The expected effectiveness from the studied formulations showed that the tested agents can be recommended for surface disinfection as stated in present guidelines and emphasizes the importance and need to develop routine and novel programs to

  20. Determination of decimal reduction time (D value of chemical agents used in hospitals for disinfection purposes

    Directory of Open Access Journals (Sweden)

    da S Martins Alzira M

    2003-10-01

    Full Text Available Abstract Background Prior to the selection of disinfectants for low, intermediate and high (sterilizing levels, the decimal reduction time, D-value, for the most common and persistent bacteria identified at a health care facility should be determined. Methods The D-value was determined by inoculating 100 mL of disinfecting solution with 1 mL of a bacterial suspension (104 – 105 CFU/mL for vegetative and spore forms. At regular intervals, 1 mL aliquots of this mixture were transferred to 8 mL of growth media containing a neutralizing agent, and incubated at optimal conditions for the microorganism. Results The highest D-values for various bacteria were determined for the following solutions: (i 0.1% sodium dichloroisocyanurate (pH 7.0 – E. coli and A. calcoaceticus (D = 5.9 min; (ii sodium hypochlorite (pH 7.0 at 0.025% for B. stearothermophilus (D = 24 min, E. coli and E. cloacae (D = 7.5 min; at 0.05% for B. stearothermophilus (D = 9.4 min and E. coli (D = 6.1 min and 0.1% for B. stearothermophilus (D = 3.5 min and B. subtilis (D = 3.2 min; (iii 2.0% glutaraldehyde (pH 7.4 – B. stearothermophilus, B. subtilis (D = 25 min and E. coli (D = 7.1 min; (iv 0.5% formaldehyde (pH 6.5 – B. subtilis (D = 11.8 min, B. stearothermophilus (D = 10.9 min and A. calcoaceticus (D = 5.2 min; (v 2.0% chlorhexidine (pH 6.2 – B. stearothermophilus (D = 9.1 min, and at 0.4% for E. cloacae (D = 8.3 min; (vi 1.0% Minncare® (peracetic acid and hydrogen peroxide, pH 2.3 – B. stearothermophilus (D = 9.1 min and E. coli (D = 6.7 min. Conclusions The suspension studies were an indication of the disinfectant efficacy on a surface. The data in this study reflect the formulations used and may vary from product to product. The expected effectiveness from the studied formulations showed that the tested agents can be recommended for surface disinfection as stated in present guidelines and emphasizes the importance and need to develop routine and novel programs to

  1. Clinical workplace learning: perceived learning value of individual and group feedback in a collectivistic culture.

    Science.gov (United States)

    Suhoyo, Yoyo; Schönrock-Adema, Johanna; Emilia, Ova; Kuks, Jan B M; Cohen-Schotanus, Janke

    2018-04-19

    Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual and group feedback in a collectivistic culture. During two weeks, on a daily basis, clerkship students (n = 215) from 12 clinical departments at Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, recorded individual and group feedback moments by using a structured form: the providers, focus and perceived learning value of feedback. Data were analysed with logistic regression and multilevel techniques. Students reported 2687 group and 1535 individual feedback moments. Group feedback more often focused on history taking, clinical judgment, patient management, patient counselling, and professional behaviour (OR ranging from 1.232, p cultures, group feedback may add to the array of educational measures that optimize student learning. Congruence between culture and type of feedback may be important for the effectiveness of feedback.

  2. Clinical reference value of retinal microvascular changes in patients with cerebral microbleeds

    Directory of Open Access Journals (Sweden)

    Ji-Yuan Guo

    2014-12-01

    Full Text Available AIM: To study clinical reference value of retinal microvascular changes in patients with cerebral microbleeds(CMBsand discuss its clinical significance. METHODS:From January 2012 to December 2013, 125 hospitalized patients were collected, including 81 cases were male, 44 cases were female, mean age 76.3±11.2 years old. For all patients, functions of liver and kidney, blood-lipoids, blood sugar and blood biochemical examination were tested, and fundus photography and cerebral MR was done. According to the fundus camera eyes, retinal arteriolar equivalent(RAE, retinal venular equivalent(RVE, retinal vein diameter ratio(AVRand arteriovenous crossing sign(AVNwere identified, CMBs were classified with cerebral MRI. All the data were processed by SPSS statistical software. RESULTS: The central retinal arteriolar equivalent(CRAE, central retinal venular equivalent(CRVEand AVR values in the eyes were found no statistical difference(PPCOCLUSION: The results show that retinal microvascular changes, especially small retinal vein arteriovenous cross width, and arteriovenous crossing phenomenon, in which CMBs will happen more likely. After sex, age, hypertension and hyperglycemia in patients with traditional cardiovascular risk factors being ruled out, the retinal microvascular changes are still relatively factors of CMB's occurrence.

  3. Echocardiography and risk prediction in advanced heart failure: incremental value over clinical markers.

    Science.gov (United States)

    Agha, Syed A; Kalogeropoulos, Andreas P; Shih, Jeffrey; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Anarado, Perry; Mangalat, Deepa; Hussain, Imad; Book, Wendy; Laskar, Sonjoy; Smith, Andrew L; Martin, Randolph; Butler, Javed

    2009-09-01

    Incremental value of echocardiography over clinical parameters for outcome prediction in advanced heart failure (HF) is not well established. We evaluated 223 patients with advanced HF receiving optimal therapy (91.9% angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 92.8% beta-blockers, 71.8% biventricular pacemaker, and/or defibrillator use). The Seattle Heart Failure Model (SHFM) was used as the reference clinical risk prediction scheme. The incremental value of echocardiographic parameters for event prediction (death or urgent heart transplantation) was measured by the improvement in fit and discrimination achieved by addition of standard echocardiographic parameters to the SHFM. After a median follow-up of 2.4 years, there were 38 (17.0%) events (35 deaths; 3 urgent transplants). The SHFM had likelihood ratio (LR) chi(2) 32.0 and C statistic 0.756 for event prediction. Left ventricular end-systolic volume, stroke volume, and severe tricuspid regurgitation were independent echocardiographic predictors of events. The addition of these parameters to SHFM improved LR chi(2) to 72.0 and C statistic to 0.866 (P advanced HF.

  4. The clinical value of routine whole-body magnetic resonance imaging (MRI) in palliative care

    Energy Technology Data Exchange (ETDEWEB)

    Geitung, Jonn Terje (Department of Radiology, Haraldspass Deaconess (University) Hospital (Norway); Department of Surgical Sciences, University of Bergen (Norway)), Email: jtgeit@online.no; Eikeland, Joakim (Department of Public Health and Primary Health Care, University of Bergen (Norway)); Rosland, Jan Henrik (Department of Public Health and Primary Health Care, University of Bergen (Norway); Sunniva Clinic for Palliative Care, Haraldsplass Deaconess (University) Hospital (Norway))

    2012-03-15

    Background. Whole-body MRI (WBMRI) has become an accessible method for detecting different types of pathologies both in the skeleton and the viscera, which may explain painful conditions, for example tumors and inflammation. Purpose. To assess a possible value of using WBMRI in order to improve palliative care. Material and Methods. Twenty patients (all eligible patients) admitted to the Department for Palliative Care were consecutively included in this study. They underwent a modified WBMRI, with fewer and shorter pulse sequences than in a standard WBMRI, to reduce patient stress. However, the patients' physicians were to exclude patients where little might be obtained and discomfort, distress, and pain could be induced. The treating physicians registered clinical utility directly after receiving the MRI report in a questionnaire. The registration was repeated after ended treatment. Results. Eighty percent had new findings detected, and 40% of the patients had a change in treatment due to the MRI result, mainly changes in analgesics and/or radiation therapy. Conclusion. The WBMRI helped the clinicians to improve treatment and a majority of the patients benefited from this. In eight patients the treatment was changed due to the results. The clinical value (utility) was indicated to be high

  5. Clinical Correlates and Prognostic Value of Proenkephalin in Acute and Chronic Heart Failure.

    Science.gov (United States)

    Matsue, Yuya; Ter Maaten, Jozine M; Struck, Joachim; Metra, Marco; O'Connor, Christopher M; Ponikowski, Piotr; Teerlink, John R; Cotter, Gad; Davison, Beth; Cleland, John G; Givertz, Michael M; Bloomfield, Daniel M; Dittrich, Howard C; van Veldhuisen, Dirk J; van der Meer, Peter; Damman, Kevin; Voors, Adriaan A

    2017-03-01

    Proenkephalin (pro-ENK) has emerged as a novel biomarker associated with both renal function and cardiac function. However, its clinical and prognostic value have not been well evaluated in symptomatic patients with heart failure. The association between pro-ENK and markers of renal function was evaluated in 95 patients with chronic heart failure who underwent renal hemodynamic measurements, including renal blood flow (RBF) and glomerular filtration rate (GFR) with the use of 131 I-Hippuran and 125 I-iothalamate clearances, respectively. The association between pro-ENK and clinical outcome in acute heart failure was assessed in another 1589 patients. Pro-ENK was strongly correlated with both RBF (P renal tubular markers. In the acute heart failure cohort, pro-ENK was a predictor of death through 180 days, heart failure rehospitalization through 60 days, and death or cardiovascular or renal rehospitalization through day 60 in univariable analyses, but its predictive value was lost in a multivariable model when other renal markers were entered in the model. In patients with chronic and acute heart failure, pro-ENK is strongly associated with glomerular function, but not with tubular damage. Pro-ENK provides limited prognostic information in patients with acute heart failure on top of established renal markers. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Chemical and Physical Predictors of the Nutritive Value of Wheat in Broiler Diets

    Directory of Open Access Journals (Sweden)

    M. E. E. Ball

    2013-01-01

    Full Text Available The aim of this study was to establish relationships between chemical and physical parameters of wheat with performance and digestibilities of feed components in broiler chickens fed on wheat-based diets. Ninety-four wheat samples were selected for inclusion in four bird trials. Birds were housed in individual wire metabolism cages from 7 to 28 d and offered water and feed ad libitum. Dry matter intake (DMI, liveweight gain (LWG and gain:feed were measured weekly. A balance collection was carried out from 14 to 21 d for determination of apparent metabolizable energy (AME, ME:gain, dry matter retention, oil and neutral detergent fibre (NDF digestibility. At 28 d the birds were humanely killed, the contents of the jejunum removed for determination of in vivo viscosity and the contents of the ileum removed for determination of ileal dry matter, starch and protein digestibility. When wheat parameters were correlated with bird performance data, it was found that specific weight was not significantly (p>0.05 related to bird performance. Bird DMI, LWG and gain:feed were best correlated (p<0.05 with the rate of starch digestion, although the coefficients of correlation (r were still low (0.246 to 0.523. A negative relationship (p<0.01 between AME and total (r = −0.432 and soluble (r = −0.304 non starch polysaccharide (NSP was observed in this study. Thousand grain weight (TG was positively correlated with DMI (r = 0.299, LWG (r = 0.343 and gain:feed (r = 0.371. When establishing multiple regression relationships, correlation coefficients greater than 0.8 were achieved for DMI, LWG, gain:feed and ileal crude protein digestibility. However, the economics involved in determining the parameters involved in the regressions make the process impractical.

  7. Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula

    International Nuclear Information System (INIS)

    Yin, Hao-Qiang; Wang, Chen; Peng, Xin; Xu, Fang; Ren, Ya-Juan; Chao, Yong-Qing; Lu, Jin-Gen; Wang, Song; Xiao, Hu-Sheng

    2016-01-01

    Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). Thirty inpatients and outpatients with suspected RVF from January 2006 to June 2013 were included in the study, among whom 28 underwent surgical repair. All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results. All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. Regarding the 30 internal openings located in the vagina during surgery, the positive predictive value of preoperative endosonography was 93 %. The six cases of simple fistulas confirmed during surgery were revealed by endosonography; for the 22 cases of complex fistula confirmed during surgery, the positive predictive value of endosonography was 90 %. Surgery confirmed 14 cases of anal fistula and 14 cases of RVF, whereas preoperative endoluminal ultrasonography suggested 16 cases of anal fistula and 12 cases of RVF, resulting in positive predictive values of 92.3 and 93 %, respectively. The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. Thus, it is a good imaging tool for examining internal and external anal sphincter injuries and provides useful information for preoperative preparation and postoperative evaluation

  8. Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

    Science.gov (United States)

    Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

    2016-03-01

    This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), pmentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula.

  9. Chemical and biological evaluation of the nutritive value of heat-sterilized and radappertized feed mixtures

    International Nuclear Information System (INIS)

    Kooij, J.G. van

    1979-01-01

    In an attempt to develop a procedure for wholesomeness testing of irradiated food, which considers the use of irradiation as a physical process, large-scale feeding tests in pigs were carried out. Basic criteria of this procedure are the testing of wholly irradiated diets and the comparison of irradiation with another physical process, viz. heat treatment. The results of the biological evaluation of the protein showed, that protein quality of sow feed was not noticeably affected by either treatment, while protein quality of creep and hog feed was more adversely affected by heat than by irradiation. Heat-sterilized feeds always demonstrated the lowest values for lysine availability. Feed-borne vitamin E appeared very sensitive to irradiation. Losses of vitamins A, B 1 , B 6 and folic acid were in the order of 20% due to irradiation with 5 Mrad. Losses in heat-sterilized feeds were about 40% for vitamins A, B 1 and B 6 . Prior to heating, sow and creep feeds were fortified with vitamins A, B 1 and B 6 , and hog feed with vitamin A. Hogs on heat-sterilized feed showed a 10% increased feed conversion, indicating a less favourable growth than the pigs on untreated or on irradiated feed. The mean body-weight of piglets at 49 days on heat-sterilized feed was approx. 10% lower (significant at p<0.05) than the body-weight of piglets on either untreated or radappertized creep feed. Body-weight gain values of piglets on heat-sterilized creep feed are markedly lower than those of piglets on either untreated or radappertized creep feeds during that part of the lactation period when the young pigs consume considerable quantities of solid feed. Piglets and hogs on heat-sterilized feeds demonstrated an increased sensitivity to stress conditions

  10. Evaluation of Physico-chemical Parameters of Manchar Lake Water and Their Comparison with Other Global Published Values

    Directory of Open Access Journals (Sweden)

    Muhammad Balal Arain

    2008-12-01

    Full Text Available The aim of current study was to evaluate the status of the Manchar lake water with respect to different physico-chemical parameters (electric conductivity, pH, chloride, phosphate, sulfate, total alkalinity, potassium, calcium, magnesium, manganese, iron, cadmium, copper, arsenic, nickel, zinc, chromium lead and selenium in 2005-2007. Among the elemental investigation of Manchar Lake water except Co, Cr, Cu and Mn, other elements (Al, As, Ca, Cd, Fe, Mg, Na, K, Ni, Pb and Se have higher values as compared to the permissible level of these elements in drinking water. The results were compared with WHO water quality guidelines as well as with literature values reported for global lake water.

  11. Clinical application value of impulse oscillometry in geriatric patients with COPD

    Directory of Open Access Journals (Sweden)

    Liu Z

    2017-03-01

    Full Text Available Zhonghui Liu,* Lianjun Lin,* Xinmin Liu Geriatrics Department, Peking University First Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Background: The diagnosis and assessment of COPD rely mainly on the use of spirometry, which is an effort-dependent test and requires good patient cooperation. Impulse oscillometry (IOS is a non-volitional method that requires less effort and cooperation and presents advantages for geriatric patients. However, the clinical application value of IOS in geriatric patients with COPD remains unclear. Aim: The aim of this study was to investigate the clinical application value of IOS in geriatric patients with COPD. Subjects and methods: A total of 234 subjects were retrospectively enrolled in this study, including 133 patients with COPD and 101 healthy volunteers. All the participants underwent IOS and spirometry examination. The data were collected and analyzed in the overall group, the geriatric group (aged ≥65 years, and the advanced elderly group (aged ≥80 years. Results: 1 In COPD patients, a significant increase in respiratory impedance (Z5, resonant frequency (Fres, and respiratory resistance (R5, R20, R5–R20 and a decrease in respiratory reactance (X5 were observed in the overall group, the geriatric group, and the advanced elderly group compared with the healthy control subjects. 2 The IOS parameters correlated well with spirometry in COPD. In particular, R5–R20 showed the best correlation with forced expiratory volume in 1 second (FEV1 in the different age groups. 3 Fres and R5–R20 had the best diagnostic efficiency for COPD. The area under the curve (AUC values for Fres, expressed by the receiver operating characteristic (ROC curve, were 0.905, 0.909, and 0.914, for the different age groups, respectively. 4 The optimal cutoff values for Fres to diagnose airflow obstruction from ROC curves was 17.715 in the COPD patients. Its sensitivity and

  12. Clinical value of 99Tcm-octreotide SPECT/CT in diagnostics of lung cancer

    International Nuclear Information System (INIS)

    Liu Xiaofang; Li Mei; Liu Yong; Li Ran; Xu Jie; Sun yongchang; Dai Haojie

    2012-01-01

    Objective: To evaluate the clinical value of 99 Tc m -Octreotide SPECT-CT in the diagnosis of lung cancer. Methods: Sixty-five consecutive patients with suspected lung cancer received intravenous injection of 740 MBq 99 Tc m -Octreotide and additional SPECT images of the chest were performed at 4h post injection. The SPECT/CT images were interpreted separately. The tumor uptake of 99 Tc m -Octreotide was visually determined and then measured and expressed as the activity ratio of tumor to normal tissues (T/N). The differences between lung cancer and benign lung lesion and between SCLC and NSCLC, and between adenocarcinoma and squamous carcinoma were studied by statistical analysis. Moreover, the receiver operating characteristic ROC curves were plotted and the predicted probabilities and areas under the curve were calculated. Results: Fifty-one patients and fourteen patients in 65 cases were diagnosed as lung cancer and benign lung lesion by histopathological analysis, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99 Tc m -Octreotide SPECT/CT in diagnosis of lung cancer were 92.2%, 85.7%, 95.9% and 75%, respectively. The area under ROC curve was 0.889 (P 99 Tc m -Octreotide SPECT/CT could play an important role in the diagnosis of lung cancer, and it may be useful for identifying SCLC and NSCLC. (authors)

  13. Measuring the nose in septorhinoplasty patients: ultrasonographic standard values and clinical correlations.

    Science.gov (United States)

    Stenner, Markus; Koopmann, Mario; Rudack, Claudia

    2017-02-01

    Although septorhinoplasty is the most commonly performed operation in plastic surgery, and the surgical plan as well as its outcome is directly related to the configuration of the anatomical structures in the nose, these are not routinely assessed preoperatively. The aim of our study was to evaluate the nasal soft tissue and cartilaginous structures by means of high-resolution ultrasonography to set up clinical correlations and standard values. We examined 44 patients before septorhinoplasty by high-resolution ultrasonography in noncontact mode. All pictures were quantitatively evaluated by measuring 13 lengths and 4 ratios. All patients underwent a rhinomanometry measuring the nasal air flow. Besides others, men as well as older patients have a significantly thicker alar cartilage. Patients with thinner alar cartilages have a significantly smaller interdomal distance as well as significantly thinner upper lateral cartilages. The soft tissue above the bony dorsum was significantly thicker in older patients. Younger patients have significantly thicker soft tissue in relation to their cartilage. Patients with thicker soft tissue and thinner cartilage have a smaller tip. The interdomal distance and the thickness of the cartilaginous septum significantly correlated with the nasal air flow. We set up standard values of nasal structures in septorhinoplasty patients which can be used as reference values. By judging cartilage and soft tissue characteristics preoperatively, relevant factors for distinct procedures could be analyzed and the surgical steps can be better planned. Visualization by ultrasonography enables the surgeon to achieve treatment goals in a more predictable fashion.

  14. ProvenCare: Geisinger's Model for Care Transformation through Innovative Clinical Initiatives and Value Creation.

    Science.gov (United States)

    2009-04-01

    Geisinger's system of care can be seen as a microcosm of the national delivery of healthcare, with implications for decision makers in other health plans. In this interview, Dr Ronald A. Paulus focuses on Geisinger's unique approach to patient care. In its core, this approach represents a system of quality and value initiatives based on 3 major programs-Proven Health Navigation (medical home); the ProvenCare model; and transitions of care. The goal of such an approach is to optimize disease management by using a rational reimbursement paradigm for appropriate interventions, providing innovative incentives, and engaging patients in their own care as part of any intervention. Dr Paulus explains the reasons why, unlike Geisinger, other stakeholders, including payers, providers, patients, and employers, have no intrinsic reasons to be concerned with quality and value initiatives. In addition, he says, an electronic infrastructure that could be modified as management paradigms evolve is a necessary tool to ensure the healthcare delivery system's ability to adapt to new clinical realities quickly to ensure the continuation of delivering best value for all stakeholders.

  15. Clinical value of diffusion-weighted MR imaging in acute contusion of spinal cord

    International Nuclear Information System (INIS)

    Zhang Jinsong; Huan Yi; Sun Lijun; Zhao Haitao; Ge Yali; Chang Yingjuan; Yang Chunmin

    2005-01-01

    Objective: To study the clinical value of diffusion-weighted MR imaging (DWI) in acute contusion of spinal cord. Methods: Eighteen cases with acute contusion of spinal cord were examined with routine MRI and DWI, including single-shot DWI (ssh-DWI) in 2 cases and multi-shot DWI (msh-DWI) in 16 cases, on a 1.5-tesla MR system within 72 h post-trauma. Results: Two cases examined by ssh-DWI showed local lesions with significant high signals, but ssh-DWI images could not be used to measure apparent diffusion coefficient (ADC) value due to its weak resolution. Other 16 cases examined by msh-DWI showed better images and were classified into three categories depending on different degrees of tissue injury and characteristics of DWI: (1) Edema-type: ten cases presented DWI high signals with different degree in local lesions. There were significant difference of ADC values between lesions and normal parts (t=7.515, P 2 WI heterogeneous high signals and T 1 WI low signals due to prominent hemorrhage. Conclusion: DWI of the spinal cord provided satisfactory images and was a useful method for visualizing the injury cord in the super-early stage, helping determine integrity and compression degree of spinal cord and detecting hemorrhage. (authors)

  16. A counterfactual p-value approach for benefit-risk assessment in clinical trials.

    Science.gov (United States)

    Zeng, Donglin; Chen, Ming-Hui; Ibrahim, Joseph G; Wei, Rachel; Ding, Beiying; Ke, Chunlei; Jiang, Qi

    2015-01-01

    Clinical trials generally allow various efficacy and safety outcomes to be collected for health interventions. Benefit-risk assessment is an important issue when evaluating a new drug. Currently, there is a lack of standardized and validated benefit-risk assessment approaches in drug development due to various challenges. To quantify benefits and risks, we propose a counterfactual p-value (CP) approach. Our approach considers a spectrum of weights for weighting benefit-risk values and computes the extreme probabilities of observing the weighted benefit-risk value in one treatment group as if patients were treated in the other treatment group. The proposed approach is applicable to single benefit and single risk outcome as well as multiple benefit and risk outcomes assessment. In addition, the prior information in the weight schemes relevant to the importance of outcomes can be incorporated in the approach. The proposed CPs plot is intuitive with a visualized weight pattern. The average area under CP and preferred probability over time are used for overall treatment comparison and a bootstrap approach is applied for statistical inference. We assess the proposed approach using simulated data with multiple efficacy and safety endpoints and compare its performance with a stochastic multi-criteria acceptability analysis approach.

  17. CHEMICALS

    CERN Multimedia

    Medical Service

    2002-01-01

    It is reminded that all persons who use chemicals must inform CERN's Chemistry Service (TIS-GS-GC) and the CERN Medical Service (TIS-ME). Information concerning their toxicity or other hazards as well as the necessary individual and collective protection measures will be provided by these two services. Users must be in possession of a material safety data sheet (MSDS) for each chemical used. These can be obtained by one of several means : the manufacturer of the chemical (legally obliged to supply an MSDS for each chemical delivered) ; CERN's Chemistry Service of the General Safety Group of TIS ; for chemicals and gases available in the CERN Stores the MSDS has been made available via EDH either in pdf format or else via a link to the supplier's web site. Training courses in chemical safety are available for registration via HR-TD. CERN Medical Service : TIS-ME :73186 or service.medical@cern.ch Chemistry Service : TIS-GS-GC : 78546

  18. Effect of gamma irradiation on chemical composition and nutritive value of sorghum grains

    International Nuclear Information System (INIS)

    Mekkawy, S.H.

    1996-01-01

    Sorghum grains were gamma irradiated at 0, 10, 50, 100, 150 and 200 KGy doses using cobalt-60 source. Irradiated and unirradiated sorghum samples were analyzed for crude fiber contents, total nitrogen, fat, ash and tannic acid. Neutral-detergent fiber (NDF), acid-detergent fiber (ADF) and acid detergent lignin (ADL) were also determined. In addition, digestibility coefficient received special attention. The irradiated sorghum grains were incorporated into basal diets and fed to rats during the digestion trials. The results indicated that gamma irradiation had no effects on total nitrogen, fat and ash contents of sorghum grains. Irradiation treatments of sorghum did not cause a pronounced effect on tannic acid content even those received the highest irradiation dose (200 kGy). Moreover, the irradiation treatments decreased the NDF content of sorghum especially those subjected to 100 or 200 kGy. On the other hand, the ADF and ADL values did not show a remarkable change due to irradiation treatments. Hemicellulose content was decreased with the increase of irradiation dose levels. Also, it was noticed that feeding rats on basal diets enriched with irradiated sorghum grains had a beneficial effects on digestibility coefficient. This trend was obvious with animals supplemented with sorghum grains subjected to the relatively high irradiation dose levels. 4 tabs

  19. The importance of handling high-value biologicals: Physico-chemical instability and immunogenicity of monoclonal antibodies.

    Science.gov (United States)

    Laptoš, Tomislav; Omersel, Jasna

    2018-04-01

    The present review specifies the various chemical and physical factors that can influence drug stability and immunogenicity, and the treatment outcomes of antibody biologicals. Although monoclonal antibodies (mAbs) are known to be more resistant to environmental changes compared with other proteins, the molecules themselves can be subjected to chemical and physical processes that promote their degradation and transformation into their specific amino-acid moieties. With increasing use of medicinal products that contain mAbs, and their self-administration by the patients, the issue of the correct manipulation of these drugs is of increasing importance. This review summarises the correct handling of mAb biologicals from the point of view of the pharmacist, clinical biochemist and patient, as is supported by relevant cases from the literature and our own data and experience. In particular, if there is a break in the cold chain, both healthcare professionals and patients need to be aware of the potential pharmacokinetics and pharmacodynamics alterations to these biologicals. Furthermore, any alterations in the protein structure can induce harmful immune reactions, including anaphylaxis and cytokine storms, or result in the production of neutralising or blocking Abs. Overall, considering also that treatment costs usually remain high, drug stability can have a tremendous effect on the clinical, humanistic and economic outcomes of such treatments.

  20. Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

    Directory of Open Access Journals (Sweden)

    Nicole Bijlsma

    2016-02-01

    Full Text Available A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the “-omics” fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the “exposome” and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health.

  1. The Clinical Test of Nano gold Cosmetic for Recovering Skin Damage Due to Chemicals: Special Case

    Science.gov (United States)

    Taufikurohmah, T.; Wardana, A. P.; Tjahjani, S.; Sanjaya, I. G. M.; Baktir, A.; Syahrani, A.

    2018-01-01

    Manufacturing of Nano gold cosmetics was done at PT. Gizi Indonesia. Clinical trials to cosmetics data supported that cosmetics are able to treat skin health which has been reported partially. For special cases, the recovery process of facial skin damage should also receive attention including cases of facial skin damage caused by chemicals such as phenol, HCl, aqua regia or other harsh chemicals. The problem determined whether the Nano gold is able to recover skin damage due to the harsh chemicals. This clinical trial data on the forms of early skin damage caused by phenol was delivered in the forms of facial photos patients. The recovery progress of facial skin condition was obtained every week for two months. The data included the forms of widespread wounds during the recovery process. This statement supported by anova statistical analysis of the widespread wound changing every week for 8 times. The conclusion is skin damage due to Phenol impregnation can be recovered with the use of Nano gold cosmetics for 8 weeks. This results support the manufacturing of Nano gold cosmetics for the needs of society. It also suggest that Nano gold material can be used for medicine manufacturing in the future.

  2. [Clinical value of angiogenin in predicting the prognosis of patients with idiopathic pulmonary fibrosis].

    Science.gov (United States)

    Bai, Yanling; Zhu, Haiyan; Sun, Qiyu; Gu, Guozhong; Zhang, Lingyu; Li, Ying; Yang, Baofeng

    2017-09-01

    To explore the relationship between angiogenin-1/2 (Ang-1/2) and clinical parameters of idiopathic pulmonary fibrosis (IPF), and to assess the value of Ang-1/2 in predicting the prognosis of patients with IPF. A retrospective analysis was conducted. Ninety-one patients diagnosed as IPF by high resolution CT (HRCT) and lung biopsy admitted to Daqing Oil Field General Hospital from March 2014 to January 2015 were enrolled. The general data, serum parameters and pulmonary function parameters of all patients were collected. After treatment, all of the 91 patients were followed-up to 2 years. The patients were divided into favorable prognosis group and unfavorable prognosis group according to follow-up results. The differences in all parameters between the two groups were compared. The relationship between Ang-1, Ang-2 and lung function parameters was analyzed by Pearson correlation analysis. Cox proportional hazard regression model was used to evaluate the effect of clinical parameters on the prognosis of patients with IPF. The effect of Ang-2 in predicting prognosis of patients with IPF was analyzed by receiver operating characteristic (ROC) curve. During the 2-year follow-up period, 30 of 91 patients showed a favorable prognosis, and 55 showed an unfavorable prognosis with a poor prognosis rate of 64.71%, and 6 patients withdrew from the study due to loss of follow-up and death. Compared with the favorable prognosis group, Ang-2 level in the unfavorable prognosis group was significantly increased (μg/L: 2.88±1.63 vs. 1.89±1.22, t = 2.909, P = 0.005), but Ang-1 only showed a slight increase (μg/L: 28.70±14.26 vs. 25.62±11.95, t = 1.005, P = 0.318). The results of Pearson correlation analysis showed that Ang-2 level was negatively correlated with forced expiratory volume in 1 second (FVC1) and the percentage of carbon monoxide diffusing capacity accounting for the expected value (DLCO%: r value was -0.227 and -0.206, and P value was 0.147 and 0.253, respectively

  3. Recent advances in engineering propionyl-CoA metabolism for microbial production of value-added chemicals and biofuels.

    Science.gov (United States)

    Srirangan, Kajan; Bruder, Mark; Akawi, Lamees; Miscevic, Dragan; Kilpatrick, Shane; Moo-Young, Murray; Chou, C Perry

    2017-09-01

    Diminishing fossil fuel reserves and mounting environmental concerns associated with petrochemical manufacturing practices have generated significant interests in developing whole-cell biocatalytic systems for the production of value-added chemicals and biofuels. Although acetyl-CoA is a common natural biogenic precursor for the biosynthesis of numerous metabolites, propionyl-CoA is unpopular and non-native to most organisms. Nevertheless, with its C3-acyl moiety as a discrete building block, propionyl-CoA can serve as another key biogenic precursor to several biological products of industrial importance. As a result, engineering propionyl-CoA metabolism, particularly in genetically tractable hosts with the use of inexpensive feedstocks, has paved an avenue for novel biomanufacturing. Herein, we present a systematic review on manipulation of propionyl-CoA metabolism as well as relevant genetic and metabolic engineering strategies for microbial production of value-added chemicals and biofuels, including odd-chain alcohols and organic acids, bio(co)polymers and polyketides. [Formula: see text].

  4. Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

    Science.gov (United States)

    Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

    2015-06-01

    In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)-(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized.

  5. Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

    International Nuclear Information System (INIS)

    Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

    2015-01-01

    In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)–(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized. (focus issue review)

  6. Recent progress in the development of solid catalysts for biomass conversion into high value-added chemicals

    Science.gov (United States)

    Hara, Michikazu; Nakajima, Kiyotaka; Kamata, Keigo

    2015-01-01

    In recent decades, the substitution of non-renewable fossil resources by renewable biomass as a sustainable feedstock has been extensively investigated for the manufacture of high value-added products such as biofuels, commodity chemicals, and new bio-based materials such as bioplastics. Numerous solid catalyst systems for the effective conversion of biomass feedstocks into value-added chemicals and fuels have been developed. Solid catalysts are classified into four main groups with respect to their structures and substrate activation properties: (a) micro- and mesoporous materials, (b) metal oxides, (c) supported metal catalysts, and (d) sulfonated polymers. This review article focuses on the activation of substrates and/or reagents on the basis of groups (a)–(d), and the corresponding reaction mechanisms. In addition, recent progress in chemocatalytic processes for the production of five industrially important products (5-hydroxymethylfurfural, lactic acid, glyceraldehyde, 1,3-dihydroxyacetone, and furan-2,5-dicarboxylic acid) as bio-based plastic monomers and their intermediates is comprehensively summarized. PMID:27877800

  7. Clinical relevance and discriminatory value of elevated liver aminotransferase levels for dengue severity.

    Science.gov (United States)

    Lee, Linda K; Gan, Victor C; Lee, Vernon J; Tan, Adriana S; Leo, Yee Sin; Lye, David C

    2012-01-01

    Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT ≥ 1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue. We retrospectively studied and classified polymerase chain reaction positive dengue patients from 2006 to 2008 treated at Tan Tock Seng Hospital, Singapore according to WHO 1997 and 2009 criteria for dengue severity. Of 690 dengue patients, 31% had DHF and 24% severe dengue. Elevated AST and ALT occurred in 86% and 46%, respectively. Seven had AST or ALT ≥ 1000 U/L. None had acute liver failure but one patient died. Median AST and ALT values were significantly higher with increasing dengue severity by both WHO 1997 and 2009 criteria. However, they were poorly discriminatory between non-severe and severe dengue (e.g., AST area under the receiver operating characteristic [ROC] curve=0.62; 95% confidence interval [CI]: 0.57-0.67) and between dengue fever (DF) and DHF (AST area under the ROC curve=0.56; 95% CI: 0.52-0.61). There was significant overlap in AST and ALT values among patients with dengue with or without warning signs and severe dengue, and between those with DF and DHF. Although aminotransferase levels increased in conjunction with dengue severity, AST or ALT values did not discriminate between DF and DHF or non-severe and severe dengue.

  8. The clinical value of three-dimensional contrast-enhanced MR angiography in abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Liu Qi; Lu Jianping; Tian Jianming; Wang Fei; Wang Li; Jin Aiguo; Zeng Hao; Gong Jianguo

    2004-01-01

    Objective: To evaluate the clinical value of three-dimensional contrast-enhanced MR angiography (3D CE-MRA) and its 3D reconstruction in the diagnosis of abdominal aortic aneurysms (AAA). Methods: Sixty-three patients with clinically diagnosed AAA underwent 3D CE-MRA combined with other sequences. 3D CE-MRA was performed with a 3D FISP sequence(TR, TE, FA=3.64 ms, 1.44 ms, 25 degrees, matrix=196 x 512, eff. slice=1.8 mm, FOV 30 cm x 40 cm, acquisition time=18-20 s) after injection of 0.2 mmol Gd-DTPA per kg b. w. A bolus-test was done before angiography to optimize imaging delay time. After 3D CE-MRA a T 1 -weighted sequence was acquired on the axial plane. The source images were subtracted from mask images and transferred to computer workstation, and subsequently post-processed using 3D reconstruction. All sequences were used to depict the type, location, extent, and thrombosis of the AAA, the morphology of its proximal neck, the distal aortoiliac inflow tract, and the relationship with the branches of aorta. The length, diameter, and angle of the aneurysm sac, and proximal and distal arteries were measured. The clinical role was evaluated for treatment planning. Results: High-quality 3D CE-MRA/MRI images were obtained in all patients. Among them, fifty-six had infrarenal AAA, five juxtarenal AAA, and two AAA with suprarenal extension. The mean diameter of aneurysms was 5.3 cm. The thrombosis was thicker than 2.0 cm in 26 patients. 3D CE-MRA clearly demonstrated the morphology and extent of AAA, and its proximal neck and distal aortoiliac inflow tract. The accurate parameters needed by endovascular treatment were gained simultaneously. Aneurysm and its neck depiction at 3D CE-MRA was better than that at DSA. The endovascular and surgical treatment were selected according the images (31 endovascular treatment, 4 surgical treatment, 28 conservative treatment only). The parameters at 3D CE-MRA coincided well with those at DSA in all cases (P>0.1). Conclusion: 3D CE

  9. Evaluation of clinical value of combined tumor markers detection in diagnosis of lung cancer

    International Nuclear Information System (INIS)

    Zhang Guangming; Deng Shouzhen; Wang Yun; Xu Lianqin; He Wanting; Gao Quan; Lin Xiangtong

    2002-01-01

    To evaluate clinical value of single or combined tumor marker detection CY21-1, CEA, CA15-3 and SCC in the diagnosis of lung cancer. There was retrospective analysis of 87 lung cancer inpatients, all of them was confirmed by pathology. Results showed: (1) Sensitivity of CY21-1, CEA, CA15-3 and SCC by single detection in diagnosing lung cancer was 59.8%, 39.1%, 44.8%, 18.4%, respectively. (2) Sensitivity of group I (CY21-1 + CEA) was 78.2%; sensitivity of group II (CY21-1 + CEA + CA15-3) was 88.5%; sensitivity of group III (CY21-1 + CEA + CA15-3 + SCC) was the same as group II. In the diagnosis of lung cancer, the combined detection with CY21-1, CEA, CA15-3 was an ideal selective combination

  10. Estimating clinical chemistry reference values based on an existing data set of unselected animals.

    Science.gov (United States)

    Dimauro, Corrado; Bonelli, Piero; Nicolussi, Paola; Rassu, Salvatore P G; Cappio-Borlino, Aldo; Pulina, Giuseppe

    2008-11-01

    In an attempt to standardise the determination of biological reference values, the International Federation of Clinical Chemistry (IFCC) has published a series of recommendations on developing reference intervals. The IFCC recommends the use of an a priori sampling of at least 120 healthy individuals. However, such a high number of samples and laboratory analysis is expensive, time-consuming and not always feasible, especially in veterinary medicine. In this paper, an alternative (a posteriori) method is described and is used to determine reference intervals for biochemical parameters of farm animals using an existing laboratory data set. The method used was based on the detection and removal of outliers to obtain a large sample of animals likely to be healthy from the existing data set. This allowed the estimation of reliable reference intervals for biochemical parameters in Sarda dairy sheep. This method may also be useful for the determination of reference intervals for different species, ages and gender.

  11. Clinical value of pre-operative embolization of maxillary artery for nasopharyngeal angiofibroma

    International Nuclear Information System (INIS)

    Zhu Wenke; Shan Hong; Zhu Kangshun; Jiang Zabo; Guan Shouhai; Huang Mingsheng; Li Zhengran; Shen Xinying

    2004-01-01

    Objective: To assess the clinical value of pre-operative embolization for nasopharyngeal angiofibroma. Methods: 13 patients with nasopharyngeal angiofibroma confirmed by surgery and biopsy were retrospectively analysed. Bilateral carotid artery angiography was performed for demonstration of the arterial supply of tumor. According to the size and different caliber of arteries, embolization were separately undertaken by different types of coil via 4.1 or 5F Head-Hunter catheter. The embolization efficacy, embolization was evaluated by amount of blood loss. Results: After coil embolization, no complication happened ranging 1-4 days (mean 2 days) in all 13 patients and then all the tumor masses were totally resected with mean blood loss of (584.6 ± 379.4) ml (range 250-1500 ml). Conclusions: Preoperative coils embolization is safe, reliable with less complication especially for reducing intraoperative blood loss and promoting the prognosis. (authors)

  12. Clinical value of arteriography in postpartum hemorrhage by transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Wang Kai; Jiang Guomin; Zhao Jinwei; Huang Wenhua; Liu Yizhi; Jin Yonghai

    2010-01-01

    Objective: To analyze the arterial supply in postpartum hemorrhage and to evaluate the clinical value of arteriography in transcatheter arterial embolization (TAE) for treating postpartum hemorrhage. Methods: The arteriography of 37 patients with postpartum hemorrhage was analyzed. TAE were performed after the bleeding artery was identified. Post TAE angiography was performed to confirm the success of embolization. Results: The bleeding artery in atonic uterus and abnormal placenta was the uterine artery. The bleeding artery in birth canal laceration is mainly non-uterine artery. Postpartum hemorrhage was successfully controlled in all 37 patients without sever complication of TAE. Conclusion: Arteriography in postpartum hemorrhage can demonstrate the bleeding artery and is potential collaterals allowing adequate embolization without complication. (authors)

  13. CLINICAL-PHARMACOLOGICAL VALUE OF TREATMENT EFFICIENCY OF BHP-PATIENTS BY ANTITHROMBOTIC THERAPY

    Directory of Open Access Journals (Sweden)

    A.A. Svistunov

    2007-09-01

    Full Text Available Patients with BHP need in pharmacological treatment of thrombosis the most often in the first 3 cases because has dysfunctions of platelets and coagulation. According to results of analysis of efficiency antithrombotic therapy in BHP-patients confirmed clinical and biochemical influence antithrombotic therapy by Ticlid 250 mg twice on the day in comparison with Aspirin 100 mg and Dipiridomol 25 mg on the basic therapy of the BHP by Permixon 160 mg. The received results have had statistically meant differences. Manifestation of BHP and value QOL and others urodynamic complications most often appear on the basic specific monotherapy of BHP and lost after antithrombotic therapy for 1-3 months. The important complications of antithrombotic therapy of BHP-patients did not observe.

  14. Establishment of virtual three-dimensional model for intravascular interventional devices and its clinical value

    International Nuclear Information System (INIS)

    Wei Xin; Zhong Liming; Xie Xiaodong; Wang Chaohua; You Jian; Hu Hong; Hu Kongqiong; Zhao Xiaowei

    2012-01-01

    Objective: To explore virtual three-dimensional (3D) model for intravascular interventional devices,the method of preoperative simulation and its value in clinical work. Methods: The virtual models including catheter, guide wire, stent and coil were established by using the 3D moulding software of 3D Studio MAX R3. The interventional preoperative simulation was performed on personal computer including 21 patients of cerebral aneurysm embolization (anterior communicating artery 5, posterior communicating artery 10,middle cerebral artery 3, internal carotid artery 2, and vertebral artery 1), during interventional procedures, the surgeon relied on the simulation results for plastic micro-guide wire, catheter and the release of micro-coils and stents. Results: (1) All the virtual instruments and real instruments had similar shape,the overall tine for constructing virtual model was about 20 hours. The preoperative simulation took 50 to 80 minutes. (2) The simulation result of catheter insertion in the 18 cases had relevant value to guide micro-catheter, molding micro-guide wire tip, and shortened the operating time. For embolization, the simulation results of filling coil and releasing stent were similar to surgical results in 76% of the patients (16/21). (3)For teaching and training, 93% (38/41) of doctors in training believed that preoperative simulation facilitated the understanding of surgery. Conclusions: The method of virtual model of intravascular interventional devices was reliable. The preoperative simulation results could be used to guide practical clinical operation with relatively high degree of similarity, and could play a role in promoting researches on interventional virtual operations. (authors)

  15. [Research progress on the clinical value of Ki-67 in breast cancer and its cut-off definition].

    Science.gov (United States)

    Chen, Qing; Wu, Kejin

    2015-08-01

    Ki-67 has an important application value in clinical practice. However, it is still a little tough in clinical application because of the debate on the cut-off definition of Ki-67 index. This review summarizes most studies on the prognostic and predictive value of Ki-67, analyzes the reasons for the discrepancies among the studies cited, and presents the necessity and clinical significance of scientifically defining the cut-off of Ki-67 index, providing a theoretical basis for Ki-67 in clinical application.

  16. [Comparison of 2D and 3D sequences for MRCP. Clinical value of the different techniques].

    Science.gov (United States)

    Wallnoefer, A M; Herrmann, K A; Beuers, U; Zech, C J; Gourtsoyianni, S; Reiser, M F; Schoenberg, S O

    2005-11-01

    Magnetic resonance cholangio-pancreaticograpy (MRCP) is a non-invasive imaging modality of the pancreatico-biliary system which plays an increasingly important role in the clinical and diagnostic workup of patients with biliary or pancreatic diseases. The present review is designed to give an overview of the currently available and appropriate sequences, their technical background, as well as new developments and their relevance to the various clinical issues and challenges. The impact of the latest technical innovations, such as integrated parallel imaging techniques and navigator-based respiratory triggering, on the diagnostic capacities of MRCP is discussed. In this context, the individual value of RARE, T2w single shot turbo/fast spin echo (SSFSE) and the recently introduced 3D T2w turbo/fast spin echo sequences (T2w 3D-T/FSE) is reviewed. RARE imaging may be preferred in severely ill patients with limitations in cooperation, SSFSE is particularly effective in differentiating benign and malignant stenosis, and 3D-FSE offers additional advantages in the detection of small biliary concrements.

  17. Clinical value of determination of TSH-binding inhibiting immunoglobulins (TBII) by a radioreceptor assay

    International Nuclear Information System (INIS)

    Heberling, H.J.; Bierwolf, B.; Lohmann, D.

    1986-01-01

    The clinical value of a commercial kit for determination of TBII was evaluated. 50 patients with untreated Graves' disease, 21 patients with Graves' disease before and during medical therapy, 18 patients after finishing medical therapy and 10 patients after surgical treatment were examined. Besides these, 41 patients with other thyroid diseases and 36 patients without any thyroid disorder were included. In 47 (94%) of 50 patients with untreated Graves' disease TBII were detectable in serum using a TSH standard curve. Binding activities exceeding 10 U/l TSH equivalents were regarded as positive. In other thyroid diseases TBII were negative with the exception of 3 of 22 patient with autonomously functioning thyroid nodules. After 12 months of antithyroid drug treatment of 19 patients the incidence of positive antibody findings was 26%. During follow-up after medical therapy (1-9 years) 7 of 18 patients had increased TBII in correlation with clinical and functional findings. The determination of TBII by TRAK assay proved to be a sensitive and specific method. The assay can be used to differentiate between hyperthyroidism of autoimmune or non-immunogenic origin. Thus the method seems to be helpful for the follow-up under medical treatment of patients with Graves' disease. (author)

  18. Clinical value of SPECT/CT imaging in the diagnosis of bone metastasis

    International Nuclear Information System (INIS)

    Wang Xinhua; Zhao Yanping; Lu Haijian; Dong Zhanfei

    2010-01-01

    Objective: To evaluate the clinical value of 99 Tc m -methylene diphosphonic acid (MDP) SPECT/CT imaging for the diagnosis of bone metastasis. Methods: Patients suspected for bone metastasis and with bone pain of unknown origin were included in this study (n=237). All cases underwent SPECT and CT imaging at 180 min after 99 Tc m -MDP injection. Diagnosis was confirmed by pathology (n=21), more than 2 kinds of radiologieal imaging (MRI, CT, X-ray) (n=106), and clinical follow up in 2 years (n=110). χ 2 -test was used to compare the results of planar and SPECT/CT imaging using SAS 6.12 software. Results: In 237 patients, planar imaging of 142 cases matched the final diagnosis in which 72 had benign lesions and 70 had bone metastases. The definite coincidence rate was 95.30% (142/149). SPECT/CT imaging of 224 cases matched the final diagnosis in which 104 had benign lesions and 120 cases diagnosed as bone metastases. The coincidence and definite coincidence rates were 94.51% (224/237), and 99.48% (192/193). Difference in the definite coincidence rate between planar and SPECT/CT imaging was statistically significant (χ 2 = 5.37, P=0.024). Conclusion: SPECT/CT imaging is valuable for accurate localization of osseous pathology and for improvement of diagnosing bone metastasis. (authors)

  19. Interventional management of spine eosinophilic granuloma in children: preliminary investigation of its clinical value

    International Nuclear Information System (INIS)

    He Yu; Wu Chungen; Gu Yifeng; Cheng Yongde

    2011-01-01

    Objective: To assess the clinical value of interventional management in treating spine eosinophilic granuloma in children. Methods: Interventional therapies, including per cutaneous biopsy and percutaneous vertebroplasty (PVP), were carried out in three child patients with five pathologically-proved eosinophilic granuloma lesions, which were localized in the vertebrae. The clinical data were retrospectively analyzed. Visual analogue pain scale (VAS) and Oswesty disability index (ODI) were assessed before and after operation. Results: A total of four operations were successfully carried out in all of three patients. The mean VAS score reduced from 7 before treatment of 1 after treatment. The mean ODI decreased from preoperative 52.5% to postoperative 10.5%. During procedures no significant complications occurred except for cement leakage in some cases. Pain relief and daily activity were remarkably improved after treatment. All patients were followed up for 3 months to 5 years. Conclusion: For the treatment of spine eosinophilic granuloma in children, interventional techniques are mini-invasive, safe and effective therapeutic methods. (authors)

  20. Clinical Value of Thyrotropin Receptor Antibodies for the Differential Diagnosis of Interferon Induced Thyroiditis.

    Science.gov (United States)

    Benaiges, D; Garcia-Retortillo, M; Mas, A; Cañete, N; Broquetas, T; Puigvehi, M; Chillarón, J J; Flores-Le Roux, J A; Sagarra, E; Cabrero, B; Zaffalon, D; Solà, R; Pedro-Botet, J; Carrión, J A

    2016-01-01

    The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin. Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis. 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 "de novo" thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (pthyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Clinical value of CARE dose 4D technique in decreasing CT scanning dose of adult chest

    International Nuclear Information System (INIS)

    Wu Aiqin; Zheng Wenlong; Xu Chongyong; Fang Bidong; Ge Wen

    2011-01-01

    Objective: To investigate the value of CARE Dose 4D technique in decreasing radiation dose and improving image quality of multi-slice spiral CT in adult chest scanning. Methods: 100 patients of chest CT scanning were equally divided into study group and control group randomly. CARE Dose 4D Technique was used in study group. Effective mAs value, volume CT dose index (CTDI vol ) and dose length product (DLP) were displayed automatically in machine while chest scanning; those values and actual mAs value of every image were recorded respectively. The image quality at apex of lung, lower edge of aorta arch, middle area of left atrium and base of lung on every image of 400 images was judged and classified as three level (excellent, good, poor) by two deputy chief physicians with double blind method, the image noise at corresponding parts was measured. Results: While setting 80 mAs for quality reference mAs, the effective mAs value in study group most decreased 44 mAs than control group with an average decrease of 9.60 (12.0%), CTDI vol with 4.75 mGy with an average decrease of 0.95 mCy (11.0%), DLP 99.50% in study group, with 98.0% in control group. But it was higher at apex of lung and base of lung, lower at middle area of left atrium, and similar at lower edge of aorta arch in study group than contrast group. The image noise were lower at apex of lung and base of lung in study group than control group (t =6.299 and 2.332, all P<0.05), higher at middle area of left atrium in study group than control group (t=3.078, P<0.05) and similar at lower edge of aorta arch in study group than control group (t=1.191, P>0.05). Conclusions: CARE Dose 4D technique provides a function regulated mAs real-time on line, it not only raises utilization rate of radiation and decreases radiation dose, but also promises and increases image quality in chest CT scanning, and has some clinical significance. (authors)

  2. Clinical relevance and prognostic value of radiographic findings in Zenker's diverticulum.

    Science.gov (United States)

    Mantsopoulos, Konstantinos; Psychogios, Georgios; Karatzanis, Alexander; Künzel, Julian; Lell, Michael; Zenk, Johannes; Koch, Michael

    2014-03-01

    The aim of this study was to evaluate the clinical relevance and prognostic value of preoperative and postoperative oesophagography in patients with Zenker's diverticulum. The medical records of 155 patients who underwent surgical treatment (with an endoscopic or transcervical approach) for Zenker's diverticulum between 1992 and 2010 in a tertiary referral centre were retrospectively evaluated. The size of the diverticula on oesophagography, recognizable muscular septum, and protection of the diverticulum were assessed relative to the surgical procedures performed. The incidence of diverticular remnants on postoperative oesophagography was also assessed relative to the surgical procedure. It was investigated whether the detection of a residual pharyngeal pouch and filling of it with contrast medium were related to the patients' immediate postoperative symptoms and the development of symptomatic recurrence. Larger diverticula (Brombart III-IV) were manageable significantly more often with endoscopic procedures (P = 0.007). Residual diverticulum and filling with contrast medium were strongly associated with prolonged dysphagia immediately postoperatively (P = 0.005 and P = 0.009, respectively). However, these parameters failed to correlate significantly with a symptomatic recurrence. Preoperative oesophagography proved to be extremely important for surgical planning, with the surgeon's personal preference seeming to be the driving indicator in many cases. Postoperative oesophagography is only useful for excluding postoperative complications in the immediate postoperative phase and did not have a prognostic value as to a recurrence of the disease.

  3. Value of Prophylactic Postoperative Antibiotic Therapy after Bimaxillary Orthognathic Surgery: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Majid Eshghpour

    2014-10-01

    Full Text Available Introduction: Antibiotic therapy before or after orthognathic surgery is commonly recommended by surgeons to minimize the risk of wound infection. This article evaluates the value of Prophylactic antibiotic therapy in order to diminish the incidence of postoperative wound infection after orthognathic surgery.   Materials and Methods: Fifty candidates for bimaxillary orthognathic surgery were divided into cases and controls. Cefazolin (1g was administered intravenously to all participants 30 mins prior to surgery followed by a similar dose 4 hours later. Case-group patients ingested amoxicillin (500 mg orally for 7 days after surgery. Postoperative wound infection was assessed using clinical features, and the P-value significance was set at P  Results: Both groups were similar according to gender, age, and operating time. During the follow-up period no infection was observed in either the case or control group.   Conclusion:  The results of this study suggest that long-term postoperative antibiotic therapy is not essential for the prevention of postoperative infection, and that application of aseptic surgical technique and hygiene instruction after surgery are sufficient.

  4. Review of clinically accessible methods to determine lean body mass for normalization of standardized uptake values

    International Nuclear Information System (INIS)

    DEVRIESE, Joke; POTTEL, Hans; BEELS, Laurence; MAES, Alex; VAN DE WIELE, Christophe; GHEYSENS, Olivier

    2016-01-01

    With the routine use of 2-deoxy-2-[ 18 F]-fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scans, metabolic activity of tumors can be quantitatively assessed through calculation of SUVs. One possible normalization parameter for the standardized uptake value (SUV) is lean body mass (LBM), which is generally calculated through predictive equations based on height and body weight. (Semi-)direct measurements of LBM could provide more accurate results in cancer populations than predictive equations based on healthy populations. In this context, four methods to determine LBM are reviewed: bioelectrical impedance analysis, dual-energy X-ray absorptiometry. CT, and magnetic resonance imaging. These methods were selected based on clinical accessibility and are compared in terms of methodology, precision and accuracy. By assessing each method’s specific advantages and limitations, a well-considered choice of method can hopefully lead to more accurate SUVLBM values, hence more accurate quantitative assessment of 18F-FDG PET images.

  5. Neurohospitalists enhance resident perception of the educational and clinical value of a night float rotation.

    Science.gov (United States)

    Greene, James G

    2013-10-01

    Neurology residency training programs have been profoundly impacted by recent changes in resident duty hours, workloads, and supervisory requirements. In response, many programs have adopted a night float coverage system to minimize the requirements for overnight call. The majority involves residents working a block of night shifts in what is typically a service-oriented rotation. Recently, concerns have arisen regarding the impact of this design on resident education and patient care. We have developed a novel on-site nighttime neurohospitalist model for the explicit purpose of steepening the initial learning curve for neurology residents in an effort to rapidly improve their neurological skills and, in conjunction, overnight patient care. We surveyed residents after the initiation of this system to assess their perception of the impact of direct overnight supervision on education and patient care. As part of ongoing quality improvement efforts, surveys were administered to neurology house staff at a tertiary academic medical center after they had completed service on the night float rotation both with and without an attending in the hospital using a retrospective pre/postdesign. There was a robust positive impact on resident's perception of overall quality, educational value, and clinical quality on the night float rotation with an attending on-site. Despite an overall perception that their autonomy was maintained, residents believed barriers to contact the attending were lower, and attending interaction during critical decision making was more frequent. Direct overnight supervision by a neurohospitalist enhances the educational value and care quality on overnight resident rotations.

  6. Biological implications and clinical value of mir-210 in gastrointestinal cancer.

    Science.gov (United States)

    Yang, Wanli; Ma, Jiaojiao; Zhou, Wei; Zhou, Xin; Cao, Bo; Fan, Daiming; Hong, Liu

    2017-06-01

    Hypoxia, a common feature of tumor microenvironment, is known to accelerate tumor development and growth by promoting the formation of a neoplastic environment. Recent studies have provided a wealth of evidence that miRNAs are significant members of the adaptive response to low oxygen in tumors. miR-210 is one of the hypoxia-induced miRNAs, which has been reported extensively in cancer researches. However, there is no systematic discussion about the role of miR-210 in gastrointestinal cancer. We conducted a literature research in database including PubMed, Elsevier Science Direct and Medline before 16 September 2016, in order to collect articles of miR-210 in gastrointestinal cancer. Areas covered: In the present review, we mainly discuss the following aspects: hypoxia-induced dysregulation of miR-210, the expression of miR-210 and tumorigenesis, the resultant changes of miR-210 targets and its roles in different types of gastrointestinal cancer progression, the diagnostic, therapeutic and prognostic value of miR-210 in gastrointestinal cancer. Expert commentary: Numerous researches have demonstrated the values of miR-210 in cancer diagnosis, prognosis and targeted therapies, especially in gastrointestinal cancers. However, there are also some existing problems and challenges in translating the new research findings into clinical utility. Further investigations and studies are still urgently required.

  7. Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia.

    Science.gov (United States)

    Chen, Po-Hao; Slanetz, Priscilla J

    2014-01-01

    To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. A total of 353 mammograms were obtained from 327 unique patients (ages 18-95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Po-Hao, E-mail: howard_chen@post.harvard.edu [Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 (United States); Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadlephia, PA 19104 (United States); Slanetz, Priscilla J., E-mail: pslanetz@bidmc.harvard.edu [Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 (United States); Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215 (United States)

    2014-01-15

    Purpose: To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Materials and Methods: Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. Results: A total of 353 mammograms were obtained from 327 unique patients (ages 18–95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. Conclusion: Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management.

  9. The Clinical Value of Prenatal 3D Ultrasonic Diagnosis on Fetus Hemivertebra Deformity- A Preliminary Study.

    Science.gov (United States)

    Wen, Yanting; Xiang, Guishuang; Liang, Xiaoqiu; Tong, Xiaoqian

    2018-02-01

    The present study is planned to discuss the clinical value of prenatal 3D ultra-sonic diagnosis on fetus hemivertebra deformity through the retrospective analysis of clinical data of fetus hemivertebra deformity. Selected 9 fetus hemivertebra deformity cases, which have been admitted to our hospital during the period from January, 2010 to January, 2016 as study samples, and analyzed their 2D and 3D ultrasonic examination data. 4 cases of the fetus hemivertebra deformity occurred at lumbar vertebra, 3 cases at thoracic vertebra, and 2 cases at thoracolumbar vertebra. There were scoliosis and opened spine bifida (OSB). In 7 cases, there was absence of ribs in fetus. The 2D ultrasonic image showed that: The echo at the center of fetus vertebral arch lesion was blurred or lost. The coronal section showed the deformity of the spine. There was obvious loss of the ossification center. From the cross section, we could see that the vertebral body of the fetus was shrinking and the edges were relatively blurred. The 3D ultrasonic image showed that: the echo at the ossification center of the fetus vertebra was relatively blurred, or even lost. The image also indicated scoliosis deformity of the spine. The vertebral body lesion could be accurately located. 9 cases of fetus hemivertebra deformity have been detected through examination. Labor inductions have been carried out after getting the permission from the family members. The X-ray examination of the fetus after labor induction showed that the diagnosis was correct. Prenatal ultra-sonic examination holds strong potential for the diagnosis of fetus hemivertebra deformity quite early and deserves further clinical evaluation with large sample size.

  10. Scientific value of systematic reviews: survey of editors of core clinical journals.

    Directory of Open Access Journals (Sweden)

    Joerg J Meerpohl

    Full Text Available BACKGROUND: Synthesizing research evidence using systematic and rigorous methods has become a key feature of evidence-based medicine and knowledge translation. Systematic reviews (SRs may or may not include a meta-analysis depending on the suitability of available data. They are often being criticised as 'secondary research' and denied the status of original research. Scientific journals play an important role in the publication process. How they appraise a given type of research influences the status of that research in the scientific community. We investigated the attitudes of editors of core clinical journals towards SRs and their value for publication. METHODS: We identified the 118 journals labelled as "core clinical journals" by the National Library of Medicine, USA in April 2009. The journals' editors were surveyed by email in 2009 and asked whether they considered SRs as original research projects; whether they published SRs; and for which section of the journal they would consider a SR manuscript. RESULTS: The editors of 65 journals (55% responded. Most respondents considered SRs to be original research (71% and almost all journals (93% published SRs. Several editors regarded the use of Cochrane methodology or a meta-analysis as quality criteria; for some respondents these criteria were premises for the consideration of SRs as original research. Journals placed SRs in various sections such as "Review" or "Feature article". Characterization of non-responding journals showed that about two thirds do publish systematic reviews. DISCUSSION: Currently, the editors of most core clinical journals consider SRs original research. Our findings are limited by a non-responder rate of 45%. Individual comments suggest that this is a grey area and attitudes differ widely. A debate about the definition of 'original research' in the context of SRs is warranted.

  11. Relationship between tooth value and skin color in patients visiting Royal Medical Services clinics of Jordan.

    Science.gov (United States)

    Al-Nsour, Hind Fahed; Al-Zoubi, Tamara Trad; Al-Rimawi, Ali Salaheddin

    2018-03-01

    Facial and dental aesthetics are becoming of great concern for patients, especially for the younger generation. Tooth color matching and selection is considered a vital element in order to create an attractive beautiful smile. The importance of tooth color matching is to adjust tooth colors to obtain a good match with adjacent teeth and the skin. This is considered a challenge especially if adjacent teeth were lost or records of patients' teeth color were not available. The aim of this study was to determine the relationship between skin complexion and tooth value in a Jordanian population. A cross-sectional study of 520 individuals who were randomly selected and belonging to different age groups, ranging from 15-65 years, with equal sex distribution. These patients visited the dental clinics at different Jordanian military hospitals. The study was carried out over a period of one year from 2015 to 2016. The randomly selected sample was examined by one researcher. Shade of the middle third of the labial surface of central incisor was determined visually using VITA tooth guide, 3D-MASTER shade guide. Tooth shades were divided into two categories according to their value. The skin complexion was identified using Fitzpatrick skin type test, and was categorized into two categories (fair and dark). Data were statistically analyzed using Epi Info version 6. A statistically significant tooth shade value difference was discovered among subjects of different skin color (pvalue among a Jordanian population. Thus, considering the skin complexion when choosing tooth shades is helpful in achieving a pleasing good-looking smile, yet further investigations in this field must be carried out.

  12. A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application.

    Science.gov (United States)

    Garland, Megan; Yim, Joshua J; Bogyo, Matthew

    2016-01-21

    The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection, and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes, as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration among chemists, biologists, and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Impact of environmental chemicals, sociodemographic variables, depression, and clinical indicators of health and nutrition on self-reported health status

    Science.gov (United States)

    Public health researchers ideally integrate social, environmental, and clinical measures to identify predictors of poor health. Chemicals measured in human tissues are often evaluated in relation to intangible or rare health outcomes, or are studied one chemical at a time. Using ...

  14. Value creation with life cycle assessment: an approach to contextualize the application of life cycle assessment in chemical companies to create sustainable value

    NARCIS (Netherlands)

    Manda, B.M. Krishna; Bosch, Henk; Karanam, Sreepadaraj; Beers, Heidi; Bosman, Harrie; Rietveld, Eelco; Worrell, Ernst; Patel, Martin K.

    2016-01-01

    Businesses have a responsibility to shareholders and other stakeholders. By establishing a direct link between sustainability and shareholder value, businesses can successfully include sustainability considerations in managerial decisions and create sustainable value. The value creation

  15. Chemical composition and the nutritive value of pistachio epicarp (in situ degradation and in vitro gas production techniques

    Directory of Open Access Journals (Sweden)

    Somayeh Bakhshizadeh

    2014-04-01

    Full Text Available The nutritive value of pistachio epicarp (PE was evaluated by in situ and in vitro techniques. Chemical analysis indicated that PE was high in crude protein (11.30% and low in neutral detergent fiber (26.20%. Total phenols, total tannins, condensed tannins and hydrolysable tannins contents in PE were 8.29%, 4.48%, 0.49% and 3.79%, respectively. Ruminal dry matter and crude protein degradation after 48 hr incubation were 75.21% and 82.52%, respectively. The gas production volume at 48 hr for PE was 122.47 mL g-1DM. As a whole, adding polyethylene glycol (PEG to PE increased (p < 0.05 gas production volumes, organic matter digestibility and the metabolizable energy that illustrated inhibitory effect of phenolics on rumen microbial fermentation and the positive influence of PEG on digestion PE. The results showed that PE possessed potentials to being used as feed supplements.

  16. Chemical composition and the nutritive value of pistachio epicarp (in situ degradation and in vitro gas production techniques).

    Science.gov (United States)

    Bakhshizadeh, Somayeh; Taghizadeh, Akbar; Janmohammadi, Hossein; Alijani, Sadegh

    2014-01-01

    The nutritive value of pistachio epicarp (PE) was evaluated by in situ and in vitro techniques. Chemical analysis indicated that PE was high in crude protein (11.30%) and low in neutral detergent fiber (26.20%). Total phenols, total tannins, condensed tannins and hydrolysable tannins contents in PE were 8.29%, 4.48%, 0.49% and 3.79%, respectively. Ruminal dry matter and crude protein degradation after 48 hr incubation were 75.21% and 82.52%, respectively. The gas production volume at 48 hr for PE was 122.47 mL g(-1)DM. As a whole, adding polyethylene glycol (PEG) to PE increased (p gas production volumes, organic matter digestibility and the metabolizable energy that illustrated inhibitory effect of phenolics on rumen microbial fermentation and the positive influence of PEG on digestion PE. The results showed that PE possessed potentials to being used as feed supplements.

  17. Demonstration of Parallel Algal Processing: Production of Renewable Diesel Blendstock and a High-Value Chemical Intermediate

    Energy Technology Data Exchange (ETDEWEB)

    Knoshaug, Eric P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mohagheghi, Ali [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Nagle, Nicholas J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Stickel, Jonathan J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Dong, Tao [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Karp, Eric M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Kruger, Jacob S [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Brandner, David [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Manker, Lorenz [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Rorrer, Nicholas [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Hyman, Deborah A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Christensen, Earl D [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Pienkos, Philip T [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-12-19

    Co-production of high-value chemicals such as succinic acid from algal sugars is a promising route to enabling conversion of algal lipids to a renewable diesel blendstock. Biomass from the green alga Scenedesmus acutus was acid pretreated and the resulting slurry separated into its solid and liquor components using charged polyamide induced flocculation and vacuum filtration. Over the course of a subsequent 756 hours continuous fermentation of the algal liquor with Actinobacillus succinogenes 130Z, we achieved maximum productivity, process conversion yield, and titer of 1.1 g L-1 h-1, 0.7 g g-1 total sugars, and 30.5 g L-1 respectively. Succinic acid was recovered from fermentation media with a yield of 60% at 98.4% purity while lipids were recovered from the flocculated cake at 83% yield with subsequent conversion through deoxygenation and hydroisomerization to a renewable diesel blendstock. This work is a first-of-its-kind demonstration of a novel integrated conversion process for algal biomass to produce fuel and chemical products of sufficient quality to be blend-ready feedstocks for further processing.

  18. Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

    Science.gov (United States)

    Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

    2013-07-01

    A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

  19. A Miniaturized Chemical Proteomic Approach for Target Profiling of Clinical Kinase Inhibitors in Tumor Biopsies

    Science.gov (United States)

    Chamrád, Ivo; Rix, Uwe; Stukalov, Alexey; Gridling, Manuela; Parapatics, Katja; Müller, André C.; Altiok, Soner; Colinge, Jacques; Superti-Furga, Giulio; Haura, Eric B.; Bennett, Keiryn L.

    2014-01-01

    While targeted therapy based on the idea of attenuating the activity of a preselected, therapeutically relevant protein has become one of the major trends in modern cancer therapy, no truly specific targeted drug has been developed and most clinical agents have displayed a degree of polypharmacology. Therefore, the specificity of anticancer therapeutics has emerged as a highly important but severely underestimated issue. Chemical proteomics is a powerful technique combining postgenomic drug-affinity chromatography with high-end mass spectrometry analysis and bioinformatic data processing to assemble a target profile of a desired therapeutic molecule. Due to high demands on the starting material, however, chemical proteomic studies have been mostly limited to cancer cell lines. Herein, we report a down-scaling of the technique to enable the analysis of very low abundance samples, as those obtained from needle biopsies. By a systematic investigation of several important parameters in pull-downs with the multikinase inhibitor bosutinib, the standard experimental protocol was optimized to 100 µg protein input. At this level, more than 30 well-known targets were detected per single pull-down replicate with high reproducibility. Moreover, as presented by the comprehensive target profile obtained from miniaturized pull-downs with another clinical drug, dasatinib, the optimized protocol seems to be extendable to other drugs of interest. Sixty distinct human and murine targets were finally identified for bosutinib and dasatinib in chemical proteomic experiments utilizing core needle biopsy samples from xenotransplants derived from patient tumor tissue. Altogether, the developed methodology proves robust and generic and holds many promises for the field of personalized health care. PMID:23901793

  20. A retrospective analysis of heterophoria values in a clinical population aged 18 to 30 years

    Directory of Open Access Journals (Sweden)

    N.T. Makgaba

    2006-12-01

    Full Text Available Information on heterophoria values in South Africans  is  scanty. The  purpose  of  this  paper therefore, is to present information on the distribution of heterophoria in a clinical popula-tion aged 18 to 30 years, which hitherto is not available. The data presented here was obtained from  the  record  cards  of  475  black  South African  patients  examined  at  the  Optometry clinic, University of Limpopo (Turfloop cam-pus between 2000 and 2005. The patients were examined by final year students under the supervision  of  qualified  optometrists.  Heterophoria was  measured  for  each  patient  using  the  von Graefe  method.  The  horizontal  heterophoria for distance vision (6 m ranged from 16 prism diopters (pd esophoria to 12 pd exophoria with a mean of 0.74 pd exophoria (SD = ± 2.84 pd. For  distance  vision,  esophoria  ranged  from 0.5 to 16 pd with a mean of 3.08 pd (SD = ± 3.09, while exophoria ranged from 0.5 pd to 12 pd with a mean of 2.21 pd (SD = 1.82 pd. For near vision (0.4 m, the horizontal phorias ranged from 17 pd esophoria to 15 pd exopho-ria with a mean of 3.84 pd exophoria (SD = ± 4.80 pd. The near esophorias ranged from 0.5 to 17 pd with a mean 4.88 pd (SD = ± 3.41, while the exophorias ranged from 1.0 to 15 pd with a mean of 6.30 pd (SD = ± 2.58. Vertical heterophoria for distance vision ranged from 5 to 3 pd right hyperphoria with a mean of 0.05 pd right hyperphoria (SD = ± 0.76 whereas at near it ranged from 4 to 6 pd right hyperphoria with a mean of 0.08 pd right hypophoria (SD =  ±  0.96.  The  distributions  of  heterophoria at distance and near were non-normal.  There was  no  significant  gender  variation  in  the horizontal  values  for  distance  vision  and  the vertical  (distance  and  near  ones.  However, there was a statistically significant gender varia-tion  in  the  near  horizontal  values  (p

  1. Hematologic reference values for clinically healthy captive golden conures (Guaruba guarouba).

    Science.gov (United States)

    Prioste, Fabíola Eloisa Setim; Zwarg, Ticiana; Teixeira, Rodrigo Hidalgo; Vanstreels, Ralph Eric Thijl; Rocha, Arnaldo; Matushima, Eliana Reiko

    2012-12-01

    Golden conures or ararajubas (Guaruba guarouba) are endangered parrots endemic to the Brazilian Amazon forest. Body mass, blood cell counts, and total plasma protein were determined for 70 clinically healthy golden conures captive at zoologic parks and private breeder facilities in Brazil. Hematologic results (mean +/- SD) were: Erythrocytes 3.6 +/- 0.5 x 10(6) cells/mm3, hemoglobin 12.8 +/- 1.4 g/dl, packed cell volume 46 +/- 3.8%, mean corpuscular volume 132 +/- 20 fl, mean corpuscular hemoglobin (MCH) 36 +/- 5.7 pg, mean corpuscular hemoglobin concentration (MCHC) 28 +/- 3.5%, thrombocytes 26.3 +/- 9.3 x 10(3) cells/mm3, leukocytes 11.9 +/- 4.5 x 10(3) cells/mm3, heterophils 6284 +/- 2715 cells/mm3, lymphocytes 5473 +/- 2408 cells/ mm3, monocytes 113 +/- 162 cells/mm3, eosinophils 10 +/- 42 cells/mm3, basophils 27 +/- 64 cells/mm3. Body mass was 254 +/- 24.9 g and total plasma protein (TPP) was 3.54 +/- 0.58 g/dl. No statistical differences were observed between genders within age groups. Differences between juveniles (J) and adults (A) were identified for TPP (J A), and MCHC (J > A). These results provide reliable reference values for the clinical interpretation of hematologic results for the species. Hematology may be an important tool for population health investigations on free-ranging golden conure populations and will also be essential to survey the health of release candidates in future reintroduction programs.

  2. The value of a core clinical rotation in urology for medical students.

    Science.gov (United States)

    Patel, Premal; Nayak, Jasmir G; McGregor, Thomas B

    2015-01-01

    In 2013, our institution underwent a change to the undergraduate medical curriculum whereby a clinical urology rotation became mandatory. In this paper, we evaluated the perceived utility and value of this change in the core curriculum. Third year medical students, required to complete a mandatory 1-week clinical urology rotation, were asked to complete a survey before and after their rotation. Fourth year medical students, not required to complete this rotation, were also asked to complete a questionnaire. Chi-squared and Fisher's exact test were used for data analysis. In total, 108 third year students rotated through urology during the study period. Of these, 66 (61%) completed the pre-rotation survey and 54 (50%) completed the post-rotation survey. In total, there were 110 fourth year students. Of these, 44 (40%) completed the questionnaire. After completing their mandatory rotations, students felt more comfortable managing and investigating common urological problems, such as hematuria and renal colic. Students felt they had a better understanding of how to insert a Foley catheter and felt comfortable independently inserting a Foley catheter. Importantly, students felt they knew when to consult urology and were also more likely to consider a career in urology. Compared to fourth year students, third year students felt urology was an important component to a family medicine practice and felt they had a better understanding of when to consult urology. The introduction of a mandatory urology rotation for undergraduate medical students leads to a perceived improvement in fundamental urological knowledge and skill set of rotating students. This mandatory rotation provides a valuable experience that validates its inclusion.

  3. Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Matthias; Dietlein, Markus; Weber, Kerstin; Moka, Detlef; Schicha, Harald [Klinik und Poliklinik fuer Nuklearmedizin, Universitaet zu Koeln, Joseph-Stelzmann-Strasse 9, 50924 Koeln (Germany); Fischer, Eva; Michel, Olaf; Stennert, Eberhard [Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenheilkunde, Universitaet zu Koeln, Koeln (Germany)

    2002-12-01

    Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [{sup 111}In-DTPA-D-Phe{sup 1}]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq {sup 111}In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further

  4. How to Identify High-Risk APS Patients: Clinical Utility and Predictive Values of Validated Scores.

    Science.gov (United States)

    Oku, Kenji; Amengual, Olga; Yasuda, Shinsuke; Atsumi, Tatsuya

    2017-08-01

    Antiphospholipid syndrome (APS) is a clinical disorder characterised by thrombosis and/or pregnancy morbidity in the persistence of antiphospholipid (aPL) antibodies that are pathogenic and have pro-coagulant activities. Thrombosis in APS tends to recur and require prophylaxis; however, the stereotypical treatment for APS patients is inadequate and stratification of the thrombotic risks is important as aPL are prevalently observed in various diseases or elderly population. It is previously known that the multiple positive aPL or high titre aPL correlate to thrombotic events. To progress the stratification of thrombotic risks in APS patients and to quantitatively analyse those risks, antiphospholipid score (aPL-S) and the Global Anti-phospholipid Syndrome Score (GAPSS) were defined. These scores were raised from the large patient cohort data and either aPL profile classified in detail (aPL-S) or simplified aPL profile with classical thrombotic risk factors (GAPSS) was put into a scoring system. Both the aPL-S and GAPSS have shown a degree of accuracy in identifying high-risk APS patients, especially those at a high risk of thrombosis. However, there are several areas requiring improvement, or at least that clinicians should be aware of, before these instruments are applied in clinical practice. One such issue is standardisation of the aPL tests, including general testing of phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT). Additionally, clinicians may need to be aware of the patient's medical history, particularly with respect to the incidence of SLE, which influences the cutoff value for identifying high-risk patients.

  5. Natural background levels and threshold values of chemical species in three large-scale groundwater bodies in Northern Italy

    International Nuclear Information System (INIS)

    Molinari, Antonio; Guadagnini, Laura; Marcaccio, Marco; Guadagnini, Alberto

    2012-01-01

    We analyze natural background levels (NBLs) and threshold values (TVs) of spatially distributed chemical species (NH 4 , B and As) which may be a potential pressure and concern in three large scale alluvial and fluvio-deltaic aquifers at different depths of the Apennines and Po river plains in Emilia–Romagna, Northern Italy. Our results are based on statistical methodologies designed to separate the natural and anthropogenic contributions in monitored concentrations by modeling the empirical distribution of the detected concentration with a mixture of probability density functions. Available chemical observations are taken over a 20 years period and are associated with different depths and cover planar investigation scales of the order of hundreds of kilometers. High concentration values detected for NH 4 and B appear to be related to high natural background levels. Due to interaction with the host rock in different geochemical environments we observed that concentration vary in time and space (including in depth) consistently with the hydrogeochemical features and the occurrence of natural attenuation mechanisms in the analyzed reservoirs. Conversely, estimated As NBLs are not consistent with the conceptual model of the hydrogeochemical behavior of the systems analyzed and experimental evidences of As content in aquifer cores. This is due to the inability of these techniques to incorporate the complex dynamics of the processes associated with the specific hydrogeochemical setting. Statistical analyses performed upon aggregating the concentration data according to different time observation windows allow identifying temporal dynamics of NBLs and TVs of target compounds within the observation time frame. Our results highlight the benefit of a dynamic monitoring process and analysis of well demarcated groundwater bodies to update the associated NBLs as a function of the temporal dependence of natural processes occurring in the subsurface. Monitoring protocols could

  6. Natural background levels and threshold values of chemical species in three large-scale groundwater bodies in Northern Italy

    Energy Technology Data Exchange (ETDEWEB)

    Molinari, Antonio, E-mail: ant.molinari2002@libero.it [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy); Guadagnini, Laura [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy); Marcaccio, Marco [ARPA Emilia-Romagna, Direzione Tecnica, Largo Caduti del Lavoro, 6-40122 Bologna (Italy); Guadagnini, Alberto [Politecnico di Milano, Dipartimento di Ingegneria Idraulica, Ambientale, Infrastrutture Viarie e Rilevamento, Piazza L. Da Vinci, 32-20133 Milano (Italy)

    2012-05-15

    We analyze natural background levels (NBLs) and threshold values (TVs) of spatially distributed chemical species (NH{sub 4}, B and As) which may be a potential pressure and concern in three large scale alluvial and fluvio-deltaic aquifers at different depths of the Apennines and Po river plains in Emilia-Romagna, Northern Italy. Our results are based on statistical methodologies designed to separate the natural and anthropogenic contributions in monitored concentrations by modeling the empirical distribution of the detected concentration with a mixture of probability density functions. Available chemical observations are taken over a 20 years period and are associated with different depths and cover planar investigation scales of the order of hundreds of kilometers. High concentration values detected for NH{sub 4} and B appear to be related to high natural background levels. Due to interaction with the host rock in different geochemical environments we observed that concentration vary in time and space (including in depth) consistently with the hydrogeochemical features and the occurrence of natural attenuation mechanisms in the analyzed reservoirs. Conversely, estimated As NBLs are not consistent with the conceptual model of the hydrogeochemical behavior of the systems analyzed and experimental evidences of As content in aquifer cores. This is due to the inability of these techniques to incorporate the complex dynamics of the processes associated with the specific hydrogeochemical setting. Statistical analyses performed upon aggregating the concentration data according to different time observation windows allow identifying temporal dynamics of NBLs and TVs of target compounds within the observation time frame. Our results highlight the benefit of a dynamic monitoring process and analysis of well demarcated groundwater bodies to update the associated NBLs as a function of the temporal dependence of natural processes occurring in the subsurface. Monitoring

  7. Paediatric renal length measurements from ultrasound and DMSA scans: does clinical practice reflect theoretical normal values?

    International Nuclear Information System (INIS)

    Que, L.; Rutland, M.D.; Hassan, I.M.

    1999-01-01

    Full text: Renal length measurement is a routine part of ultrasound examination in children and those results are plotted on a normogram style graph, so that each child's results are compared to a normal range (mean ± 2 S.D.). Renal length measurements from the posterior oblique views of dimercaptosuccinic acid (DMSA) scans in our department have not always correlated well with the ultrasound measurements on the same patients. Renal lengths from the DMSA scans of 120 patients with apparently normal kidneys were recorded and used to generate a normogram of renal length at different ages (0.5-7 years). This DMSA normogram was compared to the ultrasound (US) normogram used in the Paediatric Radiology Department, and it showed slight differences in renal lengths (3-8 mm), but that the US normogram had smaller coefficients of variation (US = 6.6%, NM 8.3%), implying a 'tighter' normal range. 39 of these patients had DMSA and ultrasound measurements of renal length within 3 months, and these were studied first by calculating the mean and CV values for different age groups, and then by plotting individual renal lengths on the appropriate normograms. The measured data produced much greater variability in the ultrasound measurements than the DTPA measurements, and the individual points produced 4/78 (5.1%) abnormal results for DMSA, but 21/78 (26.9%) abnormal results for ultrasound. Thus, in routine clinical use, using patients with apparently normal kidneys, ultrasound was unable to match the 'normal range' set by their current normogram, but the nuclear medicine showed 5.1% of values outside the normal (DMSA) range, which was completely appropriate for a range of ± 2 standard deviations

  8. Image-Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow.

    Science.gov (United States)

    Patel, Bhavik N; Lopez, Jose M; Jiang, Brian G; Roth, Christopher J; Nelson, Rendon C

    2017-01-01

    To determine the value of image-rich radiology reports (IRRR) by evaluating the interest and preferences of referring physicians, potential impact on clinical workflow, and the willingness of radiologists to create them. Referring physicians and radiologists were interviewed in this prospective, HIPAA-compliant study. Subject willingness to participate in the study was determined by an e-mail. A single investigator conducted all interviews using a standard questionnaire. All subjects reviewed a video mockup demonstration of IRRR and three methods for viewing embedded images, as follows: (1) clickable hyperlinks to access a scrollable stack of images, (2) scrollable and enlargeable small-image thumbnails, and (3) scrollable but not enlargeable medium-sized images. Questionnaire responses, free comments, and general impressions were captured and analyzed. Seventy-two physicians (36 clinicians, 36 radiologists) were interviewed. Thirty-one clinicians (86%) expressed interest in using IRRR. Seventy-seven percent of subjects believed IRRR would improve communication. Ten clinicians (28%) preferred method 1, 18 (50%) preferred method 2, and 8 (22%) preferred method 3 for embedding images. Thirty clinicians (83%) stated that IRRR would improve efficiency. Twenty-two radiologists (61%) preferred selecting a tool button with a mouse and right-clicking images to embed them, 13 (36%) preferred pressing a function key, and 11 (31%) preferred dictating series and image numbers. The average time radiologists were willing to expend for embedding images was 66.7 seconds. Referring physicians and radiologist both believe IRRR would add value by improving communication with the potential to improve the workflow efficiency of referring physicians. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  9. Increasing fetal ovine number per gestation alters fetal plasma clinical chemistry values.

    Science.gov (United States)

    Zywicki, Micaela; Blohowiak, Sharon E; Magness, Ronald R; Segar, Jeffrey L; Kling, Pamela J

    2016-08-01

    Intrauterine growth restriction (IUGR) is interconnected with developmental programming of lifelong pathophysiology. IUGR is seen in human multifetal pregnancies, with stepwise rises in fetal numbers interfering with placental nutrient delivery. It remains unknown whether fetal blood analyses would reflect fetal nutrition, liver, and excretory function in the last trimester of human or ovine IUGR In an ovine model, we hypothesized that fetal plasma biochemical values would reflect progressive placental, fetal liver, and fetal kidney dysfunction as the number of fetuses per gestation rose. To determine fetal plasma biochemical values in singleton, twin, triplet, and quadruplet/quintuplet ovine gestation, we investigated morphometric measures and comprehensive metabolic panels with nutritional measures, liver enzymes, and placental and fetal kidney excretory measures at gestational day (GD) 130 (90% gestation). As anticipated, placental dysfunction was supported by a stepwise fall in fetal weight, fetal plasma glucose, and triglyceride levels as fetal number per ewe rose. Fetal glucose and triglycerides were directly related to fetal weight. Plasma creatinine, reflecting fetal renal excretory function, and plasma cholesterol, reflecting placental excretory function, were inversely correlated with fetal weight. Progressive biochemical disturbances and growth restriction accompanied the rise in fetal number. Understanding the compensatory and adaptive responses of growth-restricted fetuses at the biochemical level may help explain how metabolic pathways in growth restriction can be predetermined at birth. This physiological understanding is important for clinical care and generating interventional strategies to prevent altered developmental programming in multifetal gestation. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  10. The Clinical Value of Deflation Cough in Chronic Coughers With Reflux Symptoms.

    Science.gov (United States)

    Lavorini, Federico; Chellini, Elisa; Bigazzi, Francesca; Surrenti, Elisabetta; Fontana, Giovanni A

    2016-06-01

    Patients with deflation cough (DC), the cough-like expulsive effort(s) evoked by maximal lung emptying during a slow vital capacity maneuver, also present symptoms of gastroesophageal reflux. DC can be inhibited by prior intake of antacids. We wished to assess DC prevalence and association between DC and chemical characteristics of refluxate in patients with gastroesophageal reflux symptoms. A total of 157 consecutive outpatients underwent DC assessment and 24-h multichannel intraluminal impedance pH (MII-pH) monitoring; 93/157 also had chronic cough. Patients performed two to four slow vital capacity maneuvers and DC was detected aurally. Subsequently, they underwent 24-h MII-pH monitoring, the outcomes of which were defined as abnormal when acid or non-acid reflux events were > 73. DC occurred in 46/157 patients, 18 of whom had abnormal MII-pH outcomes; 28 of the remaining 111 patients without DC also had abnormal MII-pH findings. Thus, in the patients as a group, there was no association between DC and MII-pH outcomes. DC occurred in 40/93 of the chronic coughers; 15 of whom had acid reflux. All but 2 of the 53 patients without DC had normal MII-pH outcomes (P < .001), and the negative predictive value of DC for excluding acid reflux was 96.2%. At follow-up, 65% of coughers showed significant improvement after treatment. The overall prevalence of DC was 29%, increasing to 43% in chronic coughers in whom the absence of DC virtually excludes acid reflux. Therefore, DC assessment may represent a useful screening test for excluding acid reflux in chronic coughers with reflux symptoms. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  11. Chemical composition and nutritional value of the freezing consolidated burgers (Kilka–Silver carp during cold storage

    Directory of Open Access Journals (Sweden)

    S Fathi

    2014-05-01

    Full Text Available Consolidated fish burger is a new product which is a combination of common Kilka (Clupeonellacultriventriscaspia and Silver carp (Hypophthalmichthys molitrix minced with flavors, fillers, vegetables and tofu dressing. Consolidated fish burger is produced in order to boost the nutritional value and to reduce the cost of end product. This study aimed to investigate the variations in the composition of consolidated burger during 4 months of storage at -18 °C. For this purpose, 4 types of burgers with a combination of a various percentages of Kilka and Silver carp were produced. The chemical composition by means of total protein, fat, moisture and ash contents were evaluated during preparation (zero phase and 4 months of storage. Results showed that at zero-phase protein% and moisture% in raw Silver carp was higher, whereas fat% and ash% in Kilka was found higher. Protein content in all groups was decreased during 4 months of storage. The decreasing rate was more rapid in control group as well as treatment 3. Fat percentage was dropped during the storage period and the decreasing trend in treatment 2 was found higher. In the case of moisture, the percentage was declined in all groups and in treatment 1, in particular. Considering the results, it was concluded that freezing could significantly decrease the nutritional value of the consolidated Burgers.

  12. Chemical composition and nutritive value of the feed used in dairy cow feeding in the Republic of Moldova

    Directory of Open Access Journals (Sweden)

    Larisa CAISIN

    2016-12-01

    Full Text Available Information on nutritive value of locally available feed ingredients is scarce, therefore the study conducted in the laboratory of the Department “General Animal Husbandry” of the State Agrarian University of Moldova, was aimed at determining the chemical composition and nutrient content of various feeds and fodder species commonly used in the diets of dairy cow sraised in the University farm. Fodder samples, proceeding from different agricultural and ecological zones of the Republic of Moldova, were analyzed for their content of total moisture, dry matter, crude protein, fat, fiber, ash and NFE quantity and the data were compared with those available in the specialized literature. The comparative analysis showed differences in the content of a number of nutrients and large fluctuations were observed in terms of the level of oat nutrition units, energetic nutrition units and metabolizable energy contentin comparison with the data contained in normative references and used in the calculation of the nutritional value of feed and diets.

  13. Experimental determination of the bulk temperature values in a nonisothermal flow of the chemically reacting nitrogen tetroxide

    International Nuclear Information System (INIS)

    Devojno, A.N.; Kolykhan, L.I.; Stepanenko, V.N.; Tverkovkin, B.E.; Uyutov, G.I.

    1975-01-01

    The technique and results of an experimental determination of mean mass temperatures of a cooled chemically active nitrogen tetroxide flowing in a circular tube under turbulent flow conditions are considered. The parameters range as follows: pressure-from 8.10 5 to 16.10 5 H/m 2 , flow temperature-from 140 deg to 550 deg C, Reynolds number-from 3,1.1g 5 , flow velocity-from 3.5 to 45 m/s. The gas temperature along the length of the test tube is measured with movable probe with a mixer and thermocouple in a stainless steel capillary 2mm in dia and the wall 0,2 mm thick. The mean-square deviations of measured temperature values from the predicted ones are about -0.9 and +1.8%. The obtained data show the predicted temperature values to be somewhat lower than the measured ones, the difference increasing with the distance to the test tube outlet. It may be explained by both unaccounted systematic experimental errors and errors in calculating the mean mass flow temperatures. The investigation described confirms the possibility of an experimental determination of the mean gas temperature along the cooled channel length by mean mass of a movable mixer with a single thermocouple

  14. Meta-Analysis of the Clinical Value of Danshen Injection and Huangqi Injection in Liver Cirrhosis

    Directory of Open Access Journals (Sweden)

    Changtai Zhu

    2013-01-01

    Full Text Available Objective. To evaluate the clinical value of Danshen injection and Huangqi injection for the treatment of liver cirrhosis. Methods. The Chinese Biomedical Literature Database (CBM, Chinese Scientific Journals Full-Text Database (VIP, Wanfang Database, China National Knowledge Infrastructure (CNKI, PubMed, and EMBASE database were searched to collect the literatures about the randomized controlled trials involving the treatment of liver cirrhosis with Danshen injection combined with Huangqi injection, and the data analyses were performed using RevMan 4.2 software. Results. A total of 11 studies involving 1086 patients (trials group: 554 cases, control group: 532 cases were included in this study. Compared with those in control group, the meta-analysis showed-that the total effectiveness rate and the level of serum albumin increased, while serum total bilirubin, alanine transmninase, type III procollagen, hyaluronic acid, laminin, and type-IV collagen decreased in trials group. The Jadad score ranged from 1 to 2 and the funnel plot analysis suggests that publication bias may occur. Conclusions. Danshen injection combined with Huangqi injection may promote the curative efficacy of liver cirrhosis, which is a promising novel treatment approach. The exact outcome needs to perform rigorously designed, multicenter, and large randomized controlled trials.

  15. The Clinical and Nonclinical Values of Nonexercise Estimation of Cardiovascular Endurance in Young Asymptomatic Individuals

    Directory of Open Access Journals (Sweden)

    Mahmoud A. Alomari

    2012-01-01

    Full Text Available Exercise testing is associated with barriers prevent using cardiovascular (CV endurance (CVE measure frequently. A recent nonexercise model (NM is alleged to estimate CVE without exercise. This study examined CVE relationships, using the NM model, with measures of obesity, physical fitness (PF, blood glucose and lipid, and circulation in 188 asymptomatic young (18–40 years adults. Estimated CVE correlated favorably with measures of PF (r=0.4-0.5 including handgrip strength, distance in 6 munities walking test, and shoulder press, and leg extension strengths, obesity (r=0.2-0.7 including % body fat, body water content, fat mass, muscle mass, BMI, waist and hip circumferences and waist/hip ratio, and circulation (r=0.2-0.3 including blood pressures, blood flow, vascular resistance, and blood (r=0.2-0.5 profile including glucose, total cholesterol, LDL-C, HDL-C, and triglycerides. Additionally, differences (P<0.05 in examined measures were found between the high, average, and low estimated CVE groups. Obviously the majority of these measures are CV disease risk factors and metabolic syndrome components. These results enhance the NM scientific value, and thus, can be further used in clinical and nonclinical settings.

  16. Clinical value of plasma endothelin levels in children with cardiovascular diseases

    International Nuclear Information System (INIS)

    Chen Nianfa; Duan Yongqiang

    2009-01-01

    To explore the clinical value of plasma endothelin (ET-1) levels in children with cardiovascular diseases, 77 children with heart failure, obesity, hyperlipemia, fatty liver and hypertension were divided into 5 experimental groups and 21 health children with same age and gender as control group. The plasma levels of ET-1 in these children were tested by RIA. The results showed that plasma levels of ET-1 in 5 experimental groups were 112.8 ± 34.1ng/L, 57.8 ± 19.1ng/L,64.5 ± 25.3ng/L, 74.9 ± 28.4ng/L and 60.7 ± 21.6ng/L, respectively. The ET-1 levels in 5 groups were significantly higher than that in control group (P<0.01). The results indicate the higher plasma ET-1 levels in children are related with cardiovascular diseases, and it is useful in the diagnosis of children cardiovascular diseases. (authors)

  17. Clinical value of detecting the serum level of TRAb of GD progeny in gestational period

    International Nuclear Information System (INIS)

    Zou Jinhai; Li Xue; Zhang Qingfeng; Wang Yansheng; Wang Jianchun

    2011-01-01

    Objective: To investigate the relationship between thyroid function and serum TRAb level of neonates borned by puerperal who have Graves disease. Methods: To detect the serum levels of FT 3 , FT 4 , sTSH (with RIA) and TRAb (with ECLIA) in 126 neonates borned by puerperal who had Graves disease and 40 neonates borned by healthy puerperal. Results: The incidence of thyroid dysfunction was 25.4% (32/126) in 126 neonates borned by puerperal who had Graves' disease. Among them, the increase of serum TRAb occupied 1.59%(2/126), the incidence of hypothyroidism made up 23.81% (30/126), the ratio of neonates who had normal serum TRAb was 98.41% (124/126), the ratio of neonates who had normal thyroid function Ab was 74.60% (94/126). The serum levels of FT 3 , FT 4 , sTSH and TRAb in 40 neonates borned by healthy puerperal were normal. Conclusion: It has important clinical value by detecting the serum TRAb level of neonates borned by puerperal who have Graves' disease to diagnose diseases of thyroid gland in neonates, especially only one Graves' disease. (authors)

  18. THE EXPRESSION AND CLINICAL VALUE OF APOPTOSIS CONTROL GENE Bcl-2 AND Bax IN BREAST CANCER

    Institute of Scientific and Technical Information of China (English)

    ZHENG Jun; YAO Zhen-xiang; ZHANG Jing

    1999-01-01

    Objective: To study the expression and clinical value of apoptosis control gene bcl-2 and bax in breast cancer.Methods: Protein bax and bcl-2 in 41 breast cancers obtained from operations in our hospital in 1996 were detected using ABC immunohistochemical stain assay and compared with 10 cases with normal breast tissues.Results: The positive rate of bax in normal breast tissue was 90% and in breast cancer was 59%, with a significant statistical difference between them (P<0.05), but there was no statistical difference in bcl-2 protein expression. Among the 41 breast cancer, the group with lymph node metastasis (21 cases) had obviously low bax expression (43%) and high bcl-2 expression (76%), showing significant difference to the group without lymph node metastasis (P<0.05).Conclusion: The antiapoptosis function of bcl-2 was stronger than bax in breast cancer. Protein bax and bcl-2 assay may be useful in understanding the biological behaviors of breast cancer.

  19. The clinical value of detecting INS and C - P in essential hypertension

    International Nuclear Information System (INIS)

    Huang Jianmin; Sun Shuqiang; Liu Xiaomei

    2001-01-01

    In order to explore the clinical value of insulin (INS) and C - peptide (C-P) in essential hypertension patients (EH), concentrations of blood glucose, serum INS and serum C - P both during fasting and 2 - hour postprandial time were measured in 32 non-diabetic patients with EH and 40 healthy persons, and the ISI of each group was calculated and compared. The results showed that with the exception of fasting blood glucose level being of no difference between two groups, all the other parameters observed, including concentrations of 2 hour postprandial glucose, both fasting and 2 hour postprandial INS and C - P were significantly higher than those of healthy control group (P < 0.01). The proportions of patients with insulin resistance and hyperinsulinemia in EH group were both significantly higher than those of control group (P < 0.01). These results suggest that EH patients may coexist with some metabolic disorders at the same time, thus INS and C - P detection may have other wider applications in non-diabetic diseases

  20. Clinical value of serum TRAb levels determination in diagnosis of Graves's disease

    International Nuclear Information System (INIS)

    Huang Zhaosui; Huang Chunhong; Liu Kaiyuan; Huang Shengli

    2005-01-01

    Objective: To investigate the clinical diagnostic value of serum TRAb levels determination in patients with Graves' disease. Methods: Serum TRAb (with RRA), FT 3 , FT 4 , TSH (with CLIA) levels were measured in 223 patients with Graves' disease both before and 6, 12, 36 months after treatment with antithyroid drugs (ATD) as well as in 50 controls. Results: Positive rate of serum TRAb was 93.3% in patients with Graves' disease before treatment. Six months after ATD therapy the positive rate dropped to 41.3%, being still significantly higher than that in controls (P<0.05). The TRAb positive rate dropped steadily with 12 (18.3% ), 24 (8.9% ) and 36 months (4.9%) of ATD treatment. In the 21 patients who had hyperthyroidism recurred after the course of treatment, TRAb remained positive in 18 of them (80.7%). Conclusion: Persistent positive TRAb despite euthyroid status in patients with Graves' disease after seemingly successful ATD treatment donates persistent immunodysfunction and possible recurrence. It is mandatory to continue ATD treatment until TRAb negative. (authors)

  1. The clinical value of adenosine triphosphate stress myocardial perfusion tomography for detecting coronary artery disease

    International Nuclear Information System (INIS)

    Yao Zhiming; He Qing; Qu Wanying; Yu Xue; Han Lijun; Yu Zhiguo; Li Wei; Zeng Xuezhai; Zhu Ming; Zhao Hongshan

    2002-01-01

    Objective: To study the clinical value of adenosine triphosphate stress myocardial perfusion tomography imaging (ATP-MPI) in detection of coronary artery disease (CAD). Methods: There were 278 patients underwent ATP-MPI, 51 patients of them also underwent coronary angiography (CAG). Seventy-three patients underwent stress-rest myocardial perfusion tomography imaging with multi-stage submaximal exercise test (ST-MPI) and CAG serving as control group. Results: 1) Side effects: there were 11 different symptoms and atrioventricular conduction block (10 patients), sinoatrial conduction block (2 patients) occurred during ATP stress. Allopathy or interruption of ATP stress did not happen. 2) The sensitivity and specificity of ATP-MPI in detection of CAD were 97.1% and 82.4%, respectively, and those in detection of ≥50% narrowing coronary artery were 91.0% and 94.7%, respectively. 3) In patients without myocardial infarction, the sensitivity and specificity of ATP-MPI in detection of myocardial ischemia were comparable to those of ST-MPI. Conclusion: ATP-MPI is an accurate, safe modality and is comparable to ST-MPI in the detection of CAD

  2. The clinical value of immunosuppression in Graves' ophthalmopathy after radioiodine therapy for hyperthyroidism

    International Nuclear Information System (INIS)

    Chen Yue; Qiu Ling; Zhang Chunying; Long Shuiqing; Gan Xilun

    2001-01-01

    Objective: The chief clinical characteristics of Graves disease are hyperthyroidism and ophthalmopathy. To assess the values of using immunosuppression in Graves ophthalmopathy. Method: 415 patients with Graves hyperthyroidism were studied. They were randomly assigned to receive radioiodine, methimazole from 1.5 to 2 years, radioiodine followed by a 3-month course of prednisone. The changes in thyroid function and progression of ophthalmopathy were evaluated. Results: Among the 138 patients treated with radioiodine, 19 patients had new or worsening ophthalmopathy; 117 had no changes in their eyes; 2 patients had improvement in their eye disease. Among the 138 patients treated with methimazole, 3 patients had new or worsening ophthalmopathy; 133 had no changes in their eyes; 2 patients had improvement in their eye disease. Among the 139 patients treated with radioiodine and prednisone, no patient had new or worsening ophthalmopathy; 107 had no changes in their eyes; 32 patients had improvement in their eye disease. The frequency of improvement of ophthalmopathy was significantly higher in the radioiodine-prednisone group than in either the radioiodine group or the methimazole group (P<0.001 for both comparisons). Conclusions: The administration of prednisone after radioiodine therapy was associated with improvement of ophthalmopathy. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone

  3. The clinical value of serum thyrotrophin receptor antibody level in patients with Graves ophthalmopathy

    International Nuclear Information System (INIS)

    Wang Chaodian; Shi Yuhong; Yan Bing

    2013-01-01

    Objective: To explore the value of serum thyrotrophin receptor antibody (TRAb) on the pathological mechanism of Graves ophthalmopathy. Methods: Two hundred and nineteen newly diagnosed Graves disease patients who were divided into Graves ophthalmopathy group (n=121) and without Graves ophthalmopathy group (n=98) were tested serum concentration with thyroid function, thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TRAb. According to the consensus statement of the European Group on Graves ophthalmopathy, clinical activity score (CAS) and severity evaluation were carried out on Graves ophthalmopathy patients. Results: There was no significant difference in serum concentration of free thyroxine (FT 4 ), free triiodothyronine (FT 3 ), TPOAb and TRAb between the Graves ophthalmopathy group and the without Graves ophthalmopathy group. Serum concentration of TRAb was not correlated with the severity and CAS of Graves ophthalmopathy. Conclusions: The CAS and the severity of Graves ophthalmopathy were irrelevant to the serum concentration of TRAb. Therefore, the correlation between TRAb and Graves ophthalmopathy still needs further study. (authors)

  4. Clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B patients

    Directory of Open Access Journals (Sweden)

    WANG Peng

    2017-07-01

    Full Text Available :ObjectiveTo investigate the clinical value of hemoglobin and its association with hepatocyte steatosis in chronic hepatitis B (CHB patients. MethodsA retrospective analysis was performed for the clinical and pathological data of 1580 CHB patients who were hospitalized in The First People′s Hospital of Shunde from January 2006 to December 2014 and underwent liver biopsy, among whom 216 (13.67% had hepatocyte steatosis (hepatocyte steatosis group and 1364 had no hepatocyte steatosis (non-hepatocyte steatosis group. The patients were divided into groups 1, 2, and 3 according to hemoglobin level, and the clinical and pathological features were analyzed and compared between the three groups. The t-test was used for comparison of continuous data between group; a one-way analysis of variance was used for comparision between multiple groups. The Mann-Whitney U test was used for ranked data between groups. The Kruskal-wallis H test was used for ranked data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Spearman correlation analysis was also performed to determine the correlation between two variables. Univariate logistic regression analysis and multivariate stepwise regression analysis were used to identify the influencing factors for hepatocyte steatosis. ResultsBody mass index (BMI, systolic pressure, diastolic pressure, uric acid, total cholesterol, low-density lipoprotein, and HBV DNA load increased with the increase in hemoglobin level (F=12718,3024,4026,4624,38276,28108,7358, all P<0.05. The incidence rates of hepatocyte steatosis in groups 1, 2, and 3 were 7.59%, 1176%,and 21.67%, respectively (χ2=44.23, P<0.05. Hemoglobin was positively correlated with hepatic steatosis (rs=0.211, P<0001. The multivariate logistic regression analysis showed that hemoglobin (odds ratio [OR]=1.066, P<0.05, BMI (OR=1576, P<005, age (OR=1.041, P<0.05, sex

  5. Clinical value of 18F-FDG coincidence imaging for diagnosis of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Ning Yanli; Lou Cen; Huang Zhongke; Shi Guohua; Chen Dongfang; Mu Da

    2012-01-01

    Objective: To investigate the value of 18 F-FDG coincidence imaging for diagnosis of nasopharyngeal carcinoma. Methods: A total of 45 patients with nasopharyngeal carcinoma (33 males and 12 females, average age (55.56 ± 13.50) years), who underwent 18 F-FDG coincidence imaging before treatment, were studied retrospectively. The images of 18 F-FDG coincidence imaging (GE Millennium VG SPECT) and MRI were analyzed. The radioactivity ratio of the accumulated regions to cerebellum (T/NT)was calculated by ROI technique. The volume of nasopharyngeal carcinoma was recorded by MRI. The positive rates of 18 F-FDG coincidence imaging and EB virus-related antibody measurements were compared by paired χ 2 test. The correlation between T/NT ratios and tumor volumes were tested by Pearson correlation, and then ROC curves were established. The T/NT ratios and tumor volumes of different groups (different first symptoms, clinical stages, T stages, pathological classification and outcomes, with or without lymph node enlargement) were compared by t-test and rank sum test. Results: The positive rate of 18 F-FDG coincidence imaging was 97.78% (44/45), and the positive rate of EB virus-related antibody measurement was 95.56% (43/45, χ 2 =1.33, P>0.05). The T/NT ratio (2.439 ±1.119) and tumor volume ((7.311 ± 8.280) cm 3 ) of primary lesions had a positive correlation (r=0.463, P<0.05). The cut-off values of T/NT ratio and the tumor volume were 2.396 and 7.348 cm 3 , respectively, by ROC curves. T/NT ratios in groups with or without first symptom of epistaxis (2.847 ± 1.254 vs 2.082 ± 0.863, t=-2.409) and groups with or without facial numbness (2.855 ± 1.261 vs 2.134 ± 0.913, t=-2.225) were both significantly different (both P<0.05). T/NT ratios of differentiated and undifferentiated cancer were 2.266 ± 0.997 and 2.971 ± 1.351, respectively (t=-2.018, P<0.05). There was a significant difference of tumor volumes between groups with or without facial numbness (t=-2.684, P<0

  6. Value-based HR practices, i-deals and clinical error control with CSR as a moderator.

    Science.gov (United States)

    Luu, Tuan; Rowley, Chris; Siengthai, Sununta; Thanh Thao, Vo

    2017-05-08

    Purpose Notwithstanding the rising magnitude of system factors in patient safety improvement, "human factors" such as idiosyncratic deals (i-deals) which also contribute to the adjustment of system deficiencies should not be neglected. The purpose of this paper is to investigate the role of value-based HR practices in catalyzing i-deals, which then influence clinical error control. The research further examines the moderating role of corporate social responsibility (CSR) on the effect of value-based HR practices on i-deals. Design/methodology/approach The data were collected from middle-level clinicians from hospitals in the Vietnam context. Findings The research results confirmed the effect chain from value-based HR practices through i-deals to clinical error control with CSR as a moderator. Originality/value The HRM literature is expanded through enlisting i-deals and clinical error control as the outcomes of HR practices.

  7. An integrated biorefinery concept for conversion of sugar beet pulp into value-added chemicals and pharmaceutical intermediates.

    Science.gov (United States)

    Cárdenas-Fernández, Max; Bawn, Maria; Hamley-Bennett, Charlotte; Bharat, Penumathsa K V; Subrizi, Fabiana; Suhaili, Nurashikin; Ward, David P; Bourdin, Sarah; Dalby, Paul A; Hailes, Helen C; Hewitson, Peter; Ignatova, Svetlana; Kontoravdi, Cleo; Leak, David J; Shah, Nilay; Sheppard, Tom D; Ward, John M; Lye, Gary J

    2017-09-21

    Over 8 million tonnes of sugar beet are grown annually in the UK. Sugar beet pulp (SBP) is the main by-product of sugar beet processing which is currently dried and sold as a low value animal feed. SBP is a rich source of carbohydrates, mainly in the form of cellulose and pectin, including d-glucose (Glu), l-arabinose (Ara) and d-galacturonic acid (GalAc). This work describes the technical feasibility of an integrated biorefinery concept for the fractionation of SBP and conversion of these monosaccharides into value-added products. SBP fractionation is initially carried out by steam explosion under mild conditions to yield soluble pectin and insoluble cellulose fractions. The cellulose is readily hydrolysed by cellulases to release Glu that can then be fermented by a commercial yeast strain to produce bioethanol at a high yield. The pectin fraction can be either fully hydrolysed, using physico-chemical methods, or selectively hydrolysed, using cloned arabinases and galacturonases, to yield Ara-rich and GalAc-rich streams. These monomers can be separated using either Centrifugal Partition Chromatography (CPC) or ultrafiltration into streams suitable for subsequent enzymatic upgrading. Building on our previous experience with transketolase (TK) and transaminase (TAm) enzymes, the conversion of Ara and GalAc into higher value products was explored. In particular the conversion of Ara into l-gluco-heptulose (GluHep), that has potential therapeutic applications in hypoglycaemia and cancer, using a mutant TK is described. Preliminary studies with TAm also suggest GluHep can be selectively aminated to the corresponding chiral aminopolyol. The current work is addressing the upgrading of the remaining SBP monomer, GalAc, and the modelling of the biorefinery concept to enable economic and Life Cycle Analysis (LCA).

  8. Metabolic disruption in context: Clinical avenues for synergistic perturbations in energy homeostasis by endocrine disrupting chemicals.

    Science.gov (United States)

    Sargis, Robert M

    2015-01-01

    The global epidemic of metabolic disease is a clear and present danger to both individual and societal health. Understanding the myriad factors contributing to obesity and diabetes is essential for curbing their decades-long expansion. Emerging data implicate environmental endocrine disrupting chemicals (EDCs) in the pathogenesis of metabolic diseases such as obesity and diabetes. The phenylsulfamide fungicide and anti-fouling agent tolylfluanid (TF) was recently added to the list of EDCs promoting metabolic dysfunction. Dietary exposure to this novel metabolic disruptor promoted weight gain, increased adiposity, and glucose intolerance as well as systemic and cellular insulin resistance. Interestingly, the increase in body weight and adipose mass was not a consequence of increased food consumption; rather, it may have resulted from disruptions in diurnal patterns of energy intake, raising the possibility that EDCs may promote metabolic dysfunction through alterations in circadian rhythms. While these studies provide further evidence that EDCs may promote the development of obesity and diabetes, many questions remain regarding the clinical factors that modulate patient-specific consequences of EDC exposure, including the impact of genetics, diet, lifestyle, underlying disease, pharmacological treatments, and clinical states of fat redistribution. Currently, little is known regarding the impact of these factors on an individual's susceptibility to environmentally-mediated metabolic disruption. Advances in these areas will be critical for translating EDC science into the clinic to enable physicians to stratify an individual's risk of developing EDC-induced metabolic disease and to provide direction for treating exposed patients.

  9. Most oxidative stress response in water samples comes from unknown chemicals: the need for effect-based water quality trigger values.

    Science.gov (United States)

    Escher, Beate I; van Daele, Charlotte; Dutt, Mriga; Tang, Janet Y M; Altenburger, Rolf

    2013-07-02

    The induction of adaptive stress response pathways is an early and sensitive indicator of the presence of chemical and non-chemical stressors in cells. An important stress response is the Nrf-2 mediated oxidative stress response pathway where electrophilic chemicals or chemicals that cause the formation of reactive oxygen species initiate the production of antioxidants and metabolic detoxification enzymes. The AREc32 cell line is sensitive to chemicals inducing oxidative stress and has been previously applied for water quality monitoring of organic micropollutants and disinfection byproducts. Here we propose an algorithm for the derivation of effect-based water quality trigger values for this end point that is based on the combined effects of mixtures of regulated chemicals. Mixture experiments agreed with predictions by the mixture toxicity concept of concentration addition. The responses in the AREc32 and the concentrations of 269 individual chemicals were quantified in nine environmental samples, ranging from treated effluent, recycled water, stormwater to drinking water. The effects of the detected chemicals could explain less than 0.1% of the observed induction of the oxidative stress response in the sample, affirming the need to use effect-based trigger values that account for all chemicals present.

  10. Investigation of the chemical origin and evidential value of differences in the SERS spectra of blue gel inks.

    Science.gov (United States)

    Ho, Yen Cheng; Lee, Wendy W Y; Bell, Steven E J

    2016-08-15

    Highly swellable polymer films doped with Ag nanoparticle aggregates (poly-SERS films) have been used to record very high signal : noise ratio, reproducible surface-enhanced (resonance) Raman (SER(R)S) spectra of in situ dried ink lines and their constituent dyes using both 633 and 785 nm excitation. These allowed the chemical origins of differences in the SERRS spectra of different inks to be determined. Initial investigation of pure samples of the 10 most common blue dyes showed that the dyes which had very similar chemical structures such as Patent Blue V and Patent Blue VF (which differ only by a single OH group) gave SERRS spectra in which the only indications that the dye structure had been changed were small differences in peak positions or relative intensities of the bands. SERRS studies of 13 gel pen inks were consistent with this observation. In some cases inks from different types of pens could be distinguished even though they were dominated by a single dye such as Victoria Blue B (Zebra Surari) or Victoria Blue BO (Pilot Acroball) because their predominant dye did not appear in other inks. Conversely, identical spectra were also recorded from different types of pens (Pilot G7, Zebra Z-grip) because they all had the same dominant Brilliant Blue G dye. Finally, some of the inks contained mixtures of dyes which could be separated by TLC and removed from the plate before being analysed with the same poly-SERS films. For example, the Pentel EnerGel ink pen was found to give TLC spots corresponding to Erioglaucine and Brilliant Blue G. Overall, this study has shown that the spectral differences between different inks which are based on chemically similar, but nonetheless distinct dyes, are extremely small, so very close matches between SERRS spectra are required for confident identification. Poly-SERS substrates can routinely provide the very stringent reproducibility and sensitivity levels required. This, coupled with the awareness of the reasons

  11. [Multiple chemical sensitivity: Clinical evaluation of the severity and psychopathological profile].

    Science.gov (United States)

    Lago Blanco, Eva; Puiguriguer Ferrando, Jordi; Rodríguez Enríquez, Mónica; Agüero Gento, Laura; Salvà Coll, Joan; Pizà Portell, Maria Rosa

    2016-02-05

    Multiple chemical sensitivity (MCS) is a multisystem disorder of controversial etiology, affecting some subjects when exposed to chemicals at no harmful concentrations. The objective of this paper is to describe the epidemiological, clinical and psychological features of a sample of patients with MCS for further specific group treatment. Descriptive study of patients diagnosed with MCS in a toxicology unit. We administered the Quick Environmental Exposure and Sensitivity Inventory, the structured interview SCID-II, the anxiety scale HAS and the type A personality test, PCTA. Seventy-three patients were included. The mean age was 52,6 years (range 33-77; SD 9.29). Sixty-six were females (90.4%). Fifty-three percent were classified as i-ii and ii grade. Sixty-one patients (83%) presented some type of comorbidity, mainly chronic pain, fibromyalgia and chronic fatigue. They exhibited higher levels of anxiety (average score of 19.2), prevalence of phobic-avoidant traits of personality and type A behavior in 31.1%. MCS affects middle-aged women with comorbidities (chronic pain, fibromyalgia and chronic fatigue) and high anxiety and avoidance behaviors. This preliminary analysis should help provide a specific therapeutic approach to these patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. Clinical application of 1H-chemical-shift imaging (CSI) to brain diseases

    International Nuclear Information System (INIS)

    Naruse, Shoji; Furuya, Seiichi; Ide, Mariko

    1992-01-01

    An H-1 chemical shift imaging (CSI) was developed as part of the clinical MRI system, by which magnetic resonance spectra (MRS) can be obtained from multiple small voxels and metabolite distribution in the brain can be visualized. The present study was to determine the feasibility and clinical potential of using an H-1 CSI. The device used was a Magnetom H 15 apparatus. The study population was comprised of 25 healthy subjects, 20 patients with brain tumor, 4 with ischemic disease, and 6 with miscellaneous degenerative disease. The H-1 CSI was obtained by the 3-dimensional Fourier transformation. After suppressing the lipid signal by the inversion-recovery method and the water signal by the chemical-shift selective pulse with a following dephasing gradient, 2-directional 16 x 16 phase encodings were applied to the 16 x 16∼18 x 18 cm field of view, in which a 8 x 8 x 2∼10 x 10 x 2 cm area was selected by the stimulated echo or spin-echo method. The metabolite mapping and its contour mapping were created by using the curve-fitted area, with interpolation to the 256 x 256 matrix. In the healthy group, high resolution spectra for N-acetyl aspartate (NAA), creatine, choline (Cho), and glutamine/glutamate were obtained from each voxel; and metabolite mapping and contour mapping also clearly showed metabolite distribution in the brain. In the group of brain tumor, an increased Cho and lactate and loss of NAA were observed, along with heterogeneity within the tumor and changes in the surrounding tissue; and there was a good correlation between lactate peak and tumor malignancy. The group of ischemic and degenerative disease had a decreased NAA and increased lactate on both spectra and metabolite mapping, depending on disease stage. These findings indicated that H-1 CSI is helpful for detecting spectra over the whole brain, as well as for determining metabolite distribution. (N.K.)

  13. Evaluation of the nutritional value of locally produced forage in Korea using chemical analysis and in vitro ruminal fermentation.

    Science.gov (United States)

    Ki, Kwang Seok; Park, Su Bum; Lim, Dong Hyun; Seo, Seongwon

    2017-03-01

    The use of locally produced forage (LPF) in cattle production has economic and environmental advantages over imported forage. The objective of this study was to characterize the nutritional value of LPF commonly used in Korea. Differences in ruminal fermentation characteristics were also examined for the LPF species commonly produced from two major production regions: Chungcheong and Jeolla. Ten LPF (five from each of the two regions) and six of the most widely used imported forages originating from North America were obtained at least three times throughout a year. Each forage species was pooled and analyzed for nutrient content using detailed chemical analysis. Ruminal fermentation characteristics were also determined by in vitro anaerobic incubations using strained rumen fluid for 0, 3, 6, 12, 24, and 48 h. At each incubation time, total gas, pH, ammonia, volatile fatty acid (VFA) concentrations, and neutral detergent fiber digestibility were measured. By fitting an exponential model, gas production kinetics were obtained. Significant differences were found in the non-fiber carbohydrate (NFC) content among the forage species and the regions (pruminal fermentation of LPF between the two regions and interactions between regions and forage species were also significant (pruminal fermentation was lower in the forages from Chungcheong than from Jeolla (p<0.01), and total VFA concentration was higher in Chungcheong than in Jeolla (p = 0.05). This implies that fermentation was more active with the forages from Chungcheong than from Jeolla. Analysis of gas production profiles showed the rate of fermentation differed among forage species (p<0.05). The results of the present study showed that the nutritional values of some LPF (i.e., corn silage and Italian ryegrass) are comparable to those of imported forages widely used in Korea. This study also indicated that the nutritional value of LPF differs by origin, as well as by forage species. Detailed analyses of nutrient

  14. The clinical value of MR elastography in the diagnosis of prostate cancer

    International Nuclear Information System (INIS)

    Chen Min; Li Saying; Wang Wenchao; Zhao Weifeng; Yang Zhenghan; Liu Ming; Zhou Cheng

    2010-01-01

    Objective: To investigate the clinical value of MR elastography in the diagnosis of prostate cancer at 3.0 T, and to assess the elasticity and viscosity of prostate cancer and benign prostatic diseases. Methods: Eight patients (63±7 years old) with 12 foci of prostate cancer and 10 patients (59±3 years old) with 14 foci of prostatitis in the peripheral zone were evaluated by MR elastography. MR elastography was performed by transmitting low-frequency longitudinal mechanical waves of 100 Hz into prostate with a transducer placed above the pubic bones. The phase images were reconstructed to acquire viscoelastic mapping. t test was used to compare the mean elasticity and viscosity of prostate cancer and prostatitis. The correlation of elasticity and Gleason scores between prostate cancer and prostatitis were also retrospectively analyzed with Pearson Correlation. Results: The mean elasticity and viscosity were significantly higher in prostate cancer [(6.55±0.47) kPa, (6.56±0.99) Pa·s, respectively] than in prostatitis [(1.99±0.66) kPa, (2.13±0.21) Pa·s, respectively], and the difference was statistically significant (t=19.392, 16.372; P<0.01). In 8 patients with prostate cancer, the Gleason scores were 5 (2 cases), 6 (3 cases), 7 (2 cases) and 8 (1 case), respectively. The mean elasticity for the cases with different Gleason scores was 5.83, 6.02, 7.45 and 8.05 kPa, respectively. There was a positive correlation between Gleason scores and elasticity of the prostate cancer(r=0.913, P<0.01) in this study. Conclusion: MR elastography can be used to visualize the difference in stiffness between prostate cancer and benign prostatic disease, it is a new imaging method with great potential in grading of prostate cancer. (authors)

  15. Value of integrated PET/CT in clinical staging of patients with lung cancer

    International Nuclear Information System (INIS)

    Zhao Jun; Guan Yihui; Zuo Chuantao; Hua Fengchun; Lin Xiangtong

    2004-01-01

    Objectives: The purpose of this study was to evaluate the value of combined fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) in patients with lung cancer, and to compare the results of PET/CT with those of FDG PET and CT alone. Methods: Forty-two patients were studied in this group. 3D whole body images were acquired using Siemens Biograph Sensetionl6 PET/CT scanner. Attenuation corrected PET images, CT and fusion images were interpreted. Reports were compared for each patient including identified the number of lesions, their anatomical localization and certainty of diagnosis. Results: PET/CT increased the number of lesions reported as being definitely abnormal or normal (+22%). In 12 patients (28.6%), the PET/CT report positively impacted surgical management when compared to the PET report alone. 6 patients were correctly downstaged negating further treatment or imaging, 3 patient was upstaged to inoperable and in another 3 ones improved localization by PET/CT led to an altered surgical incision with decreased morbidity. Lesion-based evaluation showed sensitivity for regional lymph node involvement of 61% for CT alone, 88% for FDG PET alone, and 96% for integrated PET/CT imaging respectively. In addition, PET/CT could identify some benign disease, including lung tuberculosis, cyst of liver and kidney, calculus etc. Conclusion: PET/CT improves anatomical localization and increases the certainty in reporting abnormal and normal lesions. PET/CT imaging is superior to CT alone and has additional benefit over FDG PET alone, and is accurate in clinical staging for lung cancer. (authors)

  16. Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

    International Nuclear Information System (INIS)

    Tomozawa, Yuki; Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kato, Mina; Kanamoto, Takaaki; Sakane, Makoto

    2011-01-01

    The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

  17. Clinical value of CT/MR-US fusion imaging for radiofrequency ablation of hepatic nodules

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young, E-mail: leejy4u@snu.ac.kr [Department of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Choi, Byung Ihn [Department of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Chung, Yong Eun [Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Min Wook; Kim, Se Hyung; Han, Joon Koo [Department of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Hospital, Seoul (Korea, Republic of)

    2012-09-15

    Objective: The aim of this study was to determine the registration error of an ultrasound (US) fusion imaging system during an ex vivo study and its clinical value for percutaneous radiofrequency ablation (pRFA) during an in vivo study. Materials and methods: An ex vivo study was performed using 4 bovine livers and 66 sonographically invisible lead pellets. Real-time CT-US fusion imaging was applied to assist the targeting of pellets with needles in each liver; the 4 sessions were performed by either an experienced radiologist (R1, 3 sessions) or an inexperienced resident (R2, 1 session). The distance between the pellet target and needle was measured. An in vivo study was retrospectively performed with 51 nodules (42 HCCs and 9 metastases; mean diameter, 16 mm) of 37 patients. Fusion imaging was used to create a sufficient safety margin (>5 mm) during pRFA in 24 nodules (group 1), accurately target 21 nodules obscured in the US images (group 2) and precisely identify 6 nodules surrounded by similar looking nodules (group 3). Image fusion was achieved using MR and CT images in 16 and 21 patients, respectively. The reablation rate, 1-year local recurrence rate and complications were assessed. Results: In the ex vivo study, the mean target–needle distances were 2.7 mm ± 1.9 mm (R1) and 3.1 ± 3.3 mm (R2) (p > 0.05). In the in vivo study, the reablation rates in groups 1–3 were 13%, 19% and 0%, respectively. At 1 year, the local recurrence rate was 11.8% (6/51). In our assessment of complications, one bile duct injury was observed. Conclusion: US fusion imaging system has an acceptable registration error and can be an efficacious tool for overcoming the major limitations of US-guided pRFA.

  18. Clinical value analysis of routine ultrasound combined with endoscopic ultrasonography in judging ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Jing-Mei Tuo

    2016-01-01

    Full Text Available Objective: To study the clinical value of routine ultrasound combined with endoscopic ultrasonography in judging ulcerative colitis. Methods: A total of 60 cases of patients with ulcerative colitis were collected as observation group of research and 60 cases of healthy volunteers were collected as control group of research. Intestinal wall thickness was detected by white light endoscopy, abdominal intestinal ultrasound and endoscopic ultrasonography; TNF-α, IL-1β, IL-4 and IL-10 contents were detected by Elisa kit; Th1, Th2, Th17 and Treg ratios were detected by flow cytometry. Results: (1 intestinal wall thickness: intestinal wall thickness of both active UC patients and quiescent UC patients was significantly higher than that of control group, intestinal wall thickness of active UC patients was significantly higher than that of quiescent UC patients and the higher the degree of activity, the higher the intestinal wall thickness; (2 inflammatory mediators: TNF-α and IL-1β contents in intestinal mucosa of active UC patients were higher than those of quiescent UC patients and positively correlated with intestinal wall thickness; IL-4 and IL-10 contents were lower than those of quiescent UC patients and negatively correlated with intestinal wall thickness; (3 T cell contents: Th1 and Th17 cell contents in intestinal mucosa of active UC patients were higher than those of quiescent UC patients and positively correlated with intestinal wall thickness; Th2 and Treg cell contents in intestinal mucosa of active UC patients were lower than those of quiescent UC patients and negatively correlated with intestinal wall thickness. Conclusion: Routine ultrasound combined with endoscopic ultrasonography can accurately determine the severity of ulcerative colitis; measured intestinal wall thickness is closely correlated with the degree of inflammation and abnormal immune response.

  19. [Clinical Value of Prophylactic Salpingectomy in Hysterectomy due to Uterine Benign Lesions].

    Science.gov (United States)

    Zhao, Ling-Jun; Wang, Ping; Li, Xiu-Ying

    2017-03-01

    To explore the clinical value of resection of bilateral fallopian tubes in patients with benign uterine diseases who received (laparoscopic) hysterectomy or subhysterectomy through the postoperative pathologic analysis of resected fallopian tubes. A retrospective analysis was conducted to review the histopathological examination results in 1 272 women who underwent (laparoscopic) total hysterectomy or subtotal hysterectomy and the removal of bilateral fallopian tube simultaneously due to uterine leiomyoma, adenomyosis and other benign lesions from December 2010 to December 2015. Of the 1 272 patients, laparoscopic resection was underwent in 1 005 patients (79.01%) and laparotomy in 267 patients (20.99%). In the attachment area, 334 patients (26.26%) had tenderness signs, and 401 patients (31.53%) had signs of thickening. Total 2 498 fallopian tubes were removed. There were 1 654 tubal with no obvious abnormal appearance (66.21%), 636 tubal with lumen part of the uplift (25.46%), 128 fallopian tube with congestion and swelling (5.12%), 80 fallopian tube atrophy adhesions (3.20%). Pathological. showed 2 386 (95.52%) fallopian tubes with chronic fallopian tube inflammation, 988 (39.55%) of fallopian tube cyst, 80 (3.20%) of normal fallopian tube, 78 (3.12%) of tubal effusion, 48 (1.92% ) of tubal hyperplasia, 4 (0.26%) of tubal benign tumor, 8 (0.32%) of tubal mucosa atypical hyperplasia change and 2(0.08%) of tubal cancer. In the 10 cases of fallopian tube cancer and atypical hyperplasia, 8 had obvious changes of chronic inflammation in the contralateral fallopian tube, including 7 cases of atypical hyperplasia and 1 case of fallopian tube cancer. Prophylactic salpingectomy can prevent the occurrence of tubal inflammation and removal cancer incentives.

  20. Critical value reporting: A survey of 36 clinical laboratories in South ...

    African Journals Online (AJOL)

    A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Results. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were ...

  1. Evaluation of models for prediction of the energy value of diets for growing cattle from the chemical composition of feeds

    Directory of Open Access Journals (Sweden)

    Cláudia Batista Sampaio

    2012-09-01

    Full Text Available The objective of this study was to estimate and evaluate the contents of apparently digestible fractions of crude protein, ether extract and non-fibrous carbohydrates, the digestible fraction of the neutral detergent fiber and the content of total digestible nutrients (TDN from the chemical composition of feeds in growing cattle fed different diets. Fourteen F1 Red Angus × Nellore young bulls with average age and weight of 12 months and 287±36 kg were used. Animals were fed elephant grass silage, corn silage or signal grass hay, with or without supplementation of 200 g concentrate per kg of the total diet. The experiment consisted of two 13-days periods, in which the concentrate supplementation was crossed over animals. The values of digestible fractions and the TDN content observed were obtained based on total collection of feces. Several sub-models applied to the different digestible fractions were assessed and discussed. Estimates of the TDN content in the diet were produced from the combination of sub-models applied to the individual digestible fractions. The TDN content was more efficiently predicted from the sub-models proposed by Detmann et al. (2010 when biological procedures for the estimation of the undegradable fraction of the protein and the potentially degradable fraction of the neutral detergent fiber were considered.

  2. Chemical sensitizers for hypoxic cells: a decade of experience in clinical radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dische, S [Mount Vernon Hospital, Northwood (UK)

    1985-02-01

    The clinical work with chemical agents to restore the radiosensitivity of hypoxic cells began in 1973 with metronidazole, misonidazole was first given in 1974. The results so far recorded of the clinical trials with misonidazole have been generally disappointing. Hypoxic cells must exist in all human tumours presenting for treatment and it is, however, probable that the oxygen effect is an important one at all dose fractionation regimes employed in radiotherapy but, after conventional fractionated radiotherapy, hypoxia may be a reason for failure in only a proportion of cases. The most important factor underlying the failure of misonidazole to acheive useful advantage is undoubtedly the low radiosensitizing concentrations achievable with the permitted dose of this neurotoxic drug. New drugs are under development and some have different dose-limiting toxicity. Those showing promise at this time are the Stanford compound, SR-2508 and the Roche compounds, Ro 03-8799. It is possible that the greatest sensitization with the greatest tolerance will be achieved by a combination of drugs.

  3. Chemical Profiling of Primary Mesothelioma Cultures Defines Subtypes with Different Expression Profiles and Clinical Responses.

    Science.gov (United States)

    Schunselaar, Laurel M; Quispel-Janssen, Josine M M F; Kim, Yongsoo; Alifrangis, Constantine; Zwart, Wilbert; Baas, Paul; Neefjes, Jacques

    2018-04-01

    Purpose: Finding new treatment options for patients with malignant pleural mesothelioma is challenging due to the rarity and heterogeneity of this cancer type. The absence of druggable targets further complicates the development of new therapies. Current treatment options are therefore limited, and prognosis remains poor. Experimental Design: We performed drug screening on primary mesothelioma cultures to guide treatment decisions of corresponding patients that were progressive after first- or second-line treatment. Results: We observed a high concordance between in vitro results and clinical outcomes. We defined three subgroups responding differently to the anticancer drugs tested. In addition, gene expression profiling yielded distinct signatures that segregated the differently responding subgroups. These genes signatures involved various pathways, most prominently the fibroblast growth factor pathway. Conclusions: Our primary mesothelioma culture system has proved to be suitable to test novel drugs. Chemical profiling of primary mesothelioma cultures allows personalizing treatment for a group of patients with a rare tumor type where clinical trials are notoriously difficult. This personalized treatment strategy is expected to improve the poor prospects of patients with mesothelioma. Clin Cancer Res; 24(7); 1761-70. ©2017 AACR See related commentary by John and Chia, p. 1513 . ©2017 American Association for Cancer Research.

  4. Predicting Calcium Values for Gastrointestinal Bleeding Patients in Intensive Care Unit Using Clinical Variables and Fuzzy Modeling

    Directory of Open Access Journals (Sweden)

    G Khalili-Zadeh-Mahani

    2016-07-01

    Full Text Available Introduction: Reducing unnecessary laboratory tests is an essential issue in the Intensive Care Unit. One solution for this issue is to predict the value of a laboratory test to specify the necessity of ordering the tests. The aim of this paper was to propose a clinical decision support system for predicting laboratory tests values. Calcium laboratory tests of three categories of patients, including upper and lower gastrointestinal bleeding, and unspecified hemorrhage of gastrointestinal tract, have been selected as the case studies for this research. Method: In this research, the data have been collected from MIMIC-II database. For predicting calcium laboratory values, a Fuzzy Takagi-Sugeno model is used and the input variables of the model are heart rate and previous value of calcium laboratory test. Results: The results showed that the values of calcium laboratory test for the understudy patients were predictable with an acceptable accuracy. In average, the mean absolute errors of the system for the three categories of the patients are 0.27, 0.29, and 0.28, respectively. Conclusion: In this research, using fuzzy modeling and two variables of heart rate and previous calcium laboratory values, a clinical decision support system was proposed for predicting laboratory values of three categories of patients with gastrointestinal bleeding. Using these two clinical values as input variables, the obtained results were acceptable and showed the capability of the proposed system in predicting calcium laboratory values. For achieving better results, the impact of more input variables should be studied. Since, the proposed system predicts the laboratory values instead of just predicting the necessity of the laboratory tests; it was more generalized than previous studies. So, the proposed method let the specialists make the decision depending on the condition of each patient.

  5. Is There Value in Having Radiology Provide a Second Reading in Pediatric Orthopaedic Clinic?

    Science.gov (United States)

    Natarajan, Vivek; Bosch, Patrick; Dede, Ozgur; Deeney, Vincent; Mendelson, Stephen; Ward, Timothy; Brooks, Maria; Kenkre, Tanya; Roach, James

    2017-06-01

    The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic. A retrospective review was performed of all patients who had plain radiographs obtained in the pediatric orthopaedic clinic at an academic children's hospital over a 4-month period. For each radiographic series, the orthopaedist's note and the radiology interpretation were reviewed and a determination was made of whether the radiology read provided new clinically useful information and/or a new diagnosis, whether it recommended further imaging, or if it missed a diagnosis that was reflected in the orthopaedist's note. The hospital charges associated with the radiology read for each study were also quantified. The charts of 1570 consecutive clinic patients who were seen in the pediatric orthopaedic clinic from January to April, 2012 were reviewed. There were 2509 radiographic studies performed, of which 2264 had both a documented orthopaedist's note and radiologist's read. The radiologist's interpretation added new, clinically important information in 1.0% (23/2264) of these studies. In 1.7% (38/2264) of the studies, it was determined that the radiologist missed the diagnosis or clinically important information that could affect treatment. The total amount of the professional fees charged for the radiologists' interpretations was $87,362. On average, the hospital charges for each occurrence in which the radiologist's read provided an additional diagnosis or clinically important information beyond the orthopaedist's note were $3798. The results of this study suggest that eliminating the

  6. Recurrent renal cell carcinoma: clinical and prognostic value of FDG PET/CT

    International Nuclear Information System (INIS)

    Alongi, Pierpaolo; Picchio, Maria; Gianolli, Luigi; Zattoni, Fabio; Spallino, Marianna; Saladini, Giorgio; Evangelista, Laura

    2016-01-01

    The purpose of our study was 1) to evaluate the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 2) to assess the impact of FDG PET/CT on treatment decision-making, and 3) to estimate the prognostic value of FDG PET/CT in the restaging process among patients with renal cell carcinoma (RCC). From the FDG PET/CT databases of San Raffaele Hospital in Milan, Italy, and the Veneto Institute of Oncology in Padua, Italy, we selected 104 patients with a certain diagnosis of RCC after surgery, and for whom at least 24 months of post-surgical FDG PET/CT, clinical, and instrumental follow-up data was available. The sensitivity and specificity of FDG PET/CT were assessed by histology and/or other imaging as standard of reference. Progression-free survival (PFS) and overall survival (OS) were computed using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used to identify predictors of outcome. FDG PET/CT resulted in a positive diagnosis in 58 patients and a negative diagnosis in 46 patients. Sensitivity and specificity were 74 % and 80 %, respectively. FDG PET/CT findings influenced therapeutic management in 45/104 cases (43 %). After a median follow-up period of 37 months (± standard deviation 12.9), 51 (49 %) patients had recurrence of disease, and 26 (25 %) had died. In analysis of OS, positive versus negative FDG PET/CT was associated with worse cumulative survival rates over a 5-year period (19 % vs. 69 %, respectively; p <0.05). Similarly, a positive FDG PET/CT correlated with a lower 3-year PFS rate. In addition, univariate and multivariate analysis revealed that a positive scan, alone or in combination with disease stage III-IV or nuclear grading 3-4, was associated with high risk of progression (multivariate analysis = hazard ratios [HRs] of 4.01, 3.7, and 2.8, respectively; all p < 0.05). FDG PET/CT is a valuable tool both in treatment decision-making and for

  7. Recurrent renal cell carcinoma: clinical and prognostic value of FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Alongi, Pierpaolo; Picchio, Maria; Gianolli, Luigi [IRCCS San Raffaele Scientific Institute, Nuclear Medicine Department, Milan (Italy); Zattoni, Fabio [University of Padua, Department of Oncological and Surgical Sciences, Urology Clinic, Padua (Italy); Spallino, Marianna [University of Milano-Bicocca, Milan (Italy); Saladini, Giorgio; Evangelista, Laura [Veneto Institute of Oncology IOV - IRCCS, Padua, Italy, Radiotherapy and Nuclear Medicine Unit, Padua (Italy)

    2016-03-15

    The purpose of our study was 1) to evaluate the diagnostic performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT), 2) to assess the impact of FDG PET/CT on treatment decision-making, and 3) to estimate the prognostic value of FDG PET/CT in the restaging process among patients with renal cell carcinoma (RCC). From the FDG PET/CT databases of San Raffaele Hospital in Milan, Italy, and the Veneto Institute of Oncology in Padua, Italy, we selected 104 patients with a certain diagnosis of RCC after surgery, and for whom at least 24 months of post-surgical FDG PET/CT, clinical, and instrumental follow-up data was available. The sensitivity and specificity of FDG PET/CT were assessed by histology and/or other imaging as standard of reference. Progression-free survival (PFS) and overall survival (OS) were computed using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used to identify predictors of outcome. FDG PET/CT resulted in a positive diagnosis in 58 patients and a negative diagnosis in 46 patients. Sensitivity and specificity were 74 % and 80 %, respectively. FDG PET/CT findings influenced therapeutic management in 45/104 cases (43 %). After a median follow-up period of 37 months (± standard deviation 12.9), 51 (49 %) patients had recurrence of disease, and 26 (25 %) had died. In analysis of OS, positive versus negative FDG PET/CT was associated with worse cumulative survival rates over a 5-year period (19 % vs. 69 %, respectively; p <0.05). Similarly, a positive FDG PET/CT correlated with a lower 3-year PFS rate. In addition, univariate and multivariate analysis revealed that a positive scan, alone or in combination with disease stage III-IV or nuclear grading 3-4, was associated with high risk of progression (multivariate analysis = hazard ratios [HRs] of 4.01, 3.7, and 2.8, respectively; all p < 0.05). FDG PET/CT is a valuable tool both in treatment decision-making and for

  8. Marginal zone in femoral head avascular necrosis: scintigraphic characteristics and clinical prognostic value

    International Nuclear Information System (INIS)

    Milcinski, M.; Sedonja, I.; Dolinar, D.; Jevtic, V.

    2002-01-01

    Aim: Marginal zone, seen on magnetic resonance imaging (MRI) in femoral head avascular necrosis, consists of granulation tissue and sclerosis at the junction of necrotic and normal bone. Prognostic value of this finding is not clear. Aim of our study was to evaluate osteoblastic activity of marginal zone with bone scintigraphy and to assess prognostic importance of marginal zone for further evolution of femoral head necrosis. Material and methods: MRI was performed in 37 hips in 26 patients (17 m, 9 f, 20-64 y, mean 42,9 y) with Ficat 0-II avascular necrosis (SE T1W, STIR and SE T1W FAT.SAT after Gd DTPA in the coronal plane and GE FLASH in the sagittal plane). In 26 hips of 17 patients planar and pinhole scintigraphy with 99mTc-DPD was performed. Results: On MRI, marginal zone divided necrotic and normal bone in 26/37 (70,3%) hips, in 14/26 it was thin (2% of femoral head diameter or less), but in 12/26 it was wide (more than 2% of femoral head diameter). In 11/37 (29,7%) hips marginal zone was not seen. Pinhole scintigraphy was performed in 26 hips; in all 10/10 (100%) hips with wide marginal zone, seen on MRI, increased osteoblastic activity was detected, while only in 1/9 (11,1%) hips with thin marginal zone on MRI osteoblastic activity was increased. Patients were followed 1 to 5 years (mean 2,2 y). In hips without marginal zone no collapse of femoral head was seen until now, in 2/11 (18,2%) femoral heads MRI and clinical regression was observed. Ten of 12 lesions with wide marginal zone (83,3 %) collapsed 0,25 to 2,5 (mean 1) years after onset of pain. Two of 12 lesions with wide marginal zone (16,7%) have not collapsed until now. From lesions with thin marginal zone, 4/14 (28,6 %) collapsed 0,7 to 3 (mean 1,9) years after onset of pain, 10/14 (71,4%) did not collapse until now. Conclusion: Increased osteoblastic activity in wide marginal zone between necrotic and vital bone in hip avascular necrosis is bad prognostic factor for femoral head collapse

  9. The value of participatory development to support antimicrobial stewardship with a clinical decision support system

    NARCIS (Netherlands)

    Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette

    2017-01-01

    Background: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

  10. The value of participatory development to support antimicrobial stewardship with a clinical decision support system

    NARCIS (Netherlands)

    Beerlage-de Jong, Nienke; Wentzel, M.J.; Hendrix, Ron; van Gemert-Pijnen, Julia E.W.C.

    Background Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

  11. Single and Combined Diagnostic Value of Clinical Features and Laboratory Tests in Acute Appendicitis

    NARCIS (Netherlands)

    Laméris, Wytze; van Randen, Adrienne; Go, Peter M. N. Y. H.; Bouma, Wim H.; Donkervoort, Sandra C.; Bossuyt, Patrick M. M.; Stoker, Jaap; Boermeester, Marja A.

    2009-01-01

    Objectives: The objective was to evaluate the diagnostic accuracy of clinical features and laboratory test results in detecting acute appendicitis. Methods: Clinical features and laboratory test results were prospectively recorded in a consecutive series of 1,101 patients presenting with abdominal

  12. Reference values and clinical application of magnetic peripheral nerve stimulation in cats

    NARCIS (Netherlands)

    Van Soens, Iris; Struys, Michel M. R. F.; Bhatti, Sofie F. M.; Van Ham, Luc M. L.

    Magnetic stimulation of radial (RN) and sciatic (SN) nerves was performed bilaterally in 40 healthy cats. Reference values for onset latency and peak-to-peak amplitude of magnetic motor evoked potentials (MMEPs) were obtained and compared with values of electric motor evoked potentials (EMEPs) in

  13. Service quality and perceived value of technology-based service encounters: evaluation of clinical staff satisfaction in Taiwan.

    Science.gov (United States)

    Hung, Chung-Jye; Chang, Hsin Hsin; Eng, Cheng Joo; Wong, Kit Hong

    Previous research has evaluated technology-based service encounters (TBSEs) in the delivery of health care by assessing patient satisfaction. This study examined service quality and perceived value of TBSEs used in health organisations from the perspective of clinical staff, with staff technology readiness as a moderator. A quantitative survey was conducted in Taiwan, across private and public healthcare organisations. Results showed that TBSEs had a direct effect on service quality and perceived value, which in turn had a direct effect on staff satisfaction in using TBSEs. However, service quality had no effect on perceived value when moderated by technology readiness. Theoretical and managerial implications of these findings are discussed.

  14. Modern MRI tools for the characterization of acute demyelinating lesions: value of chemical shift and diffusion-weighted imaging

    International Nuclear Information System (INIS)

    Kueker, W.; Mehnert, F.; Mader, I.; Naegele, T.; Ruff, J.; Gaertner, S.

    2004-01-01

    Acute demyelinating lesions occur in various inflammatory disorders of the CNS. Apart from multiple sclerosis, most cases can be attributed to an overshooting immunological response to infectious agents called acute disseminated encephalomyelitis (ADEM). ADEM, which is mostly characterized by a monophasic course, has a multiphasic variant (MDEM). The early application of corticosteroids has been shown to be beneficial for the outcome; thus, an early diagnosis is highly desirable. Furthermore, the differential diagnosis ruling out neoplastic disorders may be difficult using conventional MRI alone. The potential diagnostic value of advanced MR techniques such as chemical shift imaging (CSI) and diffusion-weighted imaging (DWI) was investigated in a patient with MDEM, who had a new lesion in continuity with the initial disease manifestation. CSI was performed at 1.5 T with a long echo time of 135 ms for the evaluation of N-acetyl-aspartate (NAA) and choline (Cho) and with short TE of 30 ms for macromolecules (mm) and myo-Inositol (mI). DWI was performed using a single-shot isotropic EPI sequence. Whereas acute and chronic areas of demyelination were neither distinguishable on T2- nor on contrast-enhanced T1-weigted images, CSI and DWI revealed different metabolite concentrations and diffusion characteristics within the composite lesion, clearly separating acute from chronic areas of demyelination. In conclusion, the addition of CSI and DWI may add to the diagnostic power of MRI in the setting of demyelinating disorders by identifying areas of acute and chronic demyelination, even in the absence of contrast enhancement. (orig.)

  15. Unipolar Endocardial Voltage Mapping in the Right Ventricle: Optimal Cutoff Values Correcting for Computed Tomography-Derived Epicardial Fat Thickness and Their Clinical Value for Substrate Delineation.

    Science.gov (United States)

    Venlet, Jeroen; Piers, Sebastiaan R D; Kapel, Gijsbert F L; de Riva, Marta; Pauli, Philippe F G; van der Geest, Rob J; Zeppenfeld, Katja

    2017-08-01

    Low endocardial unipolar voltage (UV) at sites with normal bipolar voltage (BV) may indicate epicardial scar. Currently applied UV cutoff values are based on studies that lacked epicardial fat information. This study aimed to define endocardial UV cutoff values using computed tomography-derived fat information and to analyze their clinical value for right ventricular substrate delineation. Thirty-three patients (50±14 years; 79% men) underwent combined endocardial-epicardial right ventricular electroanatomical mapping and ablation of right ventricular scar-related ventricular tachycardia with computed tomographic image integration, including computed tomography-derived fat thickness. Of 6889 endocardial-epicardial mapping point pairs, 547 (8%) pairs with distance 1.50 mV, the optimal endocardial UV cutoff for identification of epicardial BV the curve, 0.75; sensitivity, 60%; specificity, 79%) and cutoff for identification of abnormal epicardial electrogram was 3.7 mV (area under the curve, 0.88; sensitivity, 100%; specificity, 67%). The majority of abnormal electrograms (130 of 151) were associated with transmural scar. Eighty-six percent of abnormal epicardial electrograms had corresponding endocardial sites with BV the remaining could be identified by corresponding low endocardial UV right ventricular scar, an endocardial UV cutoff value of 3.9 mV is more accurate than previously reported cutoff values. Although the majority of epicardial abnormal electrograms are associated with transmural scar with low endocardial BV, the additional use of endocardial UV at normal BV sites improves the diagnostic accuracy resulting in identification of all epicardial abnormal electrograms at sites with <1.0 mm fat. © 2017 American Heart Association, Inc.

  16. The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low

    NARCIS (Netherlands)

    Graat, Marleen E.; Choi, Goda; Wolthuis, Esther K.; Korevaar, Johanna C.; Spronk, Peter E.; Stoker, Jaap; Vroom, Margreeth B.; Schultz, Marcus J.

    2006-01-01

    INTRODUCTION: The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care

  17. Rational clinical evaluation of suspected acute coronary syndromes: The value of more information.

    Science.gov (United States)

    Hancock, David G; Chuang, Ming-Yu Anthony; Bystrom, Rebecca; Halabi, Amera; Jones, Rachel; Horsfall, Matthew; Cullen, Louise; Parsonage, William A; Chew, Derek P

    2017-12-01

    Many meta-analyses have provided synthesised likelihood ratio data to aid clinical decision-making. However, much less has been published on how to safely combine clinical information in practice. We aimed to explore the benefits and risks of pooling clinical information during the ED assessment of suspected acute coronary syndrome. Clinical information on 1776 patients was collected within a randomised trial conducted across five South Australian EDs between July 2011 and March 2013. Bayes theorem was used to calculate patient-specific post-test probabilities using age- and gender-specific pre-test probabilities and likelihood ratios corresponding to the presence or absence of 18 clinical factors. Model performance was assessed as the presence of adverse cardiac outcomes among patients theoretically discharged at a post-test probability less than 1%. Bayes theorem-based models containing high-sensitivity troponin T (hs-troponin) outperformed models excluding hs-troponin, as well as models utilising TIMI and GRACE scores. In models containing hs-troponin, a plateau in improving discharge safety was observed after the inclusion of four clinical factors. Models with fewer clinical factors better approximated the true event rate, tended to be safer and resulted in a smaller standard deviation in post-test probability estimates. We showed that there is a definable point where additional information becomes uninformative and may actually lead to less certainty. This evidence supports the concept that clinical decision-making in the assessment of suspected acute coronary syndrome should be focused on obtaining the least amount of information that provides the highest benefit for informing the decisions of admission or discharge. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  18. Challenges in the Clinical Application of the American Society of Clinical Oncology Value Framework: A Medicare Cost-Benefit Analysis in Chronic Lymphocytic Leukemia.

    Science.gov (United States)

    Seymour, Erlene K; Schiffer, Charles A; de Souza, Jonas A

    2017-12-01

    The ASCO Value Framework calculates the value of cancer therapies. Given costly novel therapeutics for chronic lymphocytic leukemia, we used the framework to compare net health benefit (NHB) and cost within Medicare of all regimens listed in the National Comprehensive Cancer Network (NCCN) guidelines. The current NCCN guidelines for chronic lymphocytic leukemia were reviewed. All referenced studies were screened, and only randomized controlled prospective trials were included. The revised ASCO Value Framework was used to calculate NHB. Medicare drug pricing was used to calculate the cost of therapies. Forty-nine studies were screened. The following observations were made: only 10 studies (20%) could be evaluated; when comparing regimens studied against the same control arm, ranking NHB scores were comparable to their preference in guidelines; NHB scores varied depending on which variables were used, and there were no clinically validated thresholds for low or high values; treatment-related deaths were not weighted in the toxicity scores; and six of the 10 studies used less potent control arms, ranked as the least-preferred NCCN-recommended regimens. The ASCO Value Framework is an important initial step to quantify value of therapies. Essential limitations include the lack of clinically relevant validated thresholds for NHB scores and lack of incorporation of grade 5 toxicities/treatment-related mortality into its methodology. To optimize its application for clinical practice, we urge investigators/sponsors to incorporate and report the required variables to calculate the NHB of regimens and encourage trials with stronger comparator arms to properly quantify the relative value of therapies.

  19. Prognostic value of predischarge 12 lead electrocardiogram after myocardial infarction compared with other routine clinical variables

    NARCIS (Netherlands)

    Fioretti, P.; Tijssen, J. G.; Azar, A. J.; Lazzeroni, E.; Brower, R. W.; ten Katen, H. J.; Lubsen, J.; Hugenholtz, P. G.

    1987-01-01

    The prognostic value of QRS score (Selvester), ST depression, ST elevation, extrasystoles, P terminal force in V1, and QTc derived from the predischarge 12 lead electrocardiogram was assessed after myocardial infarction in 474 patients without intraventricular conduction defects, ventricular

  20. Clinical workplace learning : perceived learning value of individual and group feedback in a collectivistic culture

    NARCIS (Netherlands)

    Suhoyo, Yoyo; Schönrock-Adema, Johanna; Emilia, Ova; Kuks, Jan B M; Cohen-Schotanus, Janke

    2018-01-01

    BACKGROUND: Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual

  1. Clinical experiences with a chemical radioprotector in tumor radiotherapy: WR-2721

    International Nuclear Information System (INIS)

    Tanaka, Y.

    1984-01-01

    Since cysteine was found to protect lethally irradiated rats, sulfhydryl compounds that provide protection of laboratory animals against lethal doses of ionizing radiations have also been given much attention. The SH compounds have been the most extensively investigated, and β-aminoethylisothiouronium (AET) and cysteamine have been selected as being representative of those drugs that are highly protective. However, clinical application is limited, as the toxicity of these compounds is high. In a series of experiments to reevaluate radioprotective agents with low toxicity, the authors found that 2-mercaptopropionylglycine (MPG) and adrenochrome monoguangylhydrazone methanesulfonate (AMM) have a potent radioprotector effect in a dose far below their toxic doses in both mice and humans. Recently, the development of effective thiophosphate derivatives of cysteamine, namely WR-2721 [S-2-(3-amino-propylaminoethyl)phosphorothioate] by the U.S. Army Medical Research and Development Commands, led to a reevaluation of these compounds and their potential in radiotherapy. Initial investigations indicated that WR-2721 provided a considerable degree of radioprotection to normal tissues. This compound provided excellent protection for normal tissues (DMF = 2-2.5) but little protection for the transplanted tumor. Thus this drug may have a differential protection in vivo and may be useful for improving the therapeutic ratio in cancer radiotherapy. The results of animal and chemical experiments in Japan are summarized herein

  2. [The relevance of ADC value, T₁intensive rate and the clinical activities in ankylosing spondylitis sacroiliitis].

    Science.gov (United States)

    Zhao, Yinghua; Han, Xinai; Hu, Shaoyong; Shi, Xingliang; Zhao, Jing; Sun, Erwei; Li, Shaolin

    2014-09-23

    To evaluate the value of judging for the activity in AS by diffusion-weighted sequences (DWI) and enhance sequences MRI(DCE-MRI), to explore the correlation of Apparent diffusion coefficient(ADC) values, intensive rate and the clinical activity index in sacroiliitis (SIJ) of ankylosing spondylitis (AS). 56 patients prospectively choiced and diagnosed were divided into two groupsas, active group (n = 32) and chronic group (n = 24) by rheumatologist according to BASDAI and laboratory parameters. Twenty healthy adults were as control group. The values of ADC and intensive rate of all sacroiliac joints (SIJs) were measured on MRI. BASDAI score were got by Bath ankylosing spondylitis disease activity index. ESR, CPR and were got by laboratory. Statisticaly to analysis whether the parameters were significantly different amang AS active, chronic, and the control group. To assess the correlation of the values of ADC, intensive rate and BASDAI score, ESR, CPR and in SIJ. the values of ADC and intensive rate were significantly different among AS active, chronic and the control group. There were the significant correlation between the values of ADC, intensive rate and BASDAI score. Diffusion-weighted sequences and Contrast-enhanced sequences is superior to other methods in judging the activity in AS.combined with clinical activity index, the accuracy can significantly be improved to explore whether the activities of AS are.

  3. Changes in the classification of carcinogenic chemicals in the work area. (Section III of the German List of MAK and BAT values).

    Science.gov (United States)

    Neumann, H G; Thielmann, H W; Filser, J G; Gelbke, H P; Greim, H; Kappus, H; Norpoth, K H; Reuter, U; Vamvakas, S; Wardenbach, P; Wichmann, H E

    1998-01-01

    Carcinogenic chemicals in the work area were previously classified into three categories in section III of the German List of MAK and BAT values (the list of values on maximum workplace concentrations and biological tolerance for occupational exposures). This classification was based on qualitative criteria and reflected essentially the weight of evidence available for judging the carcinogenic potential of the chemicals. In the new classification scheme the former sections IIIA1, IIIA2, and IIIB are retained as categories 1, 2, and 3, to correspond with European Union regulations. On the basis of our advancing knowledge of reaction mechanisms and the potency of carcinogens, these three categories are supplemented with two additional categories. The essential feature of substances classified in the new categories is that exposure to these chemicals does not contribute significantly to the risk of cancer to man, provided that an appropriate exposure limit (MAK value) is observed. Chemicals known to act typically by non-genotoxic mechanisms, and for which information is available that allows evaluation of the effects of low-dose exposures, are classified in category 4. Genotoxic chemicals for which low carcinogenic potency can be expected on the basis of dose/response relationships and toxicokinetics and for which risk at low doses can be assessed are classified in category 5. The basis for a better differentiation of carcinogens is discussed, the new categories are defined, and possible criteria for classification are described. Examples for category 4 (1,4-dioxane) and category 5 (styrene) are presented.

  4. Changes in the classification of carcinogenic chemicals in the work area. Section III of the German List of MAK and BAT Values.

    Science.gov (United States)

    Neumann, H G; Vamvakas, S; Thielmann, H W; Gelbke, H P; Filser, J G; Reuter, U; Greim, H; Kappus, H; Norpoth, K H; Wardenbach, P; Wichmann, H E

    1998-11-01

    Carcinogenic chemicals in the work area are currently classified into three categories in section III of the German List of MAK and BAT Values (list of values on maximum workplace concentrations and biological tolerance for occupational exposures). This classification is based on qualitative criteria and reflects essentially the weight of evidence available for judging the carcinogenic potential of the chemicals. It is proposed that these categories - IIIA1, IIIA2, IIIB - be retained as Categories 1, 2, and 3, to correspond with European Union regulations. On the basis of our advancing knowledge of reaction mechanisms and the potency of carcinogens, these three categories are supplemented with two additional categories. The essential feature of substances classified in the new categories is that exposure to these chemicals does not contribute significantly to risk of cancer to man, provided that an appropriate exposure limit (MAK value) is observed. Chemicals known to act typically by nongenotoxic mechanisms and for which information is available that allows evaluation of the effects of low-dose exposures, are classified in Category 4. Genotoxic chemicals for which low carcinogenic potency can be expected on the basis of dose-response relationships and toxicokinetics, and for which risk at low doses can be assessed are classified in Category 5. The basis for a better differentiation of carcinogens is discussed, the new categories are defined, and possible criteria for classification are described. Examples for Category 4 (1,4-dioxane) and Category 5 (styrene) are presented.

  5. [Added value of family practitioners' supervision of junior doctors in a walk-in clinic].

    Science.gov (United States)

    Perdrix, J; Gubser, R; Gilgien, W; Bischoff, T

    2011-05-18

    The pending workforce crisis in family medicine has triggered various initiatives. This article describes the PMU-FLON walk-in clinic, a project of the Institute of General Medicine University of Lausanne. The working conditions in this clinic are close to that of a family practice. Doctors in training are supervised by family doctors who work part-time in the clinic. The objective is to improve training in the various fields of family medicine, from technical skills (improving optimal use of diagnostic tools), to integrating patients' requests in a more global patient-centered approach. This new educational model allows doctors in training to benefit from the specific approaches of different trainers. It will contribute to promoting quality family medicine in the future.

  6. Look local: the value of cancer surveillance and reporting by American Indian clinics.

    Science.gov (United States)

    Creswell, Paul D; Strickland, Rick; Stephenson, Laura; Pierce-Hudson, Kimmine; Matloub, Jacqueline; Waukau, Jerry; Adams, Alexandra; Kaur, Judith; Remington, Patrick L

    2013-11-27

    Cancer incidence and mortality rates for American Indians in the Northern Plains region of the United States are among the highest in the nation. Reliable cancer surveillance data are essential to help reduce this burden; however, racial data in state cancer registries are often misclassified, and cases are often underreported. We used a community-based participatory research approach to conduct a retrospective ascertainment of cancer cases in clinic medical records over a 9-year period (1995-2003) and compared the results with the state cancer registry to evaluate missing or racially misclassified cases. Six tribal and/or urban Indian clinics participated in the study. The project team consisted of participating clinics, a state cancer registry, a comprehensive cancer center, an American Indian/Alaska Native Leadership Initiative on Cancer, and a set of diverse organizational partners. Clinic personnel were trained by project staff to accurately identify cancer cases in clinic records. These records were then matched with the state cancer registry to assess misclassification and underreporting. Forty American Indian cases were identified that were either missing or misclassified in the state registry. Adding these cases to the registry increased the number of American Indian cases by 21.3% during the study period (P = .05). Our results indicate that direct reporting of cancer cases by tribal and urban Indian health clinics to a state cancer registry improved the quality of the data available for cancer surveillance. Higher-quality data can advance the efforts of cancer prevention and control stakeholders to address disparities in Native communities.

  7. The Diagnostic and Prognostic Value of a Dual-Tasking Paradigm in a Memory Clinic

    DEFF Research Database (Denmark)

    Nielsen, Malene Schjnning; Simonsen, Anja Hviid; Siersma, Volkert

    2018-01-01

    -tasking paradigm, such as the Timed Up and Go-Dual Task (TUG-DT), may be useful in the diagnostic assessment of mild cognitive impairment (MCI). OBJECTIVE: To investigate the diagnostic and prognostic ability of a dual-tasking paradigm in patients with MCI or mild Alzheimer's disease (AD) and to evaluate...... the association between the dual-tasking paradigm and cerebrospinal fluid (CSF) AD biomarkers. METHODS: The study is a prospective cohort study conducted in a clinical setting in two memory clinics. Eighty-six patients were included (28 MCI, 17 AD, 41 healthy controls (HC)). The ability to perform dual...

  8. Bile acid malabsorption in patients with chronic diarrhoea: clinical value of SeHCAT test

    DEFF Research Database (Denmark)

    Wildt, Signe; Nørby Rasmussen, S; Madsen, Jan Lysgård

    2003-01-01

    be evaluated. RESULTS: In 44% of patients, bile acid absorption was normal with SeHCAT retention > or = 15%. Impaired SeHCAT retention was found in 56%. All patients with ileocaecal resections had retention values presented with BAM in 39%. Only one patient...... with idiopathic BAM presented with steatorrhoea as opposed to 11 patients with type 1 and 3 BAM. Patients with idiopathic BAM and/or SeHCAT retention values value in evaluation of patients with chronic diarrhoea...... as a second-line investigation with a high diagnostic yield. The only a priori parameter to predict BAM was the existence of ileocaecal resections. The result of the SeHCAT test seems to predict the benefit of treatment with cholestyramine....

  9. Biomass valorisation by staged degasification A new pyrolysis-based thermochemical conversion option to produce value-added chemicals from lignocellulosic biomass

    NARCIS (Netherlands)

    de Wild, P. J.; den Uil, H.; Reith, J. H.; Kiel, J. H. A.; Heeres, H. J.

    Pyrolysis of lignocellulosic biomass leads to an array Of useful solid, liquid and gaseous products. Staged degasification is a pyrolysis-based conversion route to generate value-added chemicals from biomass. Because of different thermal stabilities of the main biomass constituents hemicellulose.

  10. The prognostic value of clinical factors and cancer stem cell-related markers in gliomas

    DEFF Research Database (Denmark)

    Dahlrot, Rikke Hedegaard

    2014-01-01

    are already used in clinical decision making, and they can be used in prognostic counselling of the patients and to guide clinicians regarding the potential benefit from standard treatment in specific patients. Musashi-1 was a predictor of poor survival in WHO grade III tumours, but in patients with GBMs...

  11. The clinical value of squamous cell carcinoma antigen in cancer of the uterine cervix

    NARCIS (Netherlands)

    de Bruijn, HWA; Duk, JM; van der Zee, AGJ; Pras, E; Willemse, PHB; Hollema, H; Mourits, MJE; de Vries, EGE; Aalders, JG; Boonstra, J.

    1998-01-01

    A review is given of the clinical use and interpretation of serum tumor marker levels during the treatment of patients with cancer of the uterine cervix, Pretreatment serum squamous cell carcinoma (SCC) antigen provides a new prognostic factor in early stage squamous cell carcinoma of the uterine

  12. Therapeutic value of EGFR inhibition in CRC and NSCLC: 15 years of clinical evidence.

    Science.gov (United States)

    Troiani, Teresa; Napolitano, Stefania; Della Corte, Carminia Maria; Martini, Giulia; Martinelli, Erika; Morgillo, Floriana; Ciardiello, Fortunato

    2016-01-01

    Epidermal growth factor receptor (EGFR) plays a key role in tumour evolution, proliferation and immune evasion, and is one of the most important targets for biological therapy, especially for non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC). In the past 15 years, several EGFR antagonists have been approved for the treatment of NSCLC and metastatic CRC (mCRC). To optimise the use of anti-EGFR agents in clinical practice, various clinical and molecular biomarkers have been investigated, thus moving their indication from unselected to selected populations. Nowadays, anti-EGFR drugs represent a gold-standard therapy for metastatic NSCLC harbouring EGFR activating mutation and for RAS wild-type mCRC. Their clinical efficacy is limited by the presence of intrinsic resistance or the onset of acquired resistance. In this review, we provide an overview of the antitumour activity of EGFR inhibitors in NSCLC and CRC and of mechanisms of resistance, focusing on the development of a personalised approach through 15 years of preclinical and clinical research.

  13. Exploring the feasibility and synergistic value of the One Health approach in clinical research

    DEFF Research Database (Denmark)

    Cordoba Currea, Gloria Cristina; Sørensen, Tina Møller; Holm, Anne

    2015-01-01

    diagnostic pathways (i.e., 16 possiblecombinations of diagnostic tools) to gold standard in human and veterinary primary care practice in Denmark.Fifty primary care practices and 100 veterinary clinics will each consecutively include 20 human patients or 8–10dogs, respectively. Data will be collected...

  14. The Predictive Value of Ultrasound Learning Curves Across Simulated and Clinical Settings

    DEFF Research Database (Denmark)

    Madsen, Mette E; Nørgaard, Lone N; Tabor, Ann

    2017-01-01

    OBJECTIVES: The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. METHODS: Twenty midwives completed a simulation-based tra......OBJECTIVES: The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training. METHODS: Twenty midwives completed a simulation......-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established...... settings. RESULTS: A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P VR simulator correlated well to the clinical performance scores (Pearson...

  15. Oral squamous cell carcinoma and a clinically negative neck : the value of follow-up

    NARCIS (Netherlands)

    Wensing, Bart M; Merkx, Matthias A W; Krabbe, Paul F M; Marres, Henri A M; Van den Hoogen, Frank J A

    2011-01-01

    BACKGROUND: In squamous cell carcinoma of the oral cavity (SCCOC), regular follow-up comprises 5 years of prescheduled visits, irrespective of tumor stage/classification and/or treatment. We analyzed our standard treatment and follow-up protocol in patients with a preoperative clinically negative

  16. Polycythemia vera: diagnosis, different therapy modalities and clinical value of the treatment with radiophosphorus today

    International Nuclear Information System (INIS)

    Bredow, J.; Pinkert, J.; Franke, W.G.; Schuler, U.

    2001-01-01

    The definition, diagnostic criteria and clinical findings as well as the treatment with radioactive phosphorus is described more in detail. Today, the treatment with 32 P is estimated to be an easy and safe method, especially for elderly patients (65 years or above), providing a cost-effective alternative to anti-proliferative drugs like hydroxyurea. (orig.) [de

  17. Overview of Chronic Oral Toxicity Values for Chemicals Present in Hydraulic Fracturing Fluids, Flowback and Produced Waters

    Science.gov (United States)

    as part of EPA's Hydraulic Fracturing Drinking Water Assessment, EPA is summarizing existing toxicity data for chemicals reported to be used in hydraulic fracturing fluids and/or found in flowback or produced waters from hydraulically fractured wells

  18. Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms.

    Science.gov (United States)

    Levine, Stephen Z; Leucht, Stefan

    2013-04-01

    The treatment and measurement of negative symptoms are currently at issue in schizophrenia, but the clinical meaning of symptom severity and change is unclear. To offer a clinically meaningful interpretation of severity and change scores on the Scale for the Assessment of Negative Symptoms (SANS). Patients were intention-to-treat participants (n=383) in two double-blind randomized placebo-controlled clinical trials that compared amisulpride with placebo for the treatment of predominant negative symptoms. Equipercentile linking was used to examine extrapolation from (a) CGI-S to SANS severity ratings, and (b) CGI-I to SANS percentage change (n=383). Linking was conducted at baseline, 8-14 days, 28-30 days, and 56-60 days of the trials. Across visits, CGI-S ratings of 'not ill' linked to SANS scores of 0-13, and ranged to 'extreme' ratings that linked to SANS scores of 102-105. The relationship between the CGI-S and the SANS severity scores assumed a linear trend (1=0-13, 2=15-56, 3=37-61, 4=49-66, 5=63-75, 6=79-89, 7=102-105). Similarly the relationship between CGI-I ratings and SANS percentage change followed a linear trend. For instance, CGI-I ratings of 'very much improved' were linked to SANS percent changes of -90 to -67, 'much improved' to -50 to -42, and 'minimally improved' to -21 to -13. The current results uniquely contribute to the debate surrounding negative symptoms by providing clinical meaning to SANS severity and change scores and so offer direction regarding clinically meaningful response cut-off scores to guide treatment targets of predominant negative symptoms. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months

    International Nuclear Information System (INIS)

    Ogawa, Kazuhiko; Nakamura, Katsumasa; Sasaki, Tomonari; Onishi, Hiroshi; Koizumi, Masahiko; Shioyama, Yoshiyuki; Araya, Masayuki; Mukumoto, Nobutaka M.S.; Mitsumori, Michihide; Teshima, Teruki

    2009-01-01

    Purpose: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy. Methods and Materials: Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months). Results: The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (≥0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy. Conclusions: External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.

  20. Value of ovarian reserve testing before IVF: a clinical decision analysis

    NARCIS (Netherlands)

    Mol, Ben W.; Verhagen, Tamara E. M.; Hendriks, Dave J.; Collins, John A.; Coomarasamy, Arri; Opmeer, Brent C.; Broekmans, Frank J.

    2006-01-01

    BACKGROUND: To assess the value of testing for ovarian reserve prior to a first cycle IVF incorporating patient and doctor valuation of mismatches between test results and treatment outcome. METHODS: A decision model was developed for couples who were considering participation in an IVF programme.

  1. Predictive values of thermal and electrical dental pulp tests: a clinical study.

    Science.gov (United States)

    Villa-Chávez, Carlos E; Patiño-Marín, Nuria; Loyola-Rodríguez, Juan P; Zavala-Alonso, Norma V; Martínez-Castañón, Gabriel A; Medina-Solís, Carlo E

    2013-08-01

    For a diagnostic test to be useful, it is necessary to determine the probability that the test will provide the correct diagnosis. Therefore, it is necessary to calculate the predictive value of diagnostics. The aim of the present study was to identify the sensitivity, specificity, positive and negative predictive values, accuracy, and reproducibility of thermal and electrical tests of pulp sensitivity. The thermal tests studied were the 1, 1, 1, 2-tetrafluoroethane (cold) and hot gutta-percha (hot) tests. For the electrical test, the Analytic Technology Pulp Tester (Analytic Technology, Redmond, WA) was used. A total of 110 teeth were tested: 60 teeth with vital pulp and 50 teeth with necrotic pulps (disease prevalence of 45%). The ideal standard was established by direct pulp inspection. The sensitivities of the diagnostic tests were 0.88 for the cold test, 0.86 for the heat test, and 0.76 for the electrical test, and the specificity was 1.0 for all 3 tests. The negative predictive value was 0.90 for the cold test, 0.89 for the heat test, and 0.83 for the electrical test, and the positive predictive value was 1.0 for all 3 tests. The highest accuracy (0.94) and reproducibility (0.88) were observed for the cold test. The cold test was the most accurate method for diagnostic testing. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. What is the clinical value of cancer stem cell markers in gliomas?

    DEFF Research Database (Denmark)

    Dahlrot, Rikke Hedegaard; Hermansen, Simon Kjær; Hansen, Steinbjørn

    2013-01-01

    . This review summarizes current reports on putative glioma CSC markers and reviews the prognostic value of the individual immunohistochemical markers reported in the literature. Using the Pubmed database, twenty-seven CSC studies looking at membrane markers (CD133, podoplanin, CD15, and A2B5), filament markers...

  3. The relationship between continuing education and perceived competence, professional support, and professional value among clinical psychologists.

    Science.gov (United States)

    Bradley, Stacy; Drapeau, Martin; Destefano, Jack

    2012-01-01

    Continuing education is one of the means by which professionals maintain and increase their level of competence. However, the relationship between continuing education and the professional's sense of personal competence and other practice-related variables remains unclear. This study examined practicing psychologists' continuing education activities and how these relate to feelings of perceived competence, professional value, and professional support. Psychologists (n = 418) licensed to practice in Quebec were surveyed by pencil-and-paper mail-in survey concerning their continuing education activities, as well as their perceptions of their competence in practice, and their feelings of being professionally valued and professionally supported. Results indicated that feelings of competence in practice were related to professional reading, taking courses/workshops, years being licensed, and attending psychology conferences/conventions. Feelings of professional value were related to age and participating in psychology networking groups, and feelings of professional support were related to participating in case discussion groups, supervision groups, and psychology networking groups. The results showcase the complexity of professional development. Although relationships were found between continuing education activities and the 3 factors of interest, these relationships were moderate. Findings are discussed in the context of their value to individual psychologists, as well as to psychology licensing and regulatory boards, such as promoting participation in those activities related to feelings of competence and support. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  4. Analyzing patients' values by applying cluster analysis and LRFM model in a pediatric dental clinic in Taiwan.

    Science.gov (United States)

    Wu, Hsin-Hung; Lin, Shih-Yen; Liu, Chih-Wei

    2014-01-01

    This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs.

  5. Analyzing Patients' Values by Applying Cluster Analysis and LRFM Model in a Pediatric Dental Clinic in Taiwan

    Science.gov (United States)

    Lin, Shih-Yen; Liu, Chih-Wei

    2014-01-01

    This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs. PMID:25045741

  6. Reference line-pair values of panoramic radiographs using an arch-form phantom stand to assess clinical image quality

    International Nuclear Information System (INIS)

    Choi, Da Hye; Choi, Bo Ram; Huh, Kyung Hoe; Heo, Min Suk; Choi, Soon Chul; Choi, Jin Woo; Yi, Won Jin; Lee, Sam Sun

    2013-01-01

    This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.

  7. Reference line-pair values of panoramic radiographs using an arch-form phantom stand to assess clinical image quality

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Da Hye; Choi, Bo Ram; Huh, Kyung Hoe; Heo, Min Suk; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Jin Woo [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Dankook University, Cheonan (Korea, Republic of); Yi, Won Jin; Lee, Sam Sun [Dept. of Oral and Maxillofacial Radiology, BK21 Craniomaxillofacial Life Science, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2013-03-15

    This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.

  8. Analyzing Patients’ Values by Applying Cluster Analysis and LRFM Model in a Pediatric Dental Clinic in Taiwan

    Directory of Open Access Journals (Sweden)

    Hsin-Hung Wu

    2014-01-01

    Full Text Available This study combines cluster analysis and LRFM (length, recency, frequency, and monetary model in a pediatric dental clinic in Taiwan to analyze patients’ values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients’ needs.

  9. The Clinical Value, Principle, and Basic Practical Technique of Mindfulness Intervention.

    Science.gov (United States)

    Zou, Tao; Wu, Chenghan; Fan, Xiaoduo

    2016-06-25

    Mindfulness intervention is a psychotherapy based on the Buddhist practice of meditation, combining the theories and methodology of contemporary psychology. The empirical research in recent years has indicated that mindfulness intervention yields favorable results including reduction of depression relapse, alleviation of the symptoms of depression and anxiety, reduction of substance abuse, relief of pain, blood pressure management, enhancement of immunity, and improvement of sleep. Currently, mindfulness therapy has become the mainstream of psychotherapy in the realm of European and American psychotherapy. The fields of psychology and psychotherapy in China have also begun to introduce mindfulness intervention in recent years. However, there is a lack of relevant practice and research in the field of clinical mental health. This article will briefly introduce the concept of mindfulness, the basic mechanism of the intervention, and the basic skills and guidelines in clinical practice.

  10. DIAGNOSTIC VALUE OF THE DEJA VU PHENOMENON IN THE CLINICAL PICTURE OF GLIAL BRAIN TUMORS

    Directory of Open Access Journals (Sweden)

    Pavel Nikolaevich Vlasov

    2009-01-01

    This investigation was undertaken to study the implication of the DV phenomenon in the clinical picture of glial brain tumors (GBT. One hundred and sixty-one subjects (mean age 29,2±6,4 years; males 47%, including 129 healthy individuals and 32 patients with GBT, were examined. In the clinical picture of GBT with seizures, DV is a common symptom that is encountered in the involvement of predominantly the right temporal lobe and accompanied by generalized convulsive attacks and olfactory hallucinations. DV in GBT occurs more than once daily; its duration is a few (as many as 5 minutes; DV is characterized by a negative emotional tinge and attended by fear

  11. Individualized Quality Control Plan (IQCP): Is It Value-Added for Clinical Microbiology?

    OpenAIRE

    Sharp, Susan E.; Miller, Melissa B.; Hindler, Janet

    2015-01-01

    The Center for Medicaid and Medicare Services (CMS) recently published their Individualized Quality Control Plan (IQCP [https://www.cms.gov/regulations-and-guidance/legislation/CLIA/Individualized_Quality_Control_Plan_IQCP.html]), which will be the only option for quality control (QC) starting in January 2016 if laboratories choose not to perform Clinical Laboratory Improvement Act (CLIA) [U.S. Statutes at Large 81(1967):533] default QC. Laboratories will no longer be able to use “equivalent ...

  12. Mystery of alar ligament rupture: Value of MRI in whiplash injuries - biomechanical, anatomical and clinical studies

    International Nuclear Information System (INIS)

    Bitterling, H.; Brueckmann, H.; Staebler, A.

    2007-01-01

    Purpose: Whiplash injury of the cervical spine is a frequent issue in medical expertise and causes enormous consequential costs for motor insurance companies. Some authors accuse posttraumatic changes of alar ligaments to be causative for consequential disturbances. Materials and methods: Review of recent studies on biomechanics, anatomical and clinical MR imaging. Results: Biomechanical experiments can not induce according injuries of alar ligaments. Although MRI provides excellent visualization of alar ligaments, the range of normal variants is high. (orig.)

  13. Value of Low Triiodothyronine and Subclinical Myocardial Injury for Clinical Outcomes in Chest Pain.

    Science.gov (United States)

    Lee, Young-Min; Ki, Young-Jae; Choi, Dong-Hyun; Kim, Bo-Bae; Shin, Byung Chul; Song, Heesang; Kim, Dong-Min

    2015-11-01

    Low triiodothyronine (T3) levels and subclinical myocardial injury may be associated with adverse cardiac and cerebrovascular (CCV) events in individuals without clinically apparent coronary heart disease (CHD). The aim of this study was to determine the associations of a low T3 level and subclinical myocardial injury with the development of adverse CCV events in individuals without clinically apparent CHD. T3 and high-sensitivity cardiac troponin T (hs-cTnT) levels were analyzed in 250 patients with chest pain free of CHD and heart failure. The primary end point was the composite of sudden cardiac death, ischemic stroke, newly developed atrial fibrillation, pericardial effusion and thrombosis. Throughout a mean follow-up of 15.6 months, the primary end point happened in 17 patients (6.8%). Kaplan-Meier analysis disclosed a notably higher overall occurrence rate in patients with hs-cTnT levels ≥0.014 ng/mL and in patients with T3 <60 ng/dL. An exaggerated hazard was observed in patients with combined high hs-cTnT and low T3 levels. After adjustment, the hazard ratio for overall events in patients with high hs-cTnT/low T3 versus normal hs-cTnT/T3 was 11.72 (95% confidence interval, 2.83-48.57; P = 0.001). In patients with chest pain without clinically obvious CHD, high hs-cTnT combined with low T3 was associated with adverse cardiac/CCV events and was an independent predictor of overall events even after adjustment. These data suggest the importance of systemic factors, such as low T3 syndrome, in the development of adverse cardiac/CCV events beyond advancing clinical atherosclerotic coronary disease in patients with chest pain.

  14. Antibodies to autoantigen targets in myasthenia and their value in clinical practice

    Directory of Open Access Journals (Sweden)

    S. I. Dedaev

    2014-01-01

    Full Text Available Myasthenia gravis is a classic autoimmune disease, which clinical manifestations in the form of weakness and abnormal muscle fatigue, due to the damaging effect of polyclonal antibodies to different structures of the neuromuscular synapse and muscles. The study of autoimmune substrate with myasthenia is routine in many clinics dealing with the problems of neuromuscular pathology, and the identification of high concentration of serum antibodies to a number of antigenic structures is the gold standard in diagnosis.Determination of serum antibodies to various autoimmune targets is an important tool in clinical practice. The majority of patients shows the high concentration of antibodies to AchR that gives the opportunity to use it as an important diagnostic criterion. The specificity of changes in the concentration of AchR-antibodies due to pathogenetic treatment allows to objectify the suppression of autoimmune aggression and evaluate the reliability of remission. However, the absence of AchR-antibodies when there are clear clinical and electromyography signs of myasthenia gravis suggests an autoimmune attack against a number of other targets, the most studied of which is the MuSK. On the contrary, patients with myasthenia gravis associated with thymoma, almost always have a higher level of AchR-antibodies. The presence of thymoma is accompanied by the generation of antibodies to titin and RyR, which is also observed in persons with late-onset myasthenia without thymoma. High concentration of antibodies to these structures can be interpreted as a reliable sign of thymoma in patients younger than 60 years.

  15. Examining the potential clinical value of curcumin in the prevention and diagnosis of Alzheimer's disease.

    Science.gov (United States)

    Goozee, K G; Shah, T M; Sohrabi, H R; Rainey-Smith, S R; Brown, B; Verdile, G; Martins, R N

    2016-02-14

    Curcumin derived from turmeric is well documented for its anti-carcinogenic, antioxidant and anti-inflammatory properties. Recent studies show that curcumin also possesses neuroprotective and cognitive-enhancing properties that may help delay or prevent neurodegenerative diseases, including Alzheimer's disease (AD). Currently, clinical diagnosis of AD is onerous, and it is primarily based on the exclusion of other causes of dementia. In addition, phase III clinical trials of potential treatments have mostly failed, leaving disease-modifying interventions elusive. AD can be characterised neuropathologically by the deposition of extracellular β amyloid (Aβ) plaques and intracellular accumulation of tau-containing neurofibrillary tangles. Disruptions in Aβ metabolism/clearance contribute to AD pathogenesis. In vitro studies have shown that Aβ metabolism is altered by curcumin, and animal studies report that curcumin may influence brain function and the development of dementia, because of its antioxidant and anti-inflammatory properties, as well as its ability to influence Aβ metabolism. However, clinical studies of curcumin have revealed limited effects to date, most likely because of curcumin's relatively low solubility and bioavailability, and because of selection of cohorts with diagnosed AD, in whom there is already major neuropathology. However, the fresh approach of targeting early AD pathology (by treating healthy, pre-clinical and mild cognitive impairment-stage cohorts) combined with new curcumin formulations that increase bioavailability is renewing optimism concerning curcumin-based therapy. The aim of this paper is to review the current evidence supporting an association between curcumin and modulation of AD pathology, including in vitro and in vivo studies. We also review the use of curcumin in emerging retinal imaging technology, as a fluorochrome for AD diagnostics.

  16. [Cancer screening in clinical practice: the value of shared decision-making].

    Science.gov (United States)

    Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

    2010-07-14

    Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

  17. [Who benefits from the night clinic? - Value of a part-time treatment facility].

    Science.gov (United States)

    Stutz, Constanze; Kawohl, Wolfram; Platz, Christoph; Warnke, Ingeborg; Jäger, Matthias

    2017-12-01

    The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting. Data of 253 patients covering a six-year period from 2008 up to 2013 were retrospectively assessed using descriptive methods. Subgroups according to the situation before admission and after discharge were compared. Patients admitted from home differed considerably from those who were transferred from a psychiatric ward concerning sociodemographic and clinical factors. They were more frequently single, unemployed, received disability funds and suffered from a psychotic disorder. They were also more likely to be discharged in a supported housing condition. The night clinic serves as an alternative to full inpatient treatment for individuals who have work as well as a rehabilitative option for homeless patients with severe mental illness. It contributes to a reduction of avoidance of inpatients stays for those groups of patients.

  18. The Value of Clinical Needs Assessments for Point-of-Care Diagnostics.

    Science.gov (United States)

    Weigl, Bernhard H; Gaydos, Charlotte A; Kost, Gerald; Beyette, Fred R; Sabourin, Stephanie; Rompalo, Anne; de Los Santos, Tala; McMullan, Jason T; Haller, John

    2012-06-01

    Most entrepreneurial ventures fail long before the core technology can be brought to the marketplace because of disconnects in performance and usability measures such as accuracy, cost, complexity, assay stability, and time requirements between technology developers' specifications and needs of the end-users. By going through a clinical needs assessment (CNA) process, developers will gain vital information and a clear focus that will help minimize the risks associated with the development of new technologies available for use within the health care system. This article summarizes best practices of the principal investigators of the National Institute of Biomedical Imaging and Bioengineering point-of-care (POC) centers within the National Institute of Biomedical Imaging and Bioengineering POC Technologies Research Network. Clinical needs assessments are particularly important for product development areas that do not sufficiently benefit from traditional market research, such as grant-funded research and development, new product lines using cutting-edge technologies developed in start-up companies, and products developed through product development partnerships for low-resource settings. The objectives of this article were to (1) highlight the importance of CNAs for development of POC devices, (2) discuss methods applied by POC Technologies Research Network for assessing clinical needs, and (3) provide a road map for future CNAs.

  19. Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice.

    Science.gov (United States)

    Katzan, Irene L; Thompson, Nicolas R; Lapin, Brittany; Uchino, Ken

    2017-07-21

    There is uncertainty regarding the clinical utility of the data obtained from patient-reported outcome measures (PROMs) for patient care. We evaluated the incremental information obtained by PROMs compared to the clinician-reported modified Rankin Scale (mRS). This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROMs: Stroke Impact Scale-16 (SIS-16), EQ-5D, Patient Health Questionnaire-9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROMs explained by mRS was determined using r 2 after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c-statistic was evaluated for mRS versus SIS-16. Correlation between PROMs and mRS was highest for SIS-16 ( r =-0.64, P measures. PROMs provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS-16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROMs may be a useful addition to mRS in the assessment of health status in clinical practice. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  20. Predictive value of clinical and laboratory variables for vesicoureteral reflux in children.

    Science.gov (United States)

    Soylu, Alper; Kasap, Belde; Demir, Korcan; Türkmen, Mehmet; Kavukçu, Salih

    2007-06-01

    We aimed to determine the predictability of clinical and laboratory variables for vesicoureteral reflux (VUR) in children with urinary tract infection (UTI). Data of children with febrile UTI who underwent voiding cystoureterography between 2002 and 2005 were evaluated retrospectively for clinical (age, gender, fever > or = 38.5 degrees C, recurrent UTI), laboratory [leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), pyuria, serum creatinine (S(Cr))] and imaging (renal ultrasonography) variables. Children with VUR (group 1) vs. no VUR (group 2) and children with high-grade (III-V) VUR (group 3) vs. no or low-grade (I-II) VUR (group 4) were compared. Among 88 patients (24 male), 38 had VUR and 21 high-grade VUR. Fever > or = 38.5 degrees C was associated with VUR [odds ratio (OR): 7.5]. CRP level of 50 mg/l was the best cut-off level for predicting high-grade VUR (OR 15.5; discriminative ability 0.89 +/- 0.05). Performing voiding cystourethrography based on this CRP level would result in failure to notice 9% of patients with high-grade VUR, whereas 69% of children with no/low-grade VUR would be spared from this invasive test. In conclusion, fever > or = 38 degrees C and CRP > 50 mg/l seem to be potentially useful clinical predictors of VUR and high-grade VUR, respectively, in pediatric patients with UTI. Further validation of these findings could limit unnecessary voiding cystourethrography.

  1. Effects of Ramadan Fasting on Spirometric Values and Clinical Symptoms in Asthmatic Patients

    Directory of Open Access Journals (Sweden)

    Abdolreza Norouzy

    2013-07-01

    Full Text Available Introduction: Ramadan is the 9th Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset. The effect of Ramadan intermittent fasting on asthma control is controversial. The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. Material and Methods: a cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine (19 females and 10 males well-controlled asthmatic patients aged 47 (12 years completed the study. The average duration of fasting was 26.5 days. Assessment of spirometric variables (daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. Results: No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting. Among spirometric variables, only peak expiratory flow improved after Ramadan (p <0.05. There was a reduction in the mean peak expiratory flow variability from 13% at the first week of fasting to 10% at the fourth week (p <0.05. Conclusion: In well-controlled asthmatic patients, Ramadan fasting resulted in improvement in peak expiratory flow and peak expiratory flow variability.

  2. Effects of Ramadan fasting on spirometric values and clinical symptoms in asthmatic patients

    Directory of Open Access Journals (Sweden)

    Abdolreza Norouzy

    2013-03-01

    Full Text Available Introduction: Ramadan is the 9th  Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset.  The effect of Ramadan intermittent fasting on asthma control is controversial.  The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. Material and Methods: a cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine (19 females and 10 males well-controlled asthmatic patients aged 47 (12 years completed the study.  The average duration of fasting was 26.5 days. Assessment of spirometric variables (daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. Results: No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting.  Among spirometric variables, only peak expiratory flow improved after Ramadan (p

  3. The Value of Clinical Needs Assessments for Point-of-Care Diagnostics

    Science.gov (United States)

    Weigl, Bernhard H.; Gaydos, Charlotte A.; Kost, Gerald; Beyette, Fred R.; Sabourin, Stephanie; Rompalo, Anne; de los Santos, Tala; McMullan, Jason T.; Haller, John

    2013-01-01

    Most entrepreneurial ventures fail long before the core technology can be brought to the marketplace because of disconnects in performance and usability measures such as accuracy, cost, complexity, assay stability, and time requirements between technology developers’ specifications and needs of the end-users. By going through a clinical needs assessment (CNA) process, developers will gain vital information and a clear focus that will help minimize the risks associated with the development of new technologies available for use within the health care system. This article summarizes best practices of the principal investigators of the National Institute of Biomedical Imaging and Bioengineering point-of-care (POC) centers within the National Institute of Biomedical Imaging and Bioengineering POC Technologies Research Network. Clinical needs assessments are particularly important for product development areas that do not sufficiently benefit from traditional market research, such as grant-funded research and development, new product lines using cutting-edge technologies developed in start-up companies, and products developed through product development partnerships for low-resource settings. The objectives of this article were to (1) highlight the importance of CNAs for development of POC devices, (2) discuss methods applied by POC Technologies Research Network for assessing clinical needs, and (3) provide a road map for future CNAs. PMID:23935405

  4. Value of 1.0-M gadolinium chelates: review of preclinical and clinical data on gadobutrol

    International Nuclear Information System (INIS)

    Tombach, Bernd; Heindel, Walter

    2002-01-01

    Several preclinical and clinical studies with the first commercially available highly concentrated Gd-chelate gadobutrol (1 mol/l) are reviewed. Physicochemical, pharmacological, and pharmacokinetic properties, safety analysis, as well as experimental and clinical efficacy studies are highlighted in comparison with 0.5-M Gd-chelates. The 1-mol gadobutrol has been proven to be safe in an examined dose range from 0.04 up to 0.5 mmol/kg body weight (b.w.). Even in patients with chronic renal impairment, including hemodialysis, gadobutrol can safely be applied at doses up to 0.3 mmol/kg b.w. For contrast-enhanced MRI in the equilibrium phase, efficacy data analysis shows comparable results to other commercially available extracellular Gd-chelates with lower Gd-concentrations (0.5 M). Studies focused on the potential benefit of a tighter bolus, such as brain perfusion imaging using T2*-effects, document the superiority of a highly concentrated Gd contrast agent. For contrast-enhanced MRA, clinical studies are still ongoing; therefore, the ultimate potential of a more compact bolus, using 1-M Gd-chelates, for contrast-enhanced MRI, has still to be analyzed, especially for time-resolved magnetic resonance angiography. (orig.)

  5. Clinical value of sentinel lymph node diagnostics in head and neck cancer

    International Nuclear Information System (INIS)

    Kampen, W.U.; Hoeft, S.; Maune, S.

    2006-01-01

    The concept of the so-called sentinel lymph node (SLN), being the first node draining a malignant tumor and thus carrying the highest risk of metastatic disease, is already frequently applied in patients suffering from malignant melanoma and breast cancer. It is the aim of this concept, to reduce postoperative morbidity by omitting a conventional lymph node dissection if the SLN is proven to be free of any tumor cells. First clinical studies showed promising results also in patients with head and neck cancer. However, both the anatomical localization of the primary tumor and the very complex lymphatic, frequently bilateral drainage pattern may lead to significant methodological problems. Besides a skilful intraoperative usage of the gamma probe, the precise preoperative staging of the respective patient for determination of the N0 status and the assiduous histopathological analysis of the excised SLN are extremely important to reach a maximum of sensitivity in this clinical setting. This paper summarizes the data published on the SLN concept in patients with head and neck cancer, describes the several methodological aspects of labeling the SLN with radiocolloides and reviews the today's impact of the SLN method in clinical routine. (orig.)

  6. Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

    Science.gov (United States)

    Salimi, Fereshteh; Shahabi, Shahab; Talebzadeh, Hamid; Keshavarzian, Amir; Pourfakharan, Mohammad; Safaei, Mansour

    2017-01-01

    Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis ( P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

  7. The value of the physical examination in clinical practice: an international survey.

    Science.gov (United States)

    Elder, Andrew T; McManus, I Chris; Patrick, Alan; Nair, Kichu; Vaughan, Louella; Dacre, Jane

    2017-12-01

    A structured online survey was used to establish the views of 2,684 practising clinicians of all ages in multiple countries about the value of the physical examination in the contemporary practice of internal medicine. 70% felt that physical examination was 'almost always valuable' in acute general medical referrals. 66% of trainees felt that they were never observed by a consultant when undertaking physical examination and 31% that consultants never demonstrated their use of the physical examination to them. Auscultation for pulmonary wheezes and crackles were the two signs most likely to be rated as frequently used and useful, with the character of the jugular venous waveform most likely to be rated as -infrequently used and not useful. Physicians in contemporary hospital general medical practice continue to value the contribution of the physical examination to assessment of outpatients and inpatients, but, in the opinion of trainees, teaching and demonstration could be improved. © Royal College of Physicians 2017. All rights reserved.

  8. [Is autonomy a universal value principle? The study of concrete clinical cases in perinatology].

    Science.gov (United States)

    Tilmans-Cabiax, Chantal

    2007-09-01

    Certain perinatalogy situations make one confront cultural differences and, in particular, the relative importance of the value of female autonomy. This leads to the following question: should autonomy have as much weight everywhere as it is given in Western health ethics? The passionate, philosophical and historical work by J.B. Schneewind, The Invention of Autonomy: A History of Modern Moral Philosophy, is used to assist in the understanding of the important cultural evolutions which have interacted to support the idea of moral autonomy in the West. This return to our roots brings us, not to question moral autonomy through its claim to universality, but to dare to relativize the modalities according to cultural contexts. And especially to rehabilitate other values--for example caring for one another--prominent in other more community orientated societies in which the West can be inspired.

  9. [Prognostic values of the clinical, morphological and molecular biological characteristics of colon adenocarcinoma].

    Science.gov (United States)

    Raskin, G A; Pozharissky, K M; Orlova, R V; Petrov, S V

    2015-01-01

    to estimate the predictive and prognostic factors using morphological studies in patients with colon cancer to increase survival rates. Immunohistochemical examination was made in 582 patients with colon adenocarcinoma, by determining 11 different indicators relating to the development of the tumor and its treatment. The simultaneous determination of the chemokine receptor CXCR4 and proliferative activity (Ki-67 expression) can define disease prognosis in view of relapse-survival rates in patients with Stage II colon cancer after radical surgical treatment. Thymidylate synthase and thymidine phosphorylase are of predictive value. The immunohistochemical examination of other markers, such as ALDH1, CCR10, ERCC-1, DYPD, topoisomerase II alpha, and class III beta-tubulin for the choice of treatment policy for patients with colon cancer has indicated that they are of no value.

  10. Clinical neurocardiology defining the value of neuroscience‐based cardiovascular therapeutics

    Science.gov (United States)

    Ajijola, Olujimi A.; Anand, Inder; Armour, J. Andrew; Chen, Peng‐Sheng; Esler, Murray; De Ferrari, Gaetano M.; Fishbein, Michael C.; Goldberger, Jeffrey J.; Harper, Ronald M.; Joyner, Michael J.; Khalsa, Sahib S.; Kumar, Rajesh; Lane, Richard; Mahajan, Aman; Po, Sunny; Schwartz, Peter J.; Somers, Virend K.; Valderrabano, Miguel; Vaseghi, Marmar; Zipes, Douglas P.

    2016-01-01

    Abstract The autonomic nervous system regulates all aspects of normal cardiac function, and is recognized to play a critical role in the pathophysiology of many cardiovascular diseases. As such, the value of neuroscience‐based cardiovascular therapeutics is increasingly evident. This White Paper reviews the current state of understanding of human cardiac neuroanatomy, neurophysiology, pathophysiology in specific disease conditions, autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases. PMID:27114333

  11. Clinical diagnostic value of viable Schistosoma japonicum eggs detected in host tissues.

    Science.gov (United States)

    Gu, Kongzhen; Li, Yuesheng; Driguez, Patrick; Zeng, Qingren; Yu, Xinlin; Sun, Hui; Cai, Liting; He, Yongkang; Wang, Wenyang; McManus, Donald P

    2017-04-04

    Schistosomiasis, one of the neglected tropical diseases, is endemic in more than 70 countries. However, the clinical diagnosis of patients with a low degree of infection is an unsolved technical problem. In areas endemic for schistosomiasis japonica, proctoscopy detection of eggs has been one method used for clinical diagnosis. However, it is often a challenge to find typical live eggs and it is difficult to distinguish live eggs from large numbers of partially degraded and/or completely degraded eggs within colon biopsy tissue. To address this problem, we tested six different morphological and biochemical/molecular markers (ALP; morphological characteristics of egg; CalS (calcified substance); AOS (antioxidase); SDHG (succinic dehydrogenase) and SjR2 mRNA (retrotransposons 2 of S.japonicum genome mRNA)), including four new markers (CalS; AOS; SDHG and SjR2 mRNA.), to determine the viability of S. japonicum eggs deposited in human and mouse colon tissues. Our ultimate aim is to obtain a new method that is more sensitive, practical and accurate to clinically diagnose schistosomiasis. Tissue samples were collected from mice at six different time points during S. japonicum infection with or without treatment with praziquantel (PZQ). Four new biochemical or molecular markers were used for the detection of egg viability from mouse liver and intestinal samples: CalS; AOS; SDHG and SjR2 mRNA. Subsequently, all markers were employed for the detection and analysis of eggs deposited in biopsy materials from patients with suspected schistosomiasis japonica for clinical evaluation. Microscopic examination of the egg morphology, worm burden in vivo and ALP (alkaline phosphatase) levels were used as a reference standard to evaluate the sensitivity and reliability of four new markers detecting egg viability. The results of the study showed that the morphology of S. japonicum eggs deposited in tissues of hosts with schistosomiasis, especially cases with chronic schistosomiasis, is

  12. Clinical significance of determination of SAC/PRA value in patients with primary aldosteronism

    International Nuclear Information System (INIS)

    Li Liren; Dai Yaozong; Liu Jiumin

    2003-01-01

    Objective: To investigate the diagnostic significance of determining SAC/PRA valve in hyperaldosteronism. Methods: Plasma renin activity (PRA) and angiotensin (AT-II) as well as serum aldosterone contents were measured with RIA in 48 patients with primary aldosteronism and 30 controls. The SAC/PRA value was calculated. Results: Contents of PRA, AT-II and Aldo in blood of patients with primary aldosteronism were very significantly different from those in controls (p < 0.001) (PRA 0.14 ± 0.08 ng/ml/h vs 0.57 ± 0.08 ng/ml/h; AT-II 21.21 ± 7.55 ng/L vs 36.03 ± 6.11 ng/L; Aldo 1.07 ± 0.34 nmol/L vs 0.33 ± 0.04 nmol/L). Calculated SAC/PRA value was 913 ± 409 (normal upper limit 400). Conclusion: SAC/PRA value is an useful accessory diagnostic criterion for primary aldosteronism

  13. Clinical value of detection of serum β-Crosslaps, PINP and N-MID in postmenopausal women with osteoporosis

    International Nuclear Information System (INIS)

    Ou Mengmeng; Huang Jianrong

    2011-01-01

    To evaluate the clinical value of detection of concentration of β-Crosslaps, PINP and N-MID in postmenopausal women with osteoporosis, 116 postmenopausal women were detected by dual X-ray absorptionmetry and divided into NOP group (51 cases) and OP group (65 cases). The serum levels of three bone markers (β-Crosslaps, PINP and N-MID) were measured. The results showed that serum levels of β-Crosslaps, PINP and N-MID in OP group were significantly higher than that in NOP group (P<0.01). It was suggested that three bone markers level might be closely related with osteoporosis in postmenopausal women. The combined detection of bone markers and bone mineral density has important clinical value in the diagnosis of osteoporosis in postmenopausal women. (authors)

  14. Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values.

    Science.gov (United States)

    Pasquarella, Cesira; Veronesi, Licia; Napoli, Christian; Castiglia, Paolo; Liguori, Giorgio; Rizzetto, Rolando; Torre, Ida; Righi, Elena; Farruggia, Patrizia; Tesauro, Marina; Torregrossa, Maria V; Montagna, Maria T; Colucci, Maria E; Gallè, Francesca; Masia, Maria D; Strohmenger, Laura; Bergomi, Margherita; Tinteri, Carola; Panico, Manuela; Pennino, Francesca; Cannova, Lucia; Tanzi, Marialuisa

    2012-03-15

    A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Sensitivity and predictive value of 15 PubMed search strategies to answer clinical questions rated against full systematic reviews.

    Science.gov (United States)

    Agoritsas, Thomas; Merglen, Arnaud; Courvoisier, Delphine S; Combescure, Christophe; Garin, Nicolas; Perrier, Arnaud; Perneger, Thomas V

    2012-06-12

    Clinicians perform searches in PubMed daily, but retrieving relevant studies is challenging due to the rapid expansion of medical knowledge. Little is known about the performance of search strategies when they are applied to answer specific clinical questions. To compare the performance of 15 PubMed search strategies in retrieving relevant clinical trials on therapeutic interventions. We used Cochrane systematic reviews to identify relevant trials for 30 clinical questions. Search terms were extracted from the abstract using a predefined procedure based on the population, interventions, comparison, outcomes (PICO) framework and combined into queries. We tested 15 search strategies that varied in their query (PIC or PICO), use of PubMed's Clinical Queries therapeutic filters (broad or narrow), search limits, and PubMed links to related articles. We assessed sensitivity (recall) and positive predictive value (precision) of each strategy on the first 2 PubMed pages (40 articles) and on the complete search output. The performance of the search strategies varied widely according to the clinical question. Unfiltered searches and those using the broad filter of Clinical Queries produced large outputs and retrieved few relevant articles within the first 2 pages, resulting in a median sensitivity of only 10%-25%. In contrast, all searches using the narrow filter performed significantly better, with a median sensitivity of about 50% (all P PubMed pages. These results can help clinicians apply effective strategies to answer their questions at the point of care.

  16. MR urography of obstructive uropathy: diagnostic value of the method in selected clinical groups

    Energy Technology Data Exchange (ETDEWEB)

    Zielonko, J.; Studniarek, M. [Department of Radiology, Institute of Radiology and Nuclear Medicine, Medical University of Gdansk, Debinki 7, 80-211 Gdansk (Poland); Markuszewski, M. [Department of Radiology, Clinical Hospital No. 3, Kieturakisa 1, 80-742 Gdansk (Poland)

    2003-04-01

    The aim of the study was to evaluate the role of MR urography (MRU) in the diagnosis of obstructive uropathy in selected groups of patients. The groups involved following pathologies: calculi; strictures of ureteropelvic junction (UPJ); benign and malignancy-induced ureterostenosis. Sixty patients with clinical diagnosis of obstructive uropathy were subjected to static fluid MRU (sMRU) with the use of 3D turbo spin echo (TSE) sequence in a 0.5-T magnet. The examination was completed with conventional MR sequences and in 12 cases additionally with sequences after the administration of Gd-DTPA and excretory MRU. The results were compared with intravenous urography (IVU), CT, US, clinical and histopathological data. The degree of the urinary tract dilatation as well as the level and type of obstruction were estimated. In patients with urolithiasis sMRU correctly depicted the degree of ureterohydronephrosis in 85%, in cases of UPJ stenosis and malignancy-induced ureterostenosis in 100% and in the group of benign ureterostenosis in 91% of patients. Determination of obstruction level in patients with stones was adequate in 92% and in cases of non-calculous ureteral strictures in 100% of patients. The sMRU sequence alone could not specify the nature of obstruction except 1 case of bladder carcinoma. Filling defects in ureters visible on MR urograms were verified with IVU or CT to exclude intrinsic tumours. Completed with conventional MR sequences sMRU enabled the depiction of solid mass or infiltration in 83% cases of malignancy-induced ureterostenosis, and in the remaining groups of patients neoplastic process was excluded in 91%. In conjunction with excretory MRU and conventional MR images sMRU appears to be a highly useful technique in assessment of obstructive uropathy, especially that of non-calculous origin. Among different clinical applications MRU is superior in the evaluation of dilated urinary tract in altered anatomical conditions (e.g. in patients with ileal

  17. The Diagnostic and Prognostic Value of a Dual-Tasking Paradigm in a Memory Clinic.

    Science.gov (United States)

    Nielsen, Malene Schjnning; Simonsen, Anja Hviid; Siersma, Volkert; Hasselbalch, Steen Gregers; Hoegh, Peter

    2018-01-01

    Daily living requires the ability to perform dual-tasking. As cognitive skills decrease in dementia, performing a cognitive and motor task simultaneously become increasingly challenging and subtle gait abnormalities may even be present in pre-dementia stages. Therefore, a dual-tasking paradigm, such as the Timed Up and Go-Dual Task (TUG-DT), may be useful in the diagnostic assessment of mild cognitive impairment (MCI). To investigate the diagnostic and prognostic ability of a dual-tasking paradigm in patients with MCI or mild Alzheimer's disease (AD) and to evaluate the association between the dual-tasking paradigm and cerebrospinal fluid (CSF) AD biomarkers. The study is a prospective cohort study conducted in a clinical setting in two memory clinics. Eighty-six patients were included (28 MCI, 17 AD, 41 healthy controls (HC)). The ability to perform dual-tasking was evaluated by the TUG-DT. Patients underwent a standardized diagnostic assessment and were evaluated to determine progression yearly. ROC curve analysis illustrated a high discriminative ability of the dual-tasking paradigm in separating MCI patients from HC (AUC: 0.78, AUC: 0.82) and a moderate discriminative ability in separating MCI from AD (AUC: 0.73, AUC: 0.55). Performance discriminated clearly between all groups (p paradigm for progression and rate of cognitive decline. A moderately strong correlation between the dual-tasking paradigm and CSF AD biomarkers was observed. In our study, we found that patients with MCI and mild AD have increasing difficulties in dual-tasking compared to healthy elderly. Hence, the dual-tasking paradigm may be a potential complement in the diagnostic assessment in a typical clinical setting.

  18. Diagnosis of early sacroiliitis in seronegative spondyloarthropathies by DWI and correlation of clinical and laboratory findings with ADC values

    Energy Technology Data Exchange (ETDEWEB)

    Gezmis, Esin; Donmez, Fuldem Y., E-mail: fuldemyildirim@yahoo.com; Agildere, Muhtesem

    2013-12-01

    Purpose: Sacroiliitis is one of the diagnostic criteria of seronegative SpA. The purpose of our study is to show the signal characteristics of the sacral and iliac surfaces by DWI which may contribute in early diagnosis of sacroiliitis and investigate the correlation between ADC values and clinical and laboratory parameters. Materials and methods: 62 patients with inflammatory low back pain, with a history or suspect of seronegative SpA are enrolled into the study. 40 age and sex-matched subjects without SpA constituted the control group. After obtaining routine T1 and T2 weighted sequences, echo planar imaging at b values of 0, 400 and 800 was performed. ADC values on both surfaces of the both sacroiliac joints were measured in all subjects. The CRP and sedimentation results and the presence of arthritis and enthesitis were also correlated with the ADC values. Results: ADC values on both surfaces of the both sacroiliac joints were found 0.23 × 10{sup −3} mm{sup 2}/sn in the control group. In the patient group, mean ADC value of 0.48 × 10{sup −3} mm{sup 2}/sn was obtained (p < 0.001), which was statistically significant, compatible with the increased diffusion due to medullary edema in early sacroiliitis. There was a slight correlation between CRP and ADC values; presumed to be showing the relation between the activity of the disease and the active inflammation on DWI. There was no correlation between arthritis and enthesitis and the ADC values (p > 0.001). Conclusion: DWI, by measuring ADC values, adds significant information in the early diagnosis of sacroiliitis and may help to evaluate the efficiency of the treatment.

  19. The clinical value of 14C-urea breath test for diagnosis of helicobacter pylori infection

    International Nuclear Information System (INIS)

    Zhang Shuwen; Zhang Yongxian; Zhang Jinming; Ding Yong; Shao Mingzhe; Liu Zilai; Tian Jiahe

    2003-01-01

    The purpose of this study is to evaluate a rapid microdose 14 C-urea breath test ( 14 C-UBT) with a simplified protocol for detecting the infection of helicobacter pylori (HP). 244 fasting patients with upper gastrointestinal symptoms undergo the 14 C-UBT and 124 cases appear positive. 89 patients of those undergo upper gastrointestinal endoscopy and confirmed as HP infection. The sensitivity and specificity of the 14 C-UBT is 100% when compared with the endoscopy. The test has good diagnostic accuracy with minimal radiation exposure and low cost. Thus, the test is reliable, safe, convenient and cost-effective to clinical use

  20. CLINICAL VALUE OF METFORMIN IN APPLICATION AGAINST DIABETES AND OBESITY IN CHILDREN AND TEENAGERS

    Directory of Open Access Journals (Sweden)

    E.E. Petryaikina

    2009-01-01

    Full Text Available The Type 1 and Type 2 diabetes mellitus spread is growing up among children. This article highlights the data on the disease epidemiology, etiology, risk factors of the progression, clinical run and complications. Special attention is paid to the obesity as a condition, which most often accompanies insulin resistance and diabetes formation; the authors consider also prevention opportunities. The tactics of the management of patient with the said pathology is also highlighted here.Key words: diabetes, insulin resistance, disturbed tolerance to glucose, obesity, treatment, children.

  1. Clinical value of radiological methods in evaluation and therapy of severe thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Glinz, W.

    1987-09-01

    Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm.

  2. Clinical value of radiological methods in evaluation and therapy of severe thoracic trauma

    International Nuclear Information System (INIS)

    Glinz, W.

    1987-01-01

    Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm. (orig.)

  3. Three-Year Analysis of Value and Utilization After Development of an Ultrasound-Based Orthopedic Injection Clinic.

    Science.gov (United States)

    Dukes, Chase; Melton, Thomas; Turner, Eric; Jackson, Andrew; Grassbaugh, Jason; Slevin, John; Arrington, Edward D; Eichinger, Josef K

    2017-09-01

    Sonography is an effective method of diagnosing and treating musculoskeletal conditions, and the use of ultrasound has been shown to improve the accuracy, safety, and efficacy of both therapeutic and diagnostic injections. In 2012, we established an injection clinic at our institution to address our growing need for diagnostic and therapeutic injections. We performed an analysis of value and utilization following the development of an orthopedic injection clinic. This included an evaluation of the cost of materials, equipment, and training required to develop and run the clinic, and an analysis of the services rendered and relative value units (RVUs) generated over 3 fiscal years (FYs). The cost to develop the clinic was $42,498.30. The cost to run the clinic thereafter was $16.90 to $21.60 per injection. By the end of FY 2012, 60% of providers performed at least 1 injection under ultrasound guidance. Every successive year thereafter, 100% of providers were using ultrasound guidance. In FY 2012, we performed 738 injections, 5.4% used ultrasound guidance and generated a total of 1,786.36 RVUs. In FY 2013, we performed 1,814 injections, 17.6% used ultrasound guidance, and generated a total of 7,224.5 RVUs. In FY 2014, we performed 2,821 injections, 25.2% used ultrasound guidance, and generated 13,786.82 RVUs. RVUs generated solely from ultrasound guided injections were 463.2 (2012), 3,694 (2013), 8,221.8 (2014). Injection accuracy was at least 98%. Average time until injection was 0 days. The cost to start an injection clinic is modest, with the potential for large annual growth and early return on investment, and can generate significant revenue by recapturing RVUs that would otherwise be lost to outside referrals. Furthermore, it helps to increase clinic throughput, maximize services rendered during a single patient visit improving the overall quality of their encounter, expands the clinical practice of our midlevel providers, offloads clinical time for surgical

  4. Clinical value of measurement of pulmonary radioaerosol mucociliary clearance in the work up of primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Munkholm, Mathias; Nielsen, Kim Gjerum; Mortensen, Jann

    2015-01-01

    BACKGROUND: We aimed to evaluate and define the general clinical applicability and impact of pulmonary radioaerosol mucociliary clearance (PRMC) on the work up of patients suspected of having primary ciliary dyskinesia (PCD). In addition, we wanted to evaluate the accuracy of the reference values...... primarily to results from nasal ciliary function testing, to electron microscopic (EM) examination of the ultrastructure of the cilia, and to the final clinical diagnosis. RESULTS: Of the 239 patients, 27 ended up with a final clinical diagnosis of definitive PCD. No patients with a PRMC test...... of the entire lung. Its greatest strength is its ability to reject a suspected PCD diagnosis with great certainty. In our material, this accounted for 2/3 of referred patients. In addition, the test has a high rate of conclusive results. According to our analyses, reference equations on children would benefit...

  5. Plasma biochemical reference values in clinically healthy captive bearded dragons (Pogona vitticeps) and the effects of sex and season.

    Science.gov (United States)

    Tamukai, Kenichi; Takami, Yoshinori; Akabane, Yoshihito; Kanazawa, Yuko; Une, Yumi

    2011-09-01

    Bearded dragons are one of the most popular pet lizard species, and biochemical reference values are useful for health management of these reptiles. The objectives of this study were to measure plasma biochemical values in healthy captive bearded dragons, determine reference values, and evaluate the effects of sex and season on the results. Blood samples were collected from 100 captive healthy bearded dragons in Tokyo during the summer and winter. Plasma biochemical measurements were performed using a dry-slide automated biochemical analyzer. The data were then compared based on sex and season using 2-way ANOVA. Globulin, cholesterol, and calcium concentrations of females were higher in both summer and winter compared with the values obtained for males. Both males and females had higher uric acid concentrations in winter than in summer. When compared with males, females had a higher chloride concentration in summer and a higher total protein concentration and aspartate aminotransferase activity in winter. Potassium concentration in males was lower in winter than in summer, whereas in females cholesterol concentration was lower in winter than in summer. Biochemical values that differed based on sex and season in bearded dragons were similar to those in other lizards. These differences reflect physiologic differences in reproductive status in females and seasonal changes in temperature and hydration status. Plasma biochemical values established for bearded dragons in this study will be useful in the diagnostic assessment of captive animals. ©2011 American Society for Veterinary Clinical Pathology.

  6. A clinical study of temporomandibular disorder. The value of bone scintigraphy as an aid to diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Sugiura, Masashi [Nippon Dental Univ. (Japan). School of Dentistry at Niigata

    2000-07-01

    Temporomandibular disorder (TMD) is still not defined with respect to the point of an entity, terminological problems, and clinical classification and gradings. Moreover, diagnostic problems of internal deranegement and osteodeformity at the temporomandibular joint such as type IV and mechanism of bone remodeling at condylar head are also still not clear. In this investigation, we tried to classify the severity and progressive grading according to the symptoms and objective laboratory data taken from soft tissues such as muscles related to mastication, discs and ligaments, and hard tissues such as condylar head and temporal bone changes around the temporomandibular joint. Preliminary diagnostic clinical tool of the assessment of temporomandibular joint by maens of bone scintigraphy was attributed to the additional diagnostic procedure and research for the bone remodeling for the temporomandibular disorder because this can be defined between subjective and objective symptoms in this disorder. Bone scintigraphy will solve many problems concerning undefined degenerative bone changes in TMD, enable more accurate diagnosis, and the selection of treatment and prognosis in future investigation. Also, it is believed single photon emission computed tomography (SPECT) nuclear bone imaging is a highly accurate diagnostic method for craniomandibular disorders. (author)

  7. The protective value of parental sex education: a clinic-based exploratory study of adolescent females.

    Science.gov (United States)

    Crosby, Richard A; Hanson, Amy; Rager, Kristin

    2009-06-01

    This exploratory study compared the impact of sex education provided by parents to female adolescents against the same education provided in formal settings to female adolescents. Females, 16-24 years old, attending an adolescent medicine clinic in an urban area of the South were recruited prior to examination. Each patient completed an anonymous self-administered questionnaire. Data from 110 respondents were analyzed to compare those indicating they had learned about each of four topics from parents to those not indicating learning about all four topics from a parent. The same process was repeated relative to learning about the four topics in formal educational settings. In controlled, multivariate, analyses, adolescents not communicating with parents on all four topics were nearly five times more likely to report having multiple sex partners in the past three months. Further, these adolescents were 3.5 times more likely to have low self-efficacy for condom negotiation, 2.7 times more likely to report ever using alcohol or drugs before sex, and about 70% less likely to have ever talked about HIV prevention with a partner before engaging in sex. Differences relative to learning about the four topics in formal settings were not found. Findings suggest that teen females (attending teen clinics) may experience a protective benefit based on communication with parents. This protective effect was not observed for education delivered in formal settings.

  8. A clinical study of temporomandibular disorder. The value of bone scintigraphy as an aid to diagnosis

    International Nuclear Information System (INIS)

    Sugiura, Masashi

    2000-01-01

    Temporomandibular disorder (TMD) is still not defined with respect to the point of an entity, terminological problems, and clinical classification and gradings. Moreover, diagnostic problems of internal deranegement and osteodeformity at the temporomandibular joint such as type IV and mechanism of bone remodeling at condylar head are also still not clear. In this investigation, we tried to classify the severity and progressive grading according to the symptoms and objective laboratory data taken from soft tissues such as muscles related to mastication, discs and ligaments, and hard tissues such as condylar head and temporal bone changes around the temporomandibular joint. Preliminary diagnostic clinical tool of the assessment of temporomandibular joint by maens of bone scintigraphy was attributed to the additional diagnostic procedure and research for the bone remodeling for the temporomandibular disorder because this can be defined between subjective and objective symptoms in this disorder. Bone scintigraphy will solve many problems concerning undefined degenerative bone changes in TMD, enable more accurate diagnosis, and the selection of treatment and prognosis in future investigation. Also, it is believed single photon emission computed tomography (SPECT) nuclear bone imaging is a highly accurate diagnostic method for craniomandibular disorders. (author)

  9. On being supervised: getting value from a clinical supervisor and making the relationship work when it is not.

    Science.gov (United States)

    Parker, Stephen; Suetani, Shuichi; Motamarri, Balaji

    2017-12-01

    The importance of clinical supervision is emphasised in psychiatric training programs. Despite this, the purpose and processes of supervision are often poorly defined. There is limited guidance available for trainees about their role in making supervision work. This paper considers the nature of supervision in psychiatric training and provides practical advice to help supervisees take active steps to make supervision work. In obtaining value from supervision, the active role of the supervisee in seeking feedback, finding value in criticism and building autonomy is emphasised. Additionally, the importance of exploring what value a supervisor can offer and maintaining realistic expectations is considered. Trainees can benefit from taking an active role in planning and managing their supervision to maximise their learning.

  10. On the clinical value of thallium 201 myocardial scintigraphy with special consideration of Bayes' theorem

    International Nuclear Information System (INIS)

    Glinz, B.

    1986-01-01

    304 patients (263 men, 41 women) at ages 21-69 years were studied by means of thallium 201 myocardial scintigraphy as well as by coronary angiography and laevography between the years 1978 and 1982. As a result of the coronal angiographic findings alone 146 patients (48%) were found to have coronary heart disease with lumen constrictions of 75%, and 194 patients (64%) with over 50% constriction. The thallium scintigraphy delivered quite positive results (96%) with patients with stenoses of greater than 75% and with patients with stenoses of greater than 50% it was still high (92%). The observation of individual vessels shows that LM-, RIVA- and RCA-constrictions can be diagnosed with an approximately similar sensitivity (83-89%), whereas for the RCX-constrictions, as by other authors, a clearly poorer value is found (54,1%). The view expressed by several authors, that 3-vessel diseases as a result of nonhomogeneous reduced deposition are not comprehensible by thallium scintigraphy, could be refuted. The relatively poor specificity we believe for one thing was as a result of the high disease prevalence in our group of patients. For another, the somewhat rigid limit definitions between hemodynamic effectiveness and non-effectiveness seemed to negatively influence the specificity. With the inclusion of patients with less stenosis in combination with pathological laevographs the value increased to 80,0%. (orig./MG) [de

  11. Clinical and prognostic value of the C-Met/HGF signaling pathway in cervical cancer.

    Science.gov (United States)

    Boromand, Nadia; Hasanzadeh, Malihe; ShahidSales, Soodabeh; Farazestanian, Marjaneh; Gharib, Masoumeh; Fiuji, Hamid; Behboodi, Negin; Ghobadi, Niloofar; Hassanian, Seyed Mahdi; Ferns, Gordon A; Avan, Amir

    2018-06-01

    Aberrant activation of the HGF/c-Met signalling pathway is reported to be associated with cell proliferation, progression, and metastasis features of several tumor types, including cervical cancer, suggesting that it may be of potential value as a novel therapeutic target. Furthermore, HPV-positive patients had a higher serum level of HGF or c-Met protein, compared with HPV-negative patients. c-Met or HGF overexpression in lesions of cervical cancer is reported to be related to a poorer prognosis, and hence this may be of value as a prognostic and predictive biomarker. Several approaches have been developed for targeting HGF and/or c-Met. One of these is crizotinib (a dual c-Met/ALK inhibitor). This has been approved by FDA for the treatment of lung-cancer. Further investigations are required to evaluate and optimize the use of c-Met inhibitors in cervical cancer or parallel targeting signalling pathway associated/activated via MET/HGF pathway. The main aim of current review was to give an overview of the potential of the c-Met/HGF pathway as a prognostic, or predictive biomarker in cervical cancer. © 2017 Wiley Periodicals, Inc.

  12. Acute interventional diagnosis and treatment of upper gastrointestinal arterial hemorrhage: its clinical value and influence factors

    International Nuclear Information System (INIS)

    Wang Yongli; Cui Shitao; Zhang Jiaxing; Ru Fuming; Xu Jiahua; Xu Jichong

    2009-01-01

    Objective: To evaluate emergent angiography and interventional management in treating massive upper gastrointestinal (GI) arterial hemorrhage, and to discuss the factors influencing the angiographic bleeding signs and the interventional therapeutic results. Methods: The clinical data of 56 patients with massive upper GI arterial hemorrhage, who underwent diagnostic arteriography and interventional management with trans-catheter vasopressin infusion and embolization, were retrospectively analyzed. Systolic blood pressure of both pre-and post-interventional therapy was recorded and statistically analyzed. The arteriographic positive rates were separately calculated according to the catheter tip's location, being placed at the 2nd grade branch or at the 3 rd -4 th grade branch of the artery, and the relation of the positive rate with the tip's location was analyzed. A comparison of the hemostatic effect between trans-catheter vasopressin infusion and trans-catheter embolization was made. Results: The average systolic blood pressure of pre-and post-procedure was (93.14 ± 18.63) mmHg and (11.64 ± 13.61) mmHg respectively, with a significant difference (P = 0.023). The angiographic bleeding signs were demonstrated in 12 cases (21.4%) with the catheter's tip at the 2nd grade branch and in 56 cases (100%) with the catheter's tip at the 3 rd -4 th grade branch,the difference between the two was of statistically significance (P < 0.05). The technical success rate and the clinical hemostasis rate of via catheter vasopressin infusion was 80% (16 / 20) and 55% (11/20) respectively. Of nine re-bleeding cases, seven were successfully controlled with embolization therapy by using microcatheter and two had to receive surgery because of arterial rupture which was proved by angiography. The technical and the clinical rates of success for transcatheter embolization therapy were 93% (42 / 45) and 89% (40 / 45) respectively. Recurrence of bleeding was seen in two patients who got

  13. Seasonal changes in chemical composition and nutritive value of native forages in a spruce-hemlock forest, southeastern Alaska.

    Science.gov (United States)

    Thomas A. Hanley; Jay D. McKendrick

    1983-01-01

    Twenty-two forages from Admiralty Island, southeastern Alaska, were monitored bimonthly for one year to assess seasonal changes in their chemical composition: neutral detergent fiber, acid detergent fiber, cellulose, lignin/cutin, invitro dry-matter digestibility, total nitrogen, phosphorus, potassium, calcium, magnesium, sodium, copper, manganese, iron, and zinc....

  14. Personalized pain medicine: the clinical value of psychophysical assessment of pain modulation profile.

    Science.gov (United States)

    Granovsky, Yelena; Yarnitsky, David

    2013-01-01

    Experimental pain stimuli can be used to simulate patients' pain experience. We review recent developments in psychophysical pain testing, focusing on the application of the dynamic tests-conditioned pain modulation (CPM) and temporal summation (TS). Typically, patients with clinical pain of various types express either less efficient CPM or enhanced TS, or both. These tests can be used in prediction of incidence of acquiring pain and of its intensity, as well as in assisting the correct choice of analgesic agents for individual patients. This can help to shorten the commonly occurring long and frustrating process of adjusting analgesic agents to the individual patients. We propose that evaluating pain modulation can serve as a step forward in individualizing pain medicine.

  15. Personalized Pain Medicine: The Clinical Value of Psychophysical Assessment of Pain Modulation Profile

    Directory of Open Access Journals (Sweden)

    Yelena Granovsky

    2013-10-01

    Full Text Available Experimental pain stimuli can be used to simulate patients’ pain experience. We review recent developments in psychophysical pain testing, focusing on the application of the dynamic tests—conditioned pain modulation (CPM and temporal summation (TS. Typically, patients with clinical pain of various types express either less efficient CPM or enhanced TS, or both. These tests can be used in prediction of incidence of acquiring pain and of its intensity, as well as in assisting the correct choice of analgesic agents for individual patients. This can help to shorten the commonly occurring long and frustrating process of adjusting analgesic agents to the individual patients. We propose that evaluating pain modulation can serve as a step forward in individualizing pain medicine.

  16. Added clinical value of applying myocardial deformation imaging to assess right ventricular function.

    Science.gov (United States)

    Sokalskis, Vladislavs; Peluso, Diletta; Jagodzinski, Annika; Sinning, Christoph

    2017-06-01

    Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use. © 2017, Wiley Periodicals, Inc.

  17. The clinical value of X-ray images of the teeth and jaws

    International Nuclear Information System (INIS)

    Brocklebank, Laetitia

    2003-01-01

    X-ray images of the teeth and jaws are required for a variety of diagnostic purposes to supplement a clinical examination, and are invaluable for providing pictorial information about the structures that cannot be examined with direct vision. They can be acquired using traditional film systems which produce analogue images, or using a variety of alternative image receptors which result in a digital image. Irrespective of the method of image acquisition they are utilised by the dental surgeon in order to benefit their patients' management. Numerous disease processes can affect the teeth and jaws, in addition to a range of developmental abnormalities. These can be classified according to a radiological sieve, which also includes artefactual and iatrogenic features. The key components of the classification are: developmental, inflammatory, traumatic, cystic, neoplastic, osteodystrophies and systemic disorders. This paper will utilise examples of radiographic images of patients to illustrate components of this classification which are unique to the teeth and jaws

  18. Predictive value of eosinophils and neutrophils on clinical effects of ICS in COPD

    DEFF Research Database (Denmark)

    Hartjes, Floor J; Vonk, Judith M; Faiz, Alen

    2018-01-01

    BACKGROUND AND OBJECTIVE: Inflammation is present to a variable degree and composition in patients with COPD. This study investigates associations between both eosinophils and neutrophils in blood, sputum, airway wall biopsies and bronchoalveolar lavage (BAL) and their potential use as biomarkers...... and BAL were evaluated at baseline. In addition, at baseline, 6 and 30 months, forced expiratory flow in 1 s (FEV1 ), residual volume/total lung capacity (hyperinflation) and Clinical COPD Questionnaire were evaluated. RESULTS: Cross-sectional analyses at baseline showed that higher blood eosinophils were...... significantly associated with higher eosinophil counts in sputum, biopsies and BAL. However, blood neutrophils did not significantly correlate with neutrophil counts in the other compartments. Baseline eosinophils and neutrophils, in whichever compartment measured, did not predict longitudinal FEV1 changes...

  19. Clinical value of 64-slice spiral CT for classification of femoral neck fracture

    International Nuclear Information System (INIS)

    Zhu Jiangtao; Gong Jianping; Cai Wu; Zhu Jianbing; Chen Guangqiang; Qian Minghui

    2011-01-01

    Objective: To evaluate the clinical application of 64-slice spiral CT for classification of femoral neck fracture. Methods: The survey was comprised of 46 patients with femoral neck fractures detected with plain radiographs and CT images. Cases were randomly presented in 2 formats: plain radiographs and CT. Garden classification was queried. Modification of garden classification (nondisplaced vs displaced) was taken to compare with plain radiographs and CT in the study. Results: The results of classification for plain radiographs were 2 cases of Garden Ⅰ, 10 cases of Ⅱ, 22 cases of Ⅲ, and 12 cases of Ⅳ. Those for CT were 1 cases of Garden Ⅰ, 4 cases of Ⅱ, 26 cases of Ⅲ, and 15 cases of Ⅳ. CT improved the accuracy of Garden Classification (P<0.05). Conclusion: Garden classification using CT images shows good conformation with results of surgery. 64-Slic CT is better plain radiographs for Garden classification of femoral neck fracture. (authors)

  20. Clinical value of combined determining leptin, T and E2 in male teenager obesity patients

    International Nuclear Information System (INIS)

    Bai Zhenlian; Lv Tongqin; Wu Qiuhua

    2006-01-01

    To study clinical significance of combined detection of leptin, T and E 2 for teenager obesity patients, levels of leptin, T and E 2 in male teenagers obesity patients and male adult obesity patients were determined by RIA. The result showed that in all obesity patients, the levels of leptin and E 2 were much higher than those in normal controls and T was lower than that in normal controls. After treatment, leptin and E 2 were decreased and T was increased significantly in teenager obesity patients, but only leptin was decreased in adult obesity patients. All results indicate that combined detection of leptin, T and E 2 could find endocrine and metabolism disorder of obese teenagers at early stage, instituting prevention and treatment without delay.(authors)

  1. Estimation of the prognostic value of some clinical factors and mammographical signs in breast cancer

    International Nuclear Information System (INIS)

    Luczynska, E.; Aniol, J.; Dyczek, S.; Mitus, J.; Stelmach, A.; Sokolowski, A.

    2006-01-01

    The aim of the work is to assess the probability of the breast cancer occurrence on the basis of analysis of the clinical and mammographical factors in women with unpalpable breast tumor. In the period from the 1 st February 1995 to the 31 st August 2000, 163 surgical procedures for the removal of any lesions in the breasts were conducted, after being previously marked by localized needle, in women who earlier underwent mammography exam.Following data was taken into consideration: patients age, type of the breast structure; side of the breast, where the lesion was localized in the mammography exam; localized lesions depending on the quadrant; shape of the lesion; size of the lesion in millimeters; presence and the type of microcalcifications. 1. The only one population factor, which can be distinguished as characteristic for the women suffering from the breast cancer impalpable in clinical testing, is the age of the patient, because the breast cancer in these women more frequently occurs after 53 years of age. 2. On the basis of our own material the following radiological symptoms characteristic for the breast cancer in mammography exam were stated: the breast cancer is more frequently found in the upper external quadrant; all lesions, which in mammography exam were identified as multifocal and radiologically suspected in histopathology exam turned out to be the cancer; pleomorphic microcalcifications are characteristic for the malignant lesions; external outline and the shape of the lesion are the features, which allow to differentiate malignant and benign lesions. 3. The analysis of the material indicates that the greatest probability of the breast cancer occurrence is in case of the four risk factors occurrence simultaneously, and the smallest in case of only one risk factor occurrence. (author)

  2. Clinical spectrum and diagnostic value of antibodies against the potassium channel-related protein complex☆

    Science.gov (United States)

    Montojo, M.T.; Petit-Pedrol, M.; Graus, F.; Dalmau, J.

    2016-01-01

    Introduction Antibodies against a protein complex that includes voltage-gated potassium channels (VGKC) have been reported in patients with limbic encephalitis, peripheral nerve hyperexcitability, Morvan's syndrome, and a large variety of neurological syndromes. Review summary In this article, a review is presented of the syndromes associated with antibodies against VGKC-related proteins and the main antigens of this protein complex, the proteins LGI1 (leucine rich glioma inactivated protein 1) and Caspr2 (contactin-associated protein-like 2). The conceptual problems and clinical implications of the description of antibodies against VGKC-related proteins other than LGI1 and Caspr2 are also discussed. Although initial studies indicated the occurrence of antibodies against VGKC, recent investigations have shown that the main antigens are a neuronal secreted protein known as LGI1 which modulates synaptic excitability, and a protein called Caspr2 located on the cell surface and processes of neurons of different brain regions, and at the juxtaparanodal region of myelinated axons. While antibodies against LGI1 preferentially associate with classical limbic encephalitis, antibodies against Caspr2 associate with a wider spectrum of symptoms, including Morvan's syndrome, peripheral nerve hyperexcitability or neuromyotonia, and limbic or more extensive encephalitis. In addition there are reports of patients with antibodies against VGKC-related proteins that are different from LGI1 or Caspr2. In these cases, the identity and location of the antigens are unknown, the syndrome association is not specific, and the response to treatment uncertain. Conclusions The discovery of antigens such as LGI1 and Caspr2 has resulted in a clinical and molecular definition of the broad group of diseases previously attributed to antibodies against VGKC. Considering the literature that describes the presence of antibodies against VGKC other than LGI1 and Caspr2 proteins, we propose a practical

  3. Drugs and having babies: an exploration of how a specialist clinic meets the needs of chemically dependent pregnant women.

    Science.gov (United States)

    Morris, Michelle; Seibold, Carmel; Webber, Ruth

    2012-04-01

    to explore the extent to which a specialist clinic meets the needs of chemically dependent women. a critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault. a specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia. a purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic. Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits. similar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the 'normal' expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were 'hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum

  4. CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Zueco Zueco, Carmen; Sobrido Sampedro, Carolina; Corroto, Juan D.; Rodriguez Fernandez, Paula; Fontanillo Fontanillo, Manuela [Complexo Hospitalario Universitario de Vigo - CHUVI, Vigo, Pontevedra (Spain)

    2012-06-15

    To determine the positive predictive value (PPV) for polyps {>=}6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience. 1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience. Per-polyp PPV for detected lesions of {>=}6 mm, 6-9 mm, {>=}10 mm and {>=}30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients. CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions {>=}6 mm and is well accepted by patients. circle Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients circle Cathartic-free faecal tagging CTC yields high positive predictive values circle CTC without cathartic preparation could improve uptake of colorectal cancer screening. (orig.)

  5. Is a comparative clinical trial for breast cancer tumor markers to monitor disease recurrence warranted? A value of information analysis.

    Science.gov (United States)

    Thariani, Rahber; Henry, Norah Lynn; Ramsey, Scott D; Blough, David K; Barlow, Bill; Gralow, Julie R; Veenstra, David L

    2013-05-01

    Breast cancer tumor markers are used by some clinicians to screen for disease recurrence risk. Since there is limited evidence of benefit, additional research may be warranted. To assess the potential value of a randomized clinical trial of breast tumor marker testing in routine follow-up of high-risk, stage II-III breast cancer survivors. We developed a decision-analytic model of tumor marker testing plus standard surveillance every 3-6 months for 5 years. The expected value of sample information was calculated using probabilistic simulations and was a function of: the probability of selecting the optimal monitoring strategy with current versus future information; the impact of choosing the nonoptimal strategy; and the size of the population affected. The value of information for a randomized clinical trial involving 9000 women was US$214 million compared with a cost of US$30-60 million to conduct such a trial. The probability of making an alternate, nonoptimal decision and choosing testing versus no testing was 32% with current versus future information from the trial. The impact of a nonoptimal decision was US$2150 and size of population impacted over 10 years was 308,000. The value of improved information on overall survival was US$105 million, quality of life US$37 million and test performance US$71 million. Conducting a randomized clinical trial of breast cancer tumor markers appears to offer a good societal return on investment. Retrospective analyses to assess test performance and evaluation of patient quality of life using tumor markers may also offer valuable areas of research. However, alternative investments may offer even better returns in investments and, as such, the trial concept deserves further study as part of an overall research-portfolio evaluation.

  6. Added Diagnostic Value of 11C-PiB-PET in Memory Clinic Patients with Uncertain Diagnosis

    Directory of Open Access Journals (Sweden)

    K.S. Frederiksen

    2012-12-01

    Full Text Available Introduction: The added diagnostic value of 11C-PiB-PET for the assessment of the accumulation of cortical beta-amyloid in memory clinic patients with uncertain diagnosis remains undetermined. Methods: All patients who underwent PiB-PET at the Copenhagen Memory Clinic between March 2008 and November 2011 were included in this uncontrolled, retrospective study. The standard diagnostic evaluation program included physical and neurological examination, cognitive and functional assessment, a cranial CT or MRI, functional imaging and cerebrospinal fluid sampling. Based on anonymized case reports, three experienced clinicians reached a consensus diagnosis and rated their confidence in the diagnosis before and after disclosure of PiB-PET ratings. PiB-PET scans were rated as either positive or negative. Results: A total of 57 patients (17 females, 30 males; age 65.7 years, range 44.2–82.6 were included in the study. Twenty-seven had a positive PiB-PET scan. At the first diagnostic evaluation, 16 patients were given a clinical Alheimer’s disease diagnosis (14 PiB positive. Of the 57 patients, 13 (23% were diagnostically reclassified after PiB-PET ratings were disclosed. The clinicians’ overall confidence in their diagnosis increased in 28 (49% patients. Conclusion: PiB-PET adds to the specialist clinical evaluation and other supplemental diagnostic investigations in the diagnostic classification of patients with uncertain diagnosis in a specialized memory clinic.

  7. Diagnostic and prognostic value of asphyxia, Sarnat's clinical classification, and CT-scan in perinatal brain damage

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Toshihide; Wakita, Yoshiharu; Kubonishi, Sakae; Yoshikawa, Seishi (Kochi Prefectural Central Hospital (Japan)); Ito, Toshiyuki; Okada, Yasusuke

    1990-11-01

    A retrospective review was made of 145 babies, excluding those with congenital heart disease or chromosome aberration, admitted for CT scanning. The study was done to determine the diagnostic and prognostic value of CT findings, as well as the presence of asphyxia and the clinical stage based on the Sarnat's classification, in perinatal brain damage. The patients had a minimum follow up of 2 years for the evaluation of neurologic manifestations, such as cerebral palsy, epilepsy and mental retardation. Among babies weighing 2,000 g or more at birth, neonatal asphyxia was significantly correlated with neurologic prognosis. In addition, both clinical stages and CT findings were significantly correlated with neurologic prognosis, irrespective of birth weight. The correlation between clinical stages and CT findings was significant, irrespective of body weight, however, a significant correlation between clinical stages and neonatal asphyxia was restricted to those weighing 2,000 g or more. These findings suggest that the presence of asphyxia, clinical stages and CT findings are complementary in the diagnosis and prognosis evaluation of perinatal brain damage. (N.K.).

  8. Clinical value of FDG-PET in cutaneous malignant melanoma: First experience in Estonia

    International Nuclear Information System (INIS)

    Nazarenko, S.; Niin, M.; Paats, A.; Tonnov, A.

    2004-01-01

    Full text: In November 2002 first 18F-FDG-PET was performed in Estonia using a mobile truck-mounted scanning technology (Accel, Siemens) provided by the International Healthcare Group (IHG, Amersfoort, Netherlands). The FDG was provided by MAP Medical Technologies, Schering, (Helsinki, Finland). In 2003 this scheme was repeated for further scanning sessions. Evaluation of cutaneous malignant melanoma (CMM) using nuclear technique is of particular interest in Estonia as its incidence is on the rise. F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in CMM has a well-documented high diagnostic accuracy, especially in staging of the disease. The aim of the current study was to assess the impact of 18F-FDG-PET on detailed staging and clinical management in CMM. 30 patients of CMM, 16 males and 14 females, all non-diabetic, in the age range of 26 to 69 years were studied. Of these 30 patients, 12 were of high risk primary CMM, 7 had regional lymph node metastases and 11 had distant metastases. Patients were asked to consume a low-carbohydrate diet 3 days prior to the FDG-PET scan. 194 to 410 MBq (average 335 MBq) 18F-FDG was administered to the patients who were asked to come fasting for a minimum of 6 hours. Whole body scan was performed 40 to 65 minutes after the administration of FDG on the mobile PET. In 13 of the 30 patients (43%) 18F-FDG-PET changed the staging. In remaining 17 patients (57%) 18F-FDG-PET increased confidence level for the chosen treatment. Lymphadenectomy was planned in 2 patients showing lymph node involvement on FDG-PET. In other 2 patients, one with small pulmonary and other with a liver lesions found on PET but negative on radiological examination 'wait-and-watch' strategy was chosen. An unexpected hypermetabolic lesion seen in 1 case turned out to be a benign focus of connective tissue. One patient shown to have multiple distant metastases was started on chemotherapy. Finally in 8 of the 30 (27%) patients an immediate positive

  9. Clinical spectrum and diagnostic value of antibodies against the potassium channel related protein complex.

    Science.gov (United States)

    Montojo, M T; Petit-Pedrol, M; Graus, F; Dalmau, J

    2015-06-01

    Antibodies against a protein complex that includes voltage-gated potassium channels (VGKC) have been reported in patients with limbic encephalitis, peripheral nerve hyperexcitability, Morvan's syndrome, and a large variety of neurological syndromes. In this article, a review is presented of the syndromes associated with antibodies against VGKC-related proteins and the main antigens of this protein complex, the proteins LGI1 (leucine rich glioma inactivated protein 1) and Caspr2 (contactin-associated protein-like 2). The conceptual problems and clinical implications of the description of antibodies against VGKC-related proteins other than LGI1 and Caspr2 are also discussed. Although initial studies indicated the occurrence of antibodies against VGKC, recent investigations have shown that the main antigens are a neuronal secreted protein known as LGI1 which modulates synaptic excitability, and a protein called Caspr2 located on the cell surface and processes of neurons of different brain regions, and at the juxtaparanodal region of myelinated axons. While antibodies against LGI1 preferentially associate with classical limbic encephalitis, antibodies against Caspr2 associate with a wider spectrum of symptoms, including Morvan's syndrome, peripheral nerve hyperexcitability or neuromyotonia, and limbic or more extensive encephalitis. In addition there are reports of patients with antibodies against VGKC-related proteins that are different from LGI1 or Caspr2. In these cases, the identity and location of the antigens are unknown, the syndrome association is not specific, and the response to treatment uncertain. The discovery of antigens such as LGI1 and Caspr2 has resulted in a clinical and molecular definition of the broad group of diseases previously attributed to antibodies against VGKC. Considering the literature that describes the presence of antibodies against VGKC other than LGI1 and Caspr2 proteins, we propose a practical algorithm for the diagnosis and treatment

  10. 12C. Environmental Chemical Exposure: Endocrine System Effects and Clinical Health Implications

    OpenAIRE

    Cohen, Aly

    2013-01-01

    Focus Area: Pediatrics Every day, the United States alone uses or imports about 42 million pounds of synthetic chemicals. There are more than 84 000 compounds approved for commercial use in the United States, most of which have never been tested for toxicity. A 2011 policy statement issued by the American Academy of Pediatrics acknowledges that the large quantities of chemicals that enter commerce could be harmful to children's health and development. The contribution of many of these chemica...

  11. Retinal vein occlusion and macular edema – critical evaluation of the clinical value of ranibizumab

    Directory of Open Access Journals (Sweden)

    Keane PA

    2011-06-01

    Full Text Available Pearse A Keane1, Srinivas R Sadda21NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 2Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USAAbstract: Retinal vein occlusions (RVOs constitute the second most common cause of retinal vascular disease after diabetic retinopathy, with a prevalence of between 1% and 2% in persons older than 40 years of age. Despite the existence of numerous potential therapeutic options, none is entirely satisfactory, and many patients with RVO suffer irreversible visual loss. Fortunately however, the recent introduction of antivascular endothelial growth factor (VEGF agents, such as ranibizumab (Lucentis®, Genentech, South San Francisco, CA and bevacizumab (Avastin®, Genentech, offers a potentially new treatment approach for clinicians managing this disorder. The results of the BRAVO and CRUISE trials have provided the first definitive evidence for the efficacy and safety of ranibizumab in the treatment of RVO. As a result, ranibizumab has recently been approved by the US Food and Drug Administration for the treatment of RVO-associated macular edema. In this review, we provide a critical evaluation of clinical trial data for the safety and efficacy of ranibizumab, and address unresolved issues in the management of this disorder. Keywords: ranibizumab, retinal vein occlusion, vascular endothelial growth factor, macular edema

  12. Investigations with FDG-PET Scanning in Prostate Cancer Show Limited Value for Clinical Practice

    Energy Technology Data Exchange (ETDEWEB)

    Salminen, Eeva [Univ. of Turku (Finland). Department of Oncology and Radiotherapy; Hogg, Annette; Binns, David; Hicks, Rodney [The Peter MacCallum Cancer Institute, East Melbourne, Vic (Australia). Dept. of Diagnostic Imaging; Frydenberg, Mark [Monash Medical Centre, Clayton, Vic (Australia)

    2002-09-01

    The aim of this study was to investigate FDG-PET (fluorodeoxyglucose positron emission tomography) imaging in the management of prostate cancer. Twenty-two patients were studied during different disease phases of prostate cancer, for staging or restaging to clarify specific clinical questions. FDG-PET was performed encompassing the thorax, abdomen and pelvis using the Penn PET 300H scanner. Scanning was begun 60 min after {sup 18}F fluorodeoxyglucose marker. Patients were catheterized and administered diuretics to minimize urinary activity. Information obtained with FDG-PET was concordant with findings from other investigations in 7/22 (32%) patients, discordant in 15/22 (68%) patients and equivalent in one patient (4%). PET indicated progressive disease in five patients with prostate-specific antigen (PSA) <4 ng/L. The impact on management of the patients was high in 46% of cases, low in 41% and for 14% there was no impact on management. The accuracy of FDG-PET was 72% (95% CI 50-89) as confirmed by invasive diagnostics/follow-up. FDG-PET can provide useful information and improve the clinician's decision on further management procedures in selected patients with low PSA and bone or lymph node changes. A negative PET scan in prostate cancer should be interpreted with caution.

  13. Detection and clinical value of NMO-IgG in neuromyelitis optica

    Directory of Open Access Journals (Sweden)

    De-hui HUANG

    2014-09-01

    Full Text Available Neuromyelitis optica (NMO is an inflammatory demyelinating disease of the central nervous system (CNS of autoimmune etiology which predominantly affects the optic nerves and spinal cord. In 2004, a highly specific serum antibody, NMO-IgG, was found in the sera of NMO patients. Subsequently, the target antigen of NMO-IgG was identified as aquaporin 4 (AQP4, a water channel densely expressed in optic nerves, spinal cord and area around cerebral ventricles. NMO-IgG/AQP4 antibody has demonstrated extreme importance for the diagnosis and differential diagnosis, the evaluation of disease activity, therapeutic effect and prognosis of NMO. In recent years, different techniques have been used to examine NMO-IgG in serum and cerebrospinal fluid, including tissue-based, cell-based and protein-based assays. In this review, the authors give an overview of the tests currently available for the detection of NMO-IgG and their clinical significance. doi: 10.3969/j.issn.1672-6731.2014.09.003

  14. Clinical value of the assistant interventional embolization in treatment of juvenile nasopharyngeal angiofibroma

    International Nuclear Information System (INIS)

    Xu Guobin; Zhou Shi; Liu Junfang; Hu Jinxiang; Long Qingyun

    2007-01-01

    Objective: To study the application of the assistant digital subtraction angiography (DSA) with selective intra-arterial embolization in comprehensive treatment of juvenile nasopharyngeal angiofibroma. Methods: Among 17 patients with juvenile nasopharyngeal angiofibroma confirmed by surgery and biopsy from February 2000 to June 2005, 13 cases underwent DSA examination and selective intra-arterial embolization on 1-4 days before surgical operation, and 4 cases with uncontrollable epistaxis through conventional therapy were carried out urgent DSA and embolization as well as surgical operation on a scheduled day. Angiographic manifestations and hemostatic effects and impacts in surgical operation were observed. Results: The extent and blood supply of lesions and the features of feeding artery were clearly demonstrated by DSA. Supplying vessel was mainly maxillary artery originating from external caroted artery in 16 cases, and double supplying vessels from ramus of internal and external carotid arteries in 1 case. In general, the higher the nasopharyngeal angiofibroma grade was the more supplying branches would exist. As for epistaxis patients, the number of the presence of irregular distal vessels and the punctiform extravasation of contrast media were displayed in positive proportion. No severe complications occurred and active bleeding was stopped after embolization and furthermore with less blood loss during surgical operation statistically about 280-1600 ml (460±255.5). Conclusions: DSA examination and selective arterial embolization can not only present more accurate important clinical imaging features but also in favour of stop bleeding and enhance surgical outcomes for patients with nasopharyngeal angiogibroma. (authors)

  15. Does Fat Suppression via Chemically Selective Saturation (CHESS) Affect R2*-MRI for Transfusional Iron Overload Assessment? A Clinical Evaluation at 1.5 and 3 Tesla

    Science.gov (United States)

    Krafft, Axel J.; Loeffler, Ralf B.; Song, Ruitian; Bian, Xiao; McCarville, M. Beth; Hankins, Jane S.; Hillenbrand, Claudia M.

    2015-01-01

    Purpose Fat suppression (FS) via chemically selective saturation (CHESS) eliminates fat-water oscillations in multi-echo gradient echo (mGRE) R2*-MRI. However, for increasing R2* values as seen with increasing liver iron content (LIC), the water signal spectrally overlaps with the CHESS band, which may alter R2*. Here, we investigate the effect of CHESS on R2* and describe a heuristic correction for the observed CHESS-induced R2* changes. Methods Eighty patients (49/31 female/male, mean age: 18.3±11.7 years) with iron overload were scanned with a non-FS and a CHESS-FS mGRE sequence at 1.5T and 3T. Mean liver R2* values were evaluated using 3 published fitting approaches. Measured and model-corrected R2* values were compared and statistically analyzed. Results At 1.5T, CHESS led to a systematic R2* reduction (PCHESS-induced R2* bias after correction (linear regression slopes: 1.032/0.927/0.981). No CHESS-induced R2* reductions were found at 3T. Conclusion The CHESS-induced R2* bias at 1.5T needs to be considered when applying R2*-LIC biopsy calibrations for clinical LIC assessment which were established without FS at 1.5T. The proposed model corrects the R2* bias and could therefore improve clinical iron overload assessment based on linear R2*-LIC calibrations. PMID:26308155

  16. Recent advances in the production of value added chemicals and lipids utilizing biodiesel industry generated crude glycerol as a substrate - Metabolic aspects, challenges and possibilities: An overview.

    Science.gov (United States)

    Vivek, Narisetty; Sindhu, Raveendran; Madhavan, Aravind; Anju, Alphonsa Jose; Castro, Eulogio; Faraco, Vincenza; Pandey, Ashok; Binod, Parameswaran

    2017-09-01

    One of the major ecological concerns associated with biodiesel production is the generation of waste/crude glycerol during the trans-esterification process. Purification of this crude glycerol is not economically viable. In this context, the development of an efficient and economically viable strategy would be biotransformation reactions converting the biodiesel derived crude glycerol into value added chemicals. Hence the process ensures the sustainability and waste management in biodiesel industry, paving a path to integrated biorefineries. This review addresses a waste to wealth approach for utilization of crude glycerol in the production of value added chemicals, current trends, challenges, future perspectives, metabolic approaches and the genetic tools developed for the improved synthesis over wild type microorganisms were described. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Application Values of T-SPOT.TB in Clinical Rapid Diagnosis of Tuberculosis.

    Science.gov (United States)

    Zhu, Feng; Ou, Qinfang; Zheng, Jian

    2018-01-01

    This paper aims to explore the application value of tuberculosis-specific enzyme-linked immunospot assay (T-SPOT.TB) in the diagnosis of tuberculosis. Fifty one patients with tuberculosis (TB) admitted to Wuxi No.5 People's Hospital, Wuxi, China from June 2015 to June 2017 were selected as the TB group, and 40 patients without tuberculosis admitted in the same period were randomly selected as the non-TB group. Patients in the two groups received T-SPOT.TB, TB antibody (TB-Ab) test and mycobacterium TB deoxyribonucleic acid (TB-DNA) test, and the results were compared. Comparisons of the sensitivity of the three methods showed that the sensitivity of T-SPOT.TB was the highest, followed by TB-DNA from sputum samples, and that of TB-Ab was the lowest. The specificity of TB-Ab was the highest, followed by T-SPOT.TB, and that of TB-DNA from sputum samples was the lowest. In the receiver operating characteristic (ROC) curve analysis, the area under curve (AUC) of T-SPOT.TB (0.896) was the highest, followed by TB-DNA from sputum samples (0.772), and that of sputum smears (0.698) was the lowest. T-SPOT.TB can quickly and accurately determine the presence of tuberculosis infection, and it is a non-invasive examination, which can further assist in the diagnosis and guide the treatment.

  18. Clinical value of the alveolar epithelial permeability in various pulmonary diseases

    International Nuclear Information System (INIS)

    Todisco, T.; Dottorini, M.; Rossi, F.; Polidori, A.; Bruni, B.; Iannacci, L.; Palumbo, R.; Fedeli, L.

    1984-01-01

    The authors have measured the pulmonary epithelial permeability in normals, smokers, ex-smokers and in various pulmonary diseases, using the sup(99m)Tc-DTPA monodisperse radioaerosol delivered by a newly designed nebulizer. Reference values for alveolar epithelial permeability were those of their own laboratory. Accelerated clearance of small idrophylic solutes from the lungs to the blood was found in smokers and in all the patients with idiopathic diffuse pulmonary fibrosis, chronic obstructive lung disease, congestive heart failure, acute viral pneumonia and adult respiratory distress syndrome. The greatest increase of alveolar epithelial clearance was found in the lung zone affected by the viral infection. The normal upper-lover lobe gradient of epithelial clearance was lost only in some patients. The increased permeability of the alveolar wall, although not specific, is characteristic and early feature of many acute and chronic pulmonary disease. For practical purposes, this parameter, rather than diagnostic, should be considered as a sensitive index of alveolar damage and repair, especially suitable for the follow-up of patients with spontaneous or therapeutic reversibility of parenchimal lung diseases. (orig.)

  19. The clinical values of serum TRAb by RIA in the diagnosis and treatment of thyroid diseases

    International Nuclear Information System (INIS)

    Zhang Wenzhen; Li Hong; Gao Yongdi

    2001-01-01

    The TRAb content of the thyroid diseases 758 cases (including the first visit thyroidism group 166 cases; the thyroidism group with normal thyroid function by medicine treatment 198 cases, the group with abnormal thyroid function by medicine treatment 86 cases, the group with lower thyroid function 24 cases, the group with normal thyroid function by 131 I treatment 104 cases, the subacute thyroiditis group 48 cases, the simple goiter group 52 cases, the primary hypothyroidism group 80 cases) and the normal control group 62 cases are detected. The results show that the values of TRAb are much higher in the groups with normal or abnormal thyroid function by medicine treatment, the group with lower thyroid function, the group with 131 I treatment and the group with primary hypothyroidism than that of control group (P 0.05). The differential of the TRAb average and positive rate is obvious between the groups with normal and abnormal thyroid function by medicine treatment (P 131 I treatment (P < 0.01). The TRAb levels in serum are higher in the patients with thyroidism and primary hypo-thyroidism, and the TRAb levels are normal in the patients with subacute thyroiditis and simple goiter. So, TRAb is a auxiliary index in the diagnosis of thyroidism and hypo-thyroidism and also a differential diagnosis index about the thyroidism and subacute thyroiditis. At the same time, TRAb is an important index in evaluating the autoimmune monitoring function of the body, and stopping the use of thyroid medicine

  20. Value of standard personality assessments in informing clinical decision - making in a medium secure unit.

    Science.gov (United States)

    Duggan, Conor; Mason, Lauren; Banerjee, Penny; Milton, John

    2007-05-01

    Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory. To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study. A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments. Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist-Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished ;completers' from ;non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%). Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.

  1. Clinical and diagnostic value of preoperative MR mammography and FDG-PET in suspicious breast lesions

    International Nuclear Information System (INIS)

    Walter, C.; Scheidhauer, K.; Theissen, P.; Scharl, A.; Goering, U.J.; Kugel, H.; Krahe, T.; Pietrzyk, U.

    2003-01-01

    Dynamic enhanced magnetic resonance (MR) mammography and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) of the breast were directly compared preoperatively in suspicious breast lesions. Forty-two breast lesions in 40 patients were examined with a three-dimensional dynamic MR imaging series and FDG-PET. The MR and PET examinations were evaluated separately and the results were compared with the histological findings. The sensitivity and specificity of each method were calculated. The diagnostic value of both modalities as single diagnostic tool and in combination was investigated. Nineteen malignant and 23 benign breast lesions were proven histologically. Magnetic resonance mammography and FDG-PET showed a sensitivity of 89 and 63%, respectively. The specificity was 74 and 91%, respectively. The combination of both imaging methods decreased the not-required biopsies from 55 to 17%. Only one false-negative finding - a patient pre-treated with chemotherapy - was observed in both methods. The combination of MR mammography and FDG-PET can help to decrease biopsies of benign breast lesions. Because of their high cost, these modalities should only be used in problematic cases to either rule out or to demonstrate malignancy. The best diagnostic strategy is achieved using MR mammography first. If the diagnosis is still questionable, FDG-PET can be performed. (orig.)

  2. PROMYS – Programming synthetic networks for bio-based production of value chemicals – FP7 project

    DEFF Research Database (Denmark)

    Sommer, Morten Otto Alexander

    2017-01-01

    ) Synthetic pathway construction 2) Cell factory optimization 3) Control of populations during fermentation Ligand responsive regulation and selection systems will directly couple the presence of a desired chemical product or flux state within a cell, to the survival of the cell. As such, they allow......The global chemical industry is transitioning from petrochemical production processes to bio-based production processes. This transition creates a clear market need for technologies that reduce the development time and cost of cell factories. PROMYS will develop, validate and implement a novel...... will drastically accelerate the construction, optimization and performance of cell factories by enabling industrial users to impose non-natural objectives on the engineered cell factory. PROMYS will address three major challenges in metabolic engineering that limit the development of new cell factories: 1...

  3. Interexaminer reliability in clinical measurement of L*C*h* values of anterior teeth using a spectrophotometer.

    Science.gov (United States)

    Hassel, Alexander J; Grossmann, Anne-christiane; Schmitter, Marc; Balke, Zibandeh; Buzello, Anja M

    2007-01-01

    The objective of this study was to investigate interexaminer reliability in the clinical measurement of the L*C*h* (lightness/value, chroma, hue) values of anterior teeth using a spectrophotometer (Vita Easyshade). The basic color of the maxillary right central incisors and canines of 23 subjects was spectrophotometrically determined by 4 clinicians and an experienced user (development manager) of the spectrophotometer. Also, to analyze the effect of different training with the instrument on interexaminer reliability, 2 of the clinicians were instructed in the use of the spectrophotometer by the experienced examiner, whereas the others instructed themselves by studying the operating manual. Agreement between all examiners was acceptable to excellent (intraclass coefficient > 0.4). The mean value of the measured differences for the central incisors of all subjects for L* values was 5 (for C* = 3.8, h* = 2.7 degrees) and for canines, the mean L* was 4.5 (C* = 3, h* = 1.6 degrees). Results from comparison of the 2 different training methods were inconsistent. Agreement with the experienced examiner ranged from not acceptable (C* values for incisors of self-instructed examiners) to excellent. The distribution of the measurements of 1 subject could lead to deviations in color, probably with clinical impact. For canines, the measurements were at least equally reproducible (in some cases significantly more reproducible) compared to central incisors. Because of the small number of examiners and the inconsistent results, it was not possible to reach a definite conclusion about the effect of different training methods on interexaminer reliability.

  4. Elbow Room for Best Practice? Montgomery, Patients' values, and Balanced Decision-Making in Person-Centred Clinical Care.

    Science.gov (United States)

    Herring, Jonathan; Fulford, Kmw; Dunn, Michael; Handa, Ashoki

    2017-11-01

    The UK Supreme Court Montgomery judgment marks a decisive shift in the legal test of duty of care in the context of consent to treatment, from the perspective of the clinician (as represented by Bolam rules) to that of the patient. A majority of commentators on Montgomery have focused on the implications of the judgment for disclosure of risk. In this article, we set risk disclosure in context with three further elements of the judgment: benefits, options, and dialogue. These elements, we argue, taken together with risk disclosure, reflect the origins of the Montgomery ruling in a model of consent based on autonomy of patient choice through shared decision-making with their doctor. This model reflects recent developments in both law and medicine and is widely regarded (by the General Medical Council and others) as representing best practice in contemporary person-centred medicine. So understood, we suggest, the shift marked by Montgomery in the basis of duty of care is a shift in underpinning values: it is a shift from the clinician's interpretation about what would be best for patients to the values of (to what is significant or matters from the perspective of) the particular patient concerned in the decision in question. But the values of the particular patient do not thereby become paramount. The Montgomery test of duty of care requires the values of the particular patient to be balanced alongside the values of a reasonable person in the patient's position. We illustrate some of the practical challenges arising from the balance of considerations required by Montgomery with examples from surgical care. These examples show the extent to which Montgomery, in mirroring the realities of clinical decision-making, provides elbowroom for best practice in person-centred clinical care. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Chemical and biological evaluation of the nutritive value of Algerian green seaweed Ulva lactuca using in vitro gas production technique fior ruminant animals

    OpenAIRE

    Zitouni, Hind; Arhab, Rabah; Boudry, Christelle; Bousseboua, Hacène; Beckers, Yves

    2014-01-01

    This study aimed to determine the nutritive value of seaweed Ulva lactuca collected from the Algerian coast by estimation of its chemical composition and fermentation characteristics, comparatively to vetch-oat hay (control), using in vitro gas production technique. Seaweed and control were incubated with rumen liquor taken from fistulated and non lactating cows. Gas production was recorded at: 2, 4, 6, 8, 12, 24, 48 and 72h. The in vitro rumen fermentation parameters were measured after 24h ...

  6. Clinically healthy overweight and obese dogs differ from lean controls in select CBC and serum biochemistry values.

    Science.gov (United States)

    Radakovich, Lauren B; Truelove, Matthew P; Pannone, Stephen C; Olver, Christine S; Santangelo, Kelly S

    2017-06-01

    Obesity is a global disease, affecting nearly half a billion people. Unfortunately, this trend is mirrored in our canine population. As obesity is a complex inflammatory disease, there is a need to determine whether routine medical screening tests may indicate, or be influenced by, its presence. The objective of the current study was to determine if significant differences exist between CBC and biochemical profile values from control vs overweight/obese, client-owned dogs considered clinically healthy. Dogs presented for routine health examinations, including minor dental or elective surgical procedures, were retrospectively identified from a hospital population. Animals were allocated to 2 categories based on body condition score (BCS), and data were analyzed by Mann-Whitney nonparametric analysis with statistical significance at a P ≤ .05. After exclusions, 116 dogs were assigned to the overweight/obese group (BCS ≥ 7) and 240 dogs to the control group (BCS = 4-6). Overweight/obese dogs had higher total leukocyte counts and higher plasma protein and globulin concentrations. Other differences were attributed to decreased serum water fraction (increased sodium, albumin, calcium, and anion gap) in the overweight/obese group. Interestingly, chloride concentration was decreased (in the face of increased sodium) in the obese group. There is CBC and biochemical evidence to support the concern that obesity influences laboratory values, even in dogs considered clinically healthy. Prospective studies aimed at characterizing these changes are needed to provide insight into the connection between obesity and its comorbidities. © 2017 American Society for Veterinary Clinical Pathology.

  7. Clinical Relevance and Predictive Value of Damage Biomarkers of Drug-Induced Kidney Injury.

    Science.gov (United States)

    Kane-Gill, Sandra L; Smithburger, Pamela L; Kashani, Kianoush; Kellum, John A; Frazee, Erin

    2017-11-01

    Nephrotoxin exposure accounts for up to one-fourth of acute kidney injury episodes in hospitalized patients, and the associated consequences are as severe as acute kidney injury due to other etiologies. As the use of nephrotoxic agents represents one of the few modifiable risk factors for acute kidney injury, clinicians must be able to identify patients at high risk for drug-induced kidney injury rapidly. Recently, significant advancements have been made in the field of biomarker utilization for the prediction and detection of acute kidney injury. Such biomarkers may have a role both for detection of drug-induced kidney disease and implementation of preventative and therapeutic strategies designed to mitigate injury. In this article, basic principles of renal biomarker use in practice are summarized, and the existing evidence for six markers specifically used to detect drug-induced kidney injury are outlined, including liver-type fatty acid binding protein, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2 times insulin-like growth factor-binding protein 7 ([TIMP-2]·[IGFBP7]), kidney injury molecule-1 and N-acetyl-β-D-glucosaminidase. The results of the literature search for these six kidney damage biomarkers identified 29 unique articles with none detected for liver-type fatty acid binding protein and [TIMP-2]·[IGFBP7]. For three biomarkers, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin and N-acetyl-β-D-glucosaminidase, the majority of the studies suggest utility in clinical practice. While many questions need to be answered to clearly articulate the use of biomarkers to predict drug-induced kidney disease, current data are promising.

  8. Clinical value of renal injury biomarkers in diagnosis of chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Cheng-lu ZHANG

    2011-12-01

    Full Text Available Objective To investigate the levels of renal injury biomarkers in patients with chronic kidney disease(CKD and evaluate their clinical significances in diagnosis of CKD.Methods A total of 66 subjects(37 patients with CKD and 29 healthy individuals were involved in this study.Serum blood urea nitrogen(SBUN was determined by Glutamate dehydrogenase method;serum creatinine(SCr and urinary creatinine(UCr were detected by sarcosine oxidase method;serum uric acid(SUA was measured by uricase colorimetry;serum cystatin C(Cys C and urinary microalbumin(UmAlbwere analyzed by immunological transmission turbidimetry;urinary protein(U-PROwas measured by Coomassies Brilliant Blue(CBB assay.The UmAlb and U-PRO levels were expressed in units of mg/mmolUCr.Results The results of independent samples t test indicated that significant differences were found in SBUN,SCr,SUA,Cys C,UmAlb and U-PRO(P < 0.05 between patient group and healthy control group.The evaluation of diagnostic effects showed that the areas under the curve at ROC plot for SBUN,SCr,SUA,Cys C,UmAlb and U-PRO were 0.907,0.912,0.742,0.982,0.984 and 0.991,respectively.Conclusions U-PRO,UmAlb and Cys C are ideal biomarkers,SCr and SBUN come next,SUA is the weakest when the above biomarkers are applied to evaluate the renal injury and its severity of the patients with CKD.

  9. Omalizumab management beyond clinical trials: the added value of a network model.

    Science.gov (United States)

    Caminati, Marco; Senna, Gianenrico; Chieco Bianchi, Fulvia; Marchi, Maria Rita; Vianello, Andrea; Micheletto, Claudio; Pomari, Carlo; Tognella, Silvia; Savoia, Francesca; Mirisola, Valentina; Rossi, Andrea

    2014-10-01

    Omalizumab is effective and safe in severe allergic asthma. Few data are available about its impact on lung function and on asthma comorbidities, long-term follow-up of treated patients, adherence, non-responders profile, and optimal treatment duration. We aimed at evaluating omalizumab-related clinical outcomes and unmet needs in a real-life setting. We created a collaborative network (NEONet - North East Omalizumab Network) involving 9 Allergy and Respiratory referral centres for severe asthma placed in the North-East of Italy. Patients' data were entered into a common study database shared by all the participating physicians. A preliminary retrospective analysis was performed. Patients come from a common well-defined geographical and environmental district providing a homogeneous population sample. A moderate but statistically significant improvement of the FEV1, and an increasing proportion of exacerbations-free patients were observed since the treatment start. These findings were independent of the baseline severity of bronchial obstruction. A positive impact of omalizumab on rhinitis in patients with both asthma and rhinitis was detected. Moreover the efficacy of omalizumab on asthma seemed not to be affected by the baseline severity of rhinitis. Our retrospective analysis represents a preliminary report from the NEONet activity. It confirmed omalizumab efficacy and provided some new insights about its impact on lung function and on comorbid rhinitis. The network approach, under a prospective view, allows creating a large uniform database, by means of a standardized shared tool for data collecting, and joining a multidisciplinary expertise. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Clinical value of FDG hybrid-PET in staging and restaging of malignant lymphoma. Compared with conventional diagnostic methods

    International Nuclear Information System (INIS)

    Pichler, R.; Maschek, W.; Hatzl-Griesenhofer, M.; Huber, H.; Wimmer, G.; Wahl, G.; Fridrik, M.

    2000-01-01

    Aim of the present retrospective study was to validate the clinical value of F-18-FDG PET imaging in lymphoma patients with a dual head camera modified for coincidence detection. Staging before and after oncological treatment was compared with a conservative diagnostic approach. Methods: 48 patients (28 non-Hodgkin lymphoma, 20 Hodgkin's disease) received FDG-Hybrid-PET scans. Pretherapeutic staging was realized in 28 patients, 9 of them had control studies after they had completed therapy. Totally 29 persons were examined for posttherapeutic restaging. Computed tomography imaging and lymph node sonography was performed in all cases. Results were validated by clinical follow-up, in three cases a recidive was proven by biopsy. Results: CT and ultrasound detected 77 lesions in 28 patients compared with 100 visualized by PET, but this difference in pretherapeutic staging did not reach significance at p>0.05 by Fisher's t-test. Hybrid-PET obtained a sensitivity of 93%, a specifity of 79%, a positive of 82% and a negative predictive value of 92% for detection of residual disease. The values for CT+US were 87%, 64%, 72% and 88% respectively. Conclusion: FDG Hybrid-PET is as or even more accurate than standard morphologic diagnostic methods for prestaging in malignant lymphoma. Additionally, there is a substancial benefit for therapy monitoring of residual disease using coincidence detection PET with a 3/4-inch crystal gamma camera. (orig.) [de

  11. Clinical vocabulary as a boundary object in multidisciplinary care management of multiple chemical sensitivity, a complex and chronic condition.

    Science.gov (United States)

    Sampalli, Tara; Shepherd, Michael; Duffy, Jack

    2011-04-14

    Research has shown that accurate and timely communication between multidisciplinary clinicians involved in the care of complex and chronic health conditions is often challenging. The domain knowledge for these conditions is heterogeneous, with poorly categorized, unstructured, and inconsistent clinical vocabulary. The potential of boundary object as a technique to bridge communication gaps is explored in this study. A standardized and controlled clinical vocabulary was developed as a boundary object in the domain of a complex and chronic health condition, namely, multiple chemical sensitivity, to improve communication among multidisciplinary clinicians. A convenience sample of 100 patients with a diagnosis of multiple chemical sensitivity, nine multidisciplinary clinicians involved in the care of patients with multiple chemical sensitivity, and 36 clinicians in the community participated in the study. Eighty-two percent of the multidisciplinary and inconsistent vocabulary was standardized using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED(®) CT as a reference terminology. Over 80% of the multidisciplinary clinicians agreed on the overall usefulness of having a controlled vocabulary as a boundary object. Over 65% of clinicians in the community agreed on the overall usefulness of the vocabulary. The results from this study are promising and will be further evaluated in the domain of another complex chronic condition, ie, chronic pain. The study was conducted as a preliminary analysis for developing a boundary object in a heterogeneous domain of knowledge.

  12. Clinical value of determination HIV viral load in the cerebrospinal fluid of HIV-infected patients

    Directory of Open Access Journals (Sweden)

    V. B. Musatov

    2015-01-01

    Full Text Available Aim. To analyze the concentration of HIV RNA in the cerebrospinal fluid and to evaluate its significance in the pathology of the central nervous system among HIV infected persons.Materials: We examined 36 patients with HIV infection with signs of pathology of the central nervous system. All patients was done completed a standard investigation of cerebrospinal fluid, cytological examination and detection viral load of HIV in the cerebrospinal fluid and serum.Results. A different of opportunistic and HIV-related disease was diagnosed in 29 patients. The most frequent pathology of the nervous system (12 cases is a diffuse HIV-associated brain damage occurring in 7 patients in the form of aseptic non purulent meningitis and in 5 patients in the form of encephalitis. The average value of the absolute and relative count of CD4-lymphocytes in patients amounted 147,0 cells/μl (40,0; 408,75 and 10.0% (4,00; 18,50. Pathological changes in cellular composition and protein concentration of cerebrospinal fluid detected in 19 cases. Replication of HIV in the cerebrospinal fluid are detected in 31 of 32 patients not receiving antiretroviral therapy, including 17 patients with normal values of cerebrospinal fluid. The average HIV viral load in the cerebrospinal fluid was 15 133,0 copies/ml (2501,0; 30624,0 or 4,18 (3,35; 4,48 lg HIV RNA, average HIV viral load in serum – 62 784,0 copies/ml (6027,5; 173869,0 or 4,80 4,80 (3,7; 5,2 lg HIV RNA. The concentration of HIV in the cerebrospinal fluid was significantly lower than in serum (4,18 and 4,80 lg HIV RNA, p=0.027. 4 patients with severe, multietiology damage of the central nervous system viral, microbial and fungal etiology, there was an inverse relationship between the concentration of HIV in the cerebrospinal fluid and in serum, the concentrations of HIV was higher in the cerebrospinal fluid.Conclusion: Among the majority of HIV-infected patients with signs of the central

  13. The clinical and pathogenetic value of Foxp3+ T regulatory cells in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    A. S. Avdeeva

    2016-01-01

    Full Text Available T regulatory cells (Tregs play a key role in the immune system due to the suppression of a hyperimmune response to autoantigens and opportunistic enteric microorganisms. In recent years, there has been evidence that Tregs can suppress various immunoinflammatory responses to a wide range of physiological and pathological stimuli, including microorganisms, tumor cells, allogeneic grafts, and fetal cells.Tregs express a broad spectrum of membrane molecules that determine their functional activity and make it possible to identify these cells; however, none has discovered a universal surface marker that would distinguish this cell subpopulation from a pool of T lymphocytes. The most specific intracellular marker for Tregs is the nuclear transcription factor Foxp3 that is of fundamental importance in the development of Tregs and their inhibitory function.The results of the vast majority of studies indicate that there are increased numbers of Tregs in the synovial fluid of patients with rheumatoid arthritis (RA; however, the data on the level of this cell population in their peripheral blood are very contradictory. The majority of investigators have observed a decrease in the percentage of circulating Tregs while other studies have revealed its increase or no differences from the corresponding value of healthy donors or patients with osteoarthritis. It is believed that a quantitative defect in CD4+CD25+Foxp3+CD127 regulatory cells is especially characteristic of early RA and associated with the risk of the latter in asymptomatic patients positive for anti-cyclic citrullinated peptide antibodies. The use of disease-modifying antirheumatic drugs and biologic agents is accompanied by a certain change in the level and functional activity of Tregs, which is responsible for the therapeutic effect of the medicaments.Thus, an important part is assigned to Tregs in the pathogenesis of autoimmune rheumatic diseases, RA in particular. The decrease in the level

  14. Clinical value of regression of electrocardiographic left ventricular hypertrophy after aortic valve replacement.

    Science.gov (United States)

    Yamabe, Sayuri; Dohi, Yoshihiro; Higashi, Akifumi; Kinoshita, Hiroki; Sada, Yoshiharu; Hidaka, Takayuki; Kurisu, Satoshi; Shiode, Nobuo; Kihara, Yasuki

    2016-09-01

    Electrocardiographic left ventricular hypertrophy (ECG-LVH) gradually regressed after aortic valve replacement (AVR) in patients with severe aortic stenosis. Sokolow-Lyon voltage (SV1 + RV5/6) is possibly the most widely used criterion for ECG-LVH. The aim of this study was to determine whether decrease in Sokolow-Lyon voltage reflects left ventricular reverse remodeling detected by echocardiography after AVR. Of 129 consecutive patients who underwent AVR for severe aortic stenosis, 38 patients with preoperative ECG-LVH, defined by SV1 + RV5/6 of ≥3.5 mV, were enrolled in this study. Electrocardiography and echocardiography were performed preoperatively and 1 year postoperatively. The patients were divided into ECG-LVH regression group (n = 19) and non-regression group (n = 19) according to the median value of the absolute regression in SV1 + RV5/6. Multivariate logistic regression analysis was performed to assess determinants of ECG-LVH regression among echocardiographic indices. ECG-LVH regression group showed significantly greater decrease in left ventricular mass index and left ventricular dimensions than Non-regression group. ECG-LVH regression was independently determined by decrease in the left ventricular mass index [odds ratio (OR) 1.28, 95 % confidence interval (CI) 1.03-1.69, p = 0.048], left ventricular end-diastolic dimension (OR 1.18, 95 % CI 1.03-1.41, p = 0.014), and left ventricular end-systolic dimension (OR 1.24, 95 % CI 1.06-1.52, p = 0.0047). ECG-LVH regression could be a marker of the effect of AVR on both reducing the left ventricular mass index and left ventricular dimensions. The effect of AVR on reverse remodeling can be estimated, at least in part, by regression of ECG-LVH.

  15. Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

    Energy Technology Data Exchange (ETDEWEB)

    Zaorsky, Nicholas G.; Malatesta, Theresa M.; Den, Robert B.; Wuthrick, Evan; Ahn, Peter H.; Werner-Wasik, Maria; Shi, Wenyin; Dicker, Adam P.; Anne, P. Rani; Bar-Ad, Voichita [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org [Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)

    2012-07-15

    Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students' knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students' prerotation test scores had an average of 64% (95% confidence interval [CI], 61-66%). The postrotation test scores improved to an average of 82% (95% CI, 80-83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1-9; 95% CI, 7.3-9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5-9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6-9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

  16. Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

    International Nuclear Information System (INIS)

    Zaorsky, Nicholas G.; Malatesta, Theresa M.; Den, Robert B.; Wuthrick, Evan; Ahn, Peter H.; Werner-Wasik, Maria; Shi, Wenyin; Dicker, Adam P.; Anne, P. Rani; Bar-Ad, Voichita; Showalter, Timothy N.

    2012-01-01

    Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students’ knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students’ prerotation test scores had an average of 64% (95% confidence interval [CI], 61–66%). The postrotation test scores improved to an average of 82% (95% CI, 80–83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1–9; 95% CI, 7.3–9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5–9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6–9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

  17. The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

    International Nuclear Information System (INIS)

    Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.; Turpie, A.G.

    1982-01-01

    We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value of 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

  18. The diagnostic value of the fibrinogen/fibrin fragment E antigen assay in clinically suspected deep vein thrombosis

    International Nuclear Information System (INIS)

    Zielinsky, A.; Hirsh, J.; Straumanis, G.; Carter, C.J.; Gent, M.; Sackett, D.L.; Hull, R.; Kelton, J.G.; Powers, P.

    1982-01-01

    We have evaluated the fibrinogen/fibrin fragment E antigen assay as a diagnostic test in patients with clinically suspected venous thrombosis by comparing the results of this assay with venography in 272 patients. The result of the fragment E antigen assay was elevated in 79 of 80 patients with positive venograms for recent venous thrombosis (sensitivity 99%) and within the normal range in 161 of 192 patients with normal venograms (specificity 84%). The fragment E assay was also evaluated in 130 medical and surgical controls without evidence of venous thrombosis by leg scanning and the test was found to be relatively nonspecific. However, in the patient group under study, a correct clinical diagnosis of no thrombosis, based on a normal fragment E result, was made in 161 of 162 cases (negative predictive value 99%). Therefore, a normal test result effectively excludes a diagnosis of venous thrombosis in clinically symptomatic patients. The assay, as currently performed, is technically demanding and takes 24 hr to complete. Therefore, it will have to be simplified before it can be applied to clinical practice

  19. The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?

    Energy Technology Data Exchange (ETDEWEB)

    Akita, Ayano; Tanimoto, Akihiro; Kuribayashi, Sachio [Keio University, Department of Diagnostic Radiology, School of Medicine, Tokyo (Japan); Jinno, Hiromitsu [Keio University, Department of Surgery, School of Medicine, Tokyo (Japan); Kameyama, Kaori [Keio University, Division of Diagnostic Pathology, School of Medicine, Tokyo (Japan)

    2009-09-15

    The purpose of this study was to evaluate the clinical value of bilateral breast magnetic resonance (MR) imaging (MRI) in patients showing suspicious microcalcifications on mammography and negative ultrasound findings. Fifty patients underwent MRI before stereotactic vacuum-assisted breast biopsy (SVAB). MR findings were classified into five types for interpretation, and types 4 and 5 were considered malignant. SVAB revealed 13 carcinomas and 37 benign lesions. Malignant lesions were more frequently found in cases of positive MRI diagnoses than in negative MRI diagnoses (P < 0.001). Mammography had a sensitivity of 100%, a specificity of 24% and an accuracy of 44%, whereas mammography plus MRI had a sensitivity of 85%, a specificity of 100% and an accuracy of 96%. In the evaluation of mammographically detected microcalcifications, bilateral breast MRI is of good diagnostic value and may alter the indications for SVAB. (orig.)

  20. Accounting of costs in a service of physical health. Relative units of value in dosimetry clinic in teletherapy

    International Nuclear Information System (INIS)

    Font Gomez, J. A.; Gandia Martinez, A.; Jimenez Albericio, F. J.; Andres Redondon, M. M.; Mengual Gil, M. A.

    2013-01-01

    A single - although laborious - start in the economic and clinical management of our units can be come to the knowledge of the time invested in the tasks functional, having to differentiate them, name them and even encrypt them. The time spent in performing the tasks multiplied by the annual number of these will indicate the resources necessary to achieve our objectives. In addition, pooling the values of times that members of the Unit provide analysed inter-workers dispersal, their causes and possible solutions. The establishment of relative units of value in any process benefits all workers involved in the process since it allows to know the dispersion of the times that each person employed in the development of the tasks. (Author)

  1. The clinical value of trans-vaginal ultrasound-guided puncture in the treatment of pelvic abscess

    International Nuclear Information System (INIS)

    Wang Ping; Gong Wei

    2008-01-01

    Objective: To investigate the clinical value of trans-vaginal ultrasound-guided (TVS) puncture in the treatment of pelvic abscess. Methods 30 cases with pelvic abscess were treated by transvaginal ultrasound-guided puncture. The long-dated effects were followed-up. Results: 29 cases were cured by TVS puncture. Operation was performed in 1 patient because of invalid effect. The cure rate was 97%. Conclusion: Ultrasound-guided puncture is a safe and convenient method in the treatment of pelvic abscess. (authors)

  2. Six easy steps on how to create a lean sigma value stream map for a multidisciplinary clinical operation.

    Science.gov (United States)

    Lee, Emily; Grooms, Richard; Mamidala, Soumya; Nagy, Paul

    2014-12-01

    Value stream mapping (VSM) is a very useful technique to visualize and quantify the complex workflows often seen in clinical environments. VSM brings together multidisciplinary teams to identify parts of processes, collect data, and develop interventional ideas. An example involving pediatric MRI with general anesthesia VSM is outlined. As the process progresses, the map shows a large delay between the fax referral and the date of the scheduled and registered appointment. Ideas for improved efficiency and metrics were identified to measure improvement within a 6-month period, and an intervention package was developed for the department. Copyright © 2014. Published by Elsevier Inc.

  3. The Value of the SYNTAX Score II in Predicting Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Ryan, Nicola; Nombela-Franco, Luis; Jiménez-Quevedo, Pilar; Biagioni, Corina; Salinas, Pablo; Aldazábal, Andrés; Cerrato, Enrico; Gonzalo, Nieves; Del Trigo, María; Núñez-Gil, Iván; Fernández-Ortiz, Antonio; Macaya, Carlos; Escaned, Javier

    2017-11-27

    The predictive value of the SYNTAX score (SS) for clinical outcomes after transcatheter aortic valve implantation (TAVI) is very limited and could potentially be improved by the combination of anatomic and clinical variables, the SS-II. We aimed to evaluate the value of the SS-II in predicting outcomes in patients undergoing TAVI. A total of 402 patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI were included. Preprocedural TAVI angiograms were reviewed and the SS-I and SS-II were calculated using the SS algorithms. Patients were stratified in 3 groups according to SS-II tertiles. The coprimary endpoints were all-cause death and major adverse cardiovascular events (MACE), a composite of all-cause death, cerebrovascular event, or myocardial infarction at 1 year. Increased SS-II was associated with higher 30-day mortality (P=.036) and major bleeding (P=.015). The 1-year risk of death and MACE was higher among patients in the 3rd SS-II tertile (HR, 2.60; P=.002 and HR, 2.66; P<.001) and was similar among patients in the 2nd tertile (HR, 1.27; P=.507 and HR, 1.05; P=.895) compared with patients in the 1st tertile. The highest SS-II tertile was an independent predictor of long-term mortality (P=.046) and MACE (P=.001). The SS-II seems more suited to predict clinical outcomes in patients undergoing TAVI than the SS-I. Increased SS-II was associated with poorer clinical outcomes at 1 and 4 years post-TAVI, independently of the presence of coronary artery disease. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Clinical value of Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

    Energy Technology Data Exchange (ETDEWEB)

    Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.

    1986-09-01

    The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death.

  5. The clinical value of 201Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

    International Nuclear Information System (INIS)

    Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.; Vrije Univ., Brussels

    1986-01-01

    The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death. (orig.)

  6. Prognostic value of Ki-67 index in adult medulloblastoma after accounting for molecular subgroup: a retrospective clinical and molecular analysis.

    Science.gov (United States)

    Zhao, Fu; Zhang, Jing; Li, Peng; Zhou, Qiangyi; Zhang, Shun; Zhao, Chi; Wang, Bo; Yang, Zhijun; Li, Chunde; Liu, Pinan

    2018-04-23

    Medulloblastoma (MB) is a rare primary brain tumor in adults. We previously evaluated that combining both clinical and molecular classification could improve current risk stratification for adult MB. In this study, we aimed to identify the prognostic value of Ki-67 index in adult MB. Ki-67 index of 51 primary adult MBs was reassessed using a computer-based image analysis (Image-Pro Plus). All patients were followed up ranging from 12 months up to 15 years. Gene expression profiling and immunochemistry were used to establish the molecular subgroups in adult MB. Combined risk stratification models were designed based on clinical characteristics, molecular classification and Ki-67 index, and identified by multivariable Cox proportional hazards analysis. In our cohort, the mean Ki-67 value was 30.0 ± 11.3% (range 6.56-63.55%). The average Ki-67 value was significantly higher in LC/AMB than in CMB and DNMB (P = .001). Among three molecular subgroups, Group 4-tumors had the highest average Ki-67 value compared with WNT- and SHH-tumors (P = .004). Patients with Ki-67 index large than 30% displayed poorer overall survival (OS) and progression free survival (PFS) than those with Ki-67 less than 30% (OS: P = .001; PFS: P = .006). Ki-67 index (i.e. > 30%, < 30%) was identified as an independent significant prognostic factor (OS: P = .017; PFS: P = .024) by using multivariate Cox proportional hazards model. In conclusion, Ki-67 index can be considered as a valuable independent prognostic biomarker for adult patients with MB.

  7. Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy

    DEFF Research Database (Denmark)

    Toftmann Hansen, Charlotte; Pedersen, Per T.; Jensen, Bo Amdi

    Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy.......Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy....

  8. CLINICAL VALUE OF BAFF AND APRIL CONCENTRATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    T. A. Panafidina

    2016-01-01

    Full Text Available Systemic lupus erythematosus (SLE is characterized by the pathological activation and differentiation of B lymphocytes. The B-lymphocyte stimulator (BLyS, also known as B cell-activating factor of the tumor necrosis factor family (BAFF, and its homologue, a proliferation-inducing ligand (APRIL, belong to the ligands of the tumor necrosis factor (TNF family and play a key role in B-lymphocyte selection and survival.Objective: to determine serum BAFF and APRIL concentrations in patients with SLE and a relationship of the clinical and laboratory parameters of the disease to the level of these cytokines.Subjects and methods. The investigation enrolled 73 patients (62 women and 11 men; median age, 30.0 [28.0; 46.0] years with SLE (disease duration, 5.0 [1.5; 11.0] years and its high activity (the median SLEDAI-2K scores of 8 [2; 13].Involvement of the kidneys and joints were found in 40 and 36% of cases, respectively; there were hematologic disorders in 38%, antinuclear factor (ANF in 94.5%, and anti-double stranded DNA antibodies in 77%. The concurrent antiphospholipid syndrome was detected in 15% of the patients. 66% of the patients took glucocorticoids (GCs (the median dose was 10 [0; 15] mg/day, calculated with reference to prednisolone, 42% received cytotoxic drugs (cyclophosphamide, mycophenolate mofetil, azathioprine; 12% used biological agents (BAs; 31.5% received no therapy at enrolment in the investigation. Serum BAFF and APRIL concentrations were estimated using an enzyme immunoassay.Results and discussion. The concentrations of BAFF and APRIL did not differ essentially in the patients with SLE and in the controls: the median level of BAFF was 0.02 [0.01; 0.64] and 0.02 [0.01; 0.03] ng/ml; that of APRIL was 2.09 [0.01; 3.80] and 0.01 [0.01; 4.16] ng/ml, respectively. The elevated concentration of BAFF (>0.82 ng/ml was revealed in 5.5% of the patients with SLE and that of APRIL (>5.96 ng/ml in 4.1%. There was a positive correlation between

  9. Chemical variability along the value chains of turmeric (Curcuma longa): a comparison of nuclear magnetic resonance spectroscopy and high performance thin layer chromatography.

    Science.gov (United States)

    Booker, Anthony; Frommenwiler, Debora; Johnston, Deborah; Umealajekwu, Chinenye; Reich, Eike; Heinrich, Michael

    2014-03-14

    Herbal medicine value chains have generally been overlooked compared with food commodities. Not surprisingly, revenue generation tends to be weighted towards the end of the chain and consequently the farmers and producers are the lowest paid beneficiaries. Value chains have an impact both on the livelihood of producers and on the composition and quality of products commonly sold locally and globally and consequently on the consumers. In order to understand the impact of value chains on the composition of products, we studied the production conditions for turmeric (Curcuma longa) and the metabolomic composition of products derived from it. We aimed at integrating these two components in order to gain a better understanding of the effect of different value chains on the livelihoods of some producers. This interdisciplinary project uses a mixed methods approach. Case studies were undertaken on two separate sites in India. Data was initially gathered on herbal medicine value chains by means of semi-structured interviews and non-participant observations. Samples were collected from locations in India, Europe and the USA and analysed using (1)H NMR spectroscopy coupled with multivariate analysis software and with high performance thin layer chromatography (HPTLC). We investigate medicinal plant value chains and interpret the impact different value chains have on some aspects of the livelihoods of producers in India and, for the first time, analytically assess the chemical variability and quality implications that different value chains may have on the products available to end users in Europe. There are benefits to farmers that belonged to an integrated chain and the resulting products were subject to a higher standard of processing and storage. By using analytical methods, including HPTLC and (1)H NMR spectroscopy, it has been possible to correlate some variations in product composition for selected producers and identify strengths and weaknesses of some types of value

  10. The effect of terebinth (Pistacia terebinthus L.) coffee addition on the chemical and physical characteristics, colour values, organic acid profiles, mineral compositions and sensory properties of ice creams.

    Science.gov (United States)

    Yüksel, Arzu Kavaz; Şat, Ihsan Güngör; Yüksel, Mehmet

    2015-12-01

    The aim of this research was to evaluate the effect of terebinth (Pistacia terebinthus L.) coffee addition (0.5, 1 and 2 %) on the chemical and physical properties, colour values, organic acid profiles, mineral contents and sensory characteristics of ice creams. The total solids, fat, titratable acidity, viscosity, first dripping time and complete melting time values, a (*) and b (*) colour properties, citric, lactic, acetic and butyric acid levels and Ca, Cu, Mg, Fe, K, Zn and Na concentrations of ice creams showed an increase with the increment of terebinth coffee amount, while protein, pH, L (*), propionic acid and orotic acid values decreased. However, Al and malic acid were not detected in any of the samples. The overall acceptability scores of the sensory properties showed that the addition of 1 % terebinth coffee to the ice cream was more appreciated by the panellists.

  11. The Effect of Variety and Growing Conditions on the Chemical Composition and Nutritive Value of Wheat for Broilers

    Directory of Open Access Journals (Sweden)

    M. E. E. Ball

    2013-03-01

    Full Text Available The aim of this study was to examine the effect of variety and growing conditions of wheat on broiler performance and nutrient digestibility. One hundred and sixty-four wheat samples, collected from a wide range of different sources, locations, varieties and years, were analyzed for a range of chemical and physical parameters. Chemical and physical parameters measured included specific weight, thousand grain weight (TG, in vitro viscosity, gross energy, N, NDF, starch, total and soluble non-starch polysaccharides (NSP, lysine, threonine, amylose, hardness, rate of starch digestion and protein profiles. Ninety-four of the wheat samples were selected for inclusion in four bird trials. Birds were housed in individual wire metabolizm cages from 7 to 28 d and offered water and feed ad libitum. Dry matter intake (DMI, live weight gain (LWG and gain:feed were determined weekly. A balance collection was carried out from 14 to 21 d for determination of apparent metabolizable energy (AME, ME:gain, DM retention, oil and NDF digestibility. At 28 d the birds were sacrificed, the contents of the jejunum removed for determination of in vivo viscosity and the contents of the ileum removed for determination of ileal DM, starch and protein digestibility. The wheat samples used in the study had wide-ranging chemical and physical parameters, leading to bird DMI, LWG, gain:feed, ME:GE, AME content and ileal starch and protein digestibility being significantly (p<0.05 affected by wheat sample. A high level of N fertilizer application to the English and NI wheat samples tended to benefit bird performance, with increases of up to 3.4, 7.2 and 3.8% in DMI, LWG and gain:feed, respectively. Fungicide application also appeared to have a positive effect on bird performance, with fungicide treated (+F wheat increasing bird DMI, LWG and gain:feed by 6.6, 9.3 and 2.7%, over the non-fungicide treated (-F wheats. An increase (p<0.1 of 9.3% in gain:feed was also observed at the

  12. Tumor microenvironment in head and neck squamous cell carcinomas: predictive value and clinical relevance of hypoxic markers. A review.

    Science.gov (United States)

    Hoogsteen, Ilse J; Marres, Henri A M; Bussink, Johan; van der Kogel, Albert J; Kaanders, Johannes H A M

    2007-06-01

    Hypoxia and tumor cell proliferation are important factors determining the treatment response of squamous cell carcinomas of the head and neck. Successful approaches have been developed to counteract these resistance mechanisms although usually at the cost of increased short- and long-term side effects. To provide the best attainable quality of life for individual patients and the head and neck cancer patient population as a whole, it is of increasing importance that tools be developed that allow a better selection of patients for these intensified treatments. A literature review was performed with special focus on the predictive value and clinical relevance of endogenous hypoxia-related markers. New methods for qualitative and quantitative assessment of functional microenvironmental parameters such as hypoxia, proliferation, and vasculature have identified several candidate markers for future use in predictive assays. Hypoxia-related markers include hypoxia inducible factor (HIF)-1alpha, carbonic anhydrase IX, glucose transporters, erythropoietin receptor, osteopontin, and others. Although several of these markers and combinations of markers are associated with treatment outcome, their clinical value as predictive factors remains to be established. A number of markers and marker profiles have emerged that may have potential as a predictive assay. Validation of these candidate assays requires testing in prospective trials comparing standard treatment against experimental treatments targeting the related microregional constituent. (c) 2007 Wiley Periodicals, Inc. Head Neck, 2007.

  13. Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education.

    Science.gov (United States)

    de Paula, Jonas Jardim; Bertola, Laiss; Ávila, Rafaela Teixeira; Moreira, Lafaiete; Coutinho, Gabriel; de Moraes, Edgar Nunes; Bicalho, Maria Aparecida Camargos; Nicolato, Rodrigo; Diniz, Breno Satler; Malloy-Diniz, Leandro Fernandes

    2013-01-01

    The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

  14. Study on clinical value of determination of plasma brain natriuretic peptide levels in patients with chronic congestive heart failure

    International Nuclear Information System (INIS)

    Chen Jianxiong; Li Zhuocheng; Tu Hong

    2010-01-01

    Objective: To evaluate the clinical value of determination of plasma brain natriuretic peptide (BNP) levels in patients with chronic congestive heart failure(CHF). Methods: The levels of plasma BNP were measured with fluorescence immunoassay in 341 patients with chronic CHF and 55 controls. Left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) were determined with color doppler ultrasonography in CHF patients. Results: Plasma levels of BNP were significantly increased in patients with CHF as compared with those in controls (P<0.01). There were also significant differences in plasma levels of CHF patients of different clinical stages (P<0.01). There was obvious correlation between plasma levels of BNP and the values of LVEF, LVESD and LVEDD (r was-0.62, +0.54 and +0.60 respectively, P<0.01). Conclusion: Plasma level of BNP is a sensitive indicator for assessment of ventricle function in CHF patients. (authors)

  15. Diagnostic value of brain chronic black holes on T1-weighted MR images in clinically isolated syndromes.

    Science.gov (United States)

    Mitjana, Raquel; Tintoré, Mar; Rocca, Maria A; Auger, Cristina; Barkhof, Frederik; Filippi, Massimo; Polman, Chris; Fazekas, Franz; Huerga, Elena; Montalban, Xavier; Rovira, Alex

    2014-10-01

    Non-enhancing black holes (neBHs) are more common in multiple sclerosis (MS) patients with longer disease durations and progressive disease subtypes. Our aim was to analyse the added value of neBHs in patients with clinically isolated syndromes (CISs) for predicting conversion to clinically definite MS (CDMS). Patients were classified based on the presence or absence of neBHs and on the number of Barkhof-Tintoré (B-T) criteria fulfilled. Dissemination in space (DIS) was defined as the presence of at least three of the four B-T criteria. Dissemination in time (DIT)1 was defined by simultaneous presence of enhancing and non-enhancing lesions. DIT2 was defined by simultaneous presence of neBHs and T2 lesions not apparent on T1-weighted images. Focal T2-hyperintense brain lesions were identified in 87.7% of the 520 CIS patients, and 41.4% of them presented at least one neBH. Patients meeting DIS, DIT1, and DIT2 had a significantly higher rate of conversion to CDMS. After adjusting for DIS, only patients who fulfilled DIT1 preserved a significant increase in CDMS conversion. Non-enhancing black holes in CIS patients are associated with a higher risk of conversion to CDMS. However, the predictive value of this finding is lost when added to the DIS criteria. © The Author(s) 2014.

  16. Catalytic Upgrading of Thermochemical Intermediates to Hydrocarbons: Conversion of Lignocellulosic Feedstocks to Aromatic Fuels and High Value Chemicals

    Energy Technology Data Exchange (ETDEWEB)

    Cortright, Randy [Virent, Inc., Madison, WI (United States); Rozmiarek, Bob [Virent, Inc., Madison, WI (United States); Van Straten, Matt [Virent, Inc., Madison, WI (United States)

    2017-11-28

    The principal objective of this project was to develop a fully integrated catalytic process that efficiently converts lignocellulosic feedstocks (e.g. bagasse, corn stover, and loblolly pine) into aromatic-rich fuels and chemicals. Virent led this effort with key feedstock support from Iowa State University. Within this project, Virent leveraged knowledge of catalytic processing of sugars and biomass to investigate two liquefaction technologies (Reductive Catalytic Liquefaction (USA Patent No. 9,212,320, 2015) and Solvolysis (USA Patent No. 9,157,030, 2015) (USA Patent No. 9,157,031, 2015)) that take advantage of proprietary catalysts at temperatures less than 300°C in the presence of unique solvent molecules generated in-situ within the liquefaction processes.

  17. Clinical value of CT-based preoperative software assisted lung lobe volumetry for predicting postoperative pulmonary function after lung surgery

    Science.gov (United States)

    Wormanns, Dag; Beyer, Florian; Hoffknecht, Petra; Dicken, Volker; Kuhnigk, Jan-Martin; Lange, Tobias; Thomas, Michael; Heindel, Walter

    2005-04-01

    This study was aimed to evaluate a morphology-based approach for prediction of postoperative forced expiratory volume in one second (FEV1) after lung resection from preoperative CT scans. Fifteen Patients with surgically treated (lobectomy or pneumonectomy) bronchogenic carcinoma were enrolled in the study. A preoperative chest CT and pulmonary function tests before and after surgery were performed. CT scans were analyzed by prototype software: automated segmentation and volumetry of lung lobes was performed with minimal user interaction. Determined volumes of different lung lobes were used to predict postoperative FEV1 as percentage of the preoperative values. Predicted FEV1 values were compared to the observed postoperative values as standard of reference. Patients underwent lobectomy in twelve cases (6 upper lobes; 1 middle lobe; 5 lower lobes; 6 right side; 6 left side) and pneumonectomy in three cases. Automated calculation of predicted postoperative lung function was successful in all cases. Predicted FEV1 ranged from 54% to 95% (mean 75% +/- 11%) of the preoperative values. Two cases with obviously erroneous LFT were excluded from analysis. Mean error of predicted FEV1 was 20 +/- 160 ml, indicating absence of systematic error; mean absolute error was 7.4 +/- 3.3% respective 137 +/- 77 ml/s. The 200 ml reproducibility criterion for FEV1 was met in 11 of 13 cases (85%). In conclusion, software-assisted prediction of postoperative lung function yielded a clinically acceptable agreement with the observed postoperative values. This method might add useful information for evaluation of functional operability of patients with lung cancer.

  18. Clinical value of FDG-PET/CT in suspected paraneoplastic syndromes: a retrospective analysis of 137 patients

    Energy Technology Data Exchange (ETDEWEB)

    Bjoern Kristensen, Stine; Hess, Soeren; Petersen, Henrik; Hoeilund-Carlsen, Poul Flemming [Odense University Hospital, Department of Nuclear Medicine, Odense (Denmark)

    2015-12-15

    Paraneoplastic syndromes (PNS) are relatively infrequent manifestations appearing before or after a cancer declares itself. Autoimmune mechanisms may be involved, but their cause and pathogenesis are often unknown. Due to disparity of symptoms, PNS remain a major diagnostic challenge. We examined the value of FDG-PET/CT for ruling in or out malignancy in a heterogeneous group of patients with suspected PNS. We retrospectively extracted data from all patients referred 2009-2013 with suspected PNS. Data included age, sex, follow-up period, scan report, further diagnostic procedures, and final clinical diagnosis. Conclusions of the scan reports were compared to the final follow-up outcome as determined during an average follow-up of 31 months (range 6-51.5) in patients who were not diagnosed with cancer in immediate continuation of a positive PET/CT scan. A total of 137 patients were included. Main causes for referral were neurological (n = 67), rheumatological (n = 25), dermatological (n = 18), nephrological (n = 6), haematological (n = 2), abnormal biochemistry (n = 11), and others (n = 8). The cancer prevalence was 8.8 %. The FDG-PET/CT results were as follows: nine true positives, 22 false positives, 103 true negatives, and three false negatives. Corresponding diagnostic values were: sensitivity 75 %, specificity 82 %, accuracy 82 %, and positive and negative predictive values of 29 % and 97 %, respectively. FDG-PET/CT has in patients with suspected PNS an impressively high negative predictive value and may be of value in ruling out PNS, the more so, the more the number of false positives can be minimized or used in differential diagnosis. We believe that FDG-PET/CT may become an important adjunct to the work-up and triage of patients with suspected PNS. (orig.)

  19. Discriminating the endogenous and exogenous urinary estrogens in human by isotopic ratio mass spectrometry and its potential clinical value.

    Science.gov (United States)

    Yang, Sheng; Zhang, Dapeng; Xu, Youxuan; Wang, Xiaobing; Liu, Xin; Wang, Shan; Wang, Jingzhu; Wu, Moutian; He, Zhenwen; Zhao, Jian; Yuan, Hong

    2013-02-01

    Estrogens were prohibited in the food producing animals by European Union (96/22/EC directive) and added to the Report on Carcinogens in United States since 2002. Due to very low concentration in serum or urine (~pg/mL), the method of control its abuse had not been fully developed. The endogenous estrogens were separated from urines of 18 adult men and women. The exogenous estrogens were chemical reference standards and over the counter preparations. Two patients of dysfunctional uterine bleeding (DUB) administered exogenous estradiol and the urines were collected for 72 h. The urinary estrogens were separated by high-performance liquid chromatography (HPLC) and confirmed. The exogenous and exogenous estrogens were analyzed by gas chromatography combustion isotope ratio mass spectrometry (GC-C-IRMS) to determine the (13)C/(12)C ratio (δ(13)C‰). The δ(13)C‰ values of reference standard of E1, E2, and E3 were -29.36±0.72, -27.98±0.35, -27.62±0.51, respectively. The δ(13)C‰ values of the endogenous E1, E2, and E3 were -21.62±1.07, -22.14±0.98, and -21.88±1.16, with Pendogenous and exogenous urinary estrogen in human. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Nutritional Value and Potential Chemical Food Safety Hazards of Selected Traditional and Conventional Pork Hams from Poland

    Directory of Open Access Journals (Sweden)

    Michał Halagarda

    2017-01-01

    Full Text Available Consumers no longer look for food characterized only by health safety and proper nutritional value. As a result, an increased interest in traditional and regional food can be observed. The aim of this paper is to analyze the results of a comparative analysis of three types of hams: traditional products registered on the List of Traditional Products of the Polish Ministry of Agriculture and Rural Development, then products whose names, retail prices, appearance, and manufacturer’s description suggest traditional methods of production, and finally conventional hams. The results show that traditional hams are characterized by the highest nutritional value among the analyzed groups of products. They have the lowest water and a high protein content. In addition, traditional hams are distinguished by a low concentration of sodium chloride and no addition of phosphates. The residues of nitrites and nitrates indicate their moderate use in manufacturing processes.

  1. Analysis of determination modalities concerning the exposure and emission limits values of chemical and radioactive substances; Analyse des modalites de fixation des valeurs limites d'exposition et d'emission pour les substances chimiques et radioactives

    Energy Technology Data Exchange (ETDEWEB)

    Schieber, C.; Schneider, T

    2002-08-01

    This document presents the generic approach adopted by various organizations for the determination of the public exposure limits values to chemical and radioactive substances and for the determination of limits values of chemical products emissions by some installations. (A.L.B.)

  2. Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Kreidy R

    2011-09-01

    Full Text Available Raghid Kreidy1, Elias Stephan2, Pascale Salameh3, Mirna Waked4 1Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 2Department of Geriatrics, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 3Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 4Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon Aim: The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%. Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied. Methods: Between July 2007 and January 2010, 95 consecutive Lebanese geriatric ($60 years of age inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years. Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis. Results: Out of 95 patients, 33 patients (34.7% were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal using complete venous ultrasound. Nine of these 33 patients (27.2% had a history of venous thromboembolism and eleven (33.3% presented with edema of lower

  3. Clinical value of patient-specific three-dimensional printing of congenital heart disease: Quantitative and qualitative assessments

    Science.gov (United States)

    Lau, Ivan Wen Wen; Liu, Dongting; Xu, Lei; Fan, Zhanming

    2018-01-01

    Objective Current diagnostic assessment tools remain suboptimal in demonstrating complex morphology of congenital heart disease (CHD). This limitation has posed several challenges in preoperative planning, communication in medical practice, and medical education. This study aims to investigate the dimensional accuracy and the clinical value of 3D printed model of CHD in the above three areas. Methods Using cardiac computed tomography angiography (CCTA) data, a patient-specific 3D model of a 20-month-old boy with double outlet right ventricle was printed in Tango Plus material. Pearson correlation coefficient was used to evaluate correlation of the quantitative measurements taken at analogous anatomical locations between the CCTA images pre- and post-3D printing. Qualitative analysis was conducted by distributing surveys to six health professionals (two radiologists, two cardiologists and two cardiac surgeons) and three medical academics to assess the clinical value of the 3D printed model in these three areas. Results Excellent correlation (r = 0.99) was noted in the measurements between CCTA and 3D printed model, with a mean difference of 0.23 mm. Four out of six health professionals found the model to be useful in facilitating preoperative planning, while all of them thought that the model would be invaluable in enhancing patient-doctor communication. All three medical academics found the model to be helpful in teaching, and thought that the students will be able to learn the pathology quicker with better understanding. Conclusion The complex cardiac anatomy can be accurately replicated in flexible material using 3D printing technology. 3D printed heart models could serve as an excellent tool in facilitating preoperative planning, communication in medical practice, and medical education, although further studies with inclusion of more clinical cases are needed. PMID:29561912

  4. The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

    Science.gov (United States)

    Morer, Carla; Roques, Christian-François; Françon, Alain; Forestier, Romain; Maraver, Francisco

    2017-12-01

    The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain

  5. Interactive cervical motion kinematics: sensitivity, specificity and clinically significant values for identifying kinematic impairments in patients with chronic neck pain.

    Science.gov (United States)

    Sarig Bahat, Hilla; Chen, Xiaoqi; Reznik, David; Kodesh, Einat; Treleaven, Julia

    2015-04-01

    Chronic neck pain has been consistently shown to be associated with impaired kinematic control including reduced range, velocity and smoothness of cervical motion, that seem relevant to daily function as in quick neck motion in response to surrounding stimuli. The objectives of this study were: to compare interactive cervical kinematics in patients with neck pain and controls; to explore the new measures of cervical motion accuracy; and to find the sensitivity, specificity, and optimal cutoff values for defining impaired kinematics in those with neck pain. In this cross-section study, 33 patients with chronic neck pain and 22 asymptomatic controls were assessed for their cervical kinematic control using interactive virtual reality hardware and customized software utilizing a head mounted display with built-in head tracking. Outcome measures included peak and mean velocity, smoothness (represented by number of velocity peaks (NVP)), symmetry (represented by time to peak velocity percentage (TTPP)), and accuracy of cervical motion. Results demonstrated significant and strong effect-size differences in peak and mean velocities, NVP and TTPP in all directions excluding TTPP in left rotation, and good effect-size group differences in 5/8 accuracy measures. Regression results emphasized the high clinical value of neck motion velocity, with very high sensitivity and specificity (85%-100%), followed by motion smoothness, symmetry and accuracy. These finding suggest cervical kinematics should be evaluated clinically, and screened by the provided cut off values for identification of relevant impairments in those with neck pain. Such identification of presence or absence of kinematic impairments may direct treatment strategies and additional evaluation when needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. The study on clinical value of the detection about serum and Unconjugated Bilirubin in diagnosis of neonatal jaundice.

    Science.gov (United States)

    Wang, Guangzhou; Wang, Jiefei; Huang, Nannan; Yu, Fengqin

    2016-01-01

    In this paper, the clinical value of the detection about serum and unconjugated bilirubin (UCB) in neonatal jaundice was studied to found an effective and rapid method for diagnose of neonatal jaundice. ALB (Serum Albumin), total serum bilirubin (TSB) and UCB were detected by ELISA method among the 100 cases with neonatal jaundice selected for the study. The values of ALB, UCB and TSB in moderate jaundice patients were (42.83±3.87) g/L, (287.35±44.38) μm/L, (304.16±43.40) μm/L, respectively; as for the severe jaundice patients, the values were (38.41±4.82) g/L, (354.38±48.75) μm/L, (375.20±47.51) μm/L. The results showed significant differences with the pjaundice patients. The level of ALB, UCB, TSB in hemolytic jaundice, obstructive jaundice and jaundice caused by other infections also had significant differences, and the difference was statistically significant (pjaundice.

  7. Biochemical and hematologic reference values for free-ranging, chemically immobilized wild norwegian reindeer (rangifer tarandus tarandus) during early winter.

    Science.gov (United States)

    Miller, Andrea L; Evans, Alina L; Os, Øystein; Arnemo, Jon M

    2013-04-01

    Hematologic and serum biochemistry values were evaluated in free-ranging, wild Norwegian reindeer (Rangifer tarandus tarandus) as part of a reintroduction program in southwestern Norway in November 1995 and 1996. Animals were immobilized with medetomidine-ketamine by dart from a helicopter. Blood was drawn for serum chemistry from 31 adults (nine males and 22 females) and for hematology from 29 adults (eight males and 21 females). Significant differences (Ppaper provides the first report of baseline hematologic and serum biochemistry reference ranges for free-ranging, wild Norwegian reindeer during early winter.

  8. Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

    Science.gov (United States)

    Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

    2015-09-01

    In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in

  9. Combining value of information analysis and ethical argumentation in decisions on participation of vulnerable patients in clinical research.

    Science.gov (United States)

    van der Wilt, Gert J; Grutters, Janneke P C; Maas, Angela H E M; Rolden, Herbert J A

    2018-02-05

    The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research.

  10. Prediction of pKa values for druglike molecules using semiempirical quantum chemical methods

    DEFF Research Database (Denmark)

    Jensen, Jan Halborg; Swain, Christopher J; Olsen, Lars

    2017-01-01

    Rapid yet accurate pKa prediction for druglike molecules is a key challenge in computational chemistry. This study uses PM6-DH+/COSMO, PM6/COSMO, PM7/COSMO, PM3/COSMO, AM1/COSMO, PM3/SMD, AM1/SMD, and DFTB3/SMD to predict the pKa values of 53 amine groups in 48 druglike compounds. The approach uses...... uncertainties of ±0.2-0.3 pH units, which make them statistically equivalent. However, for all but PM3/SMD and AM1/SMD the RMSEs are dominated by a single outlier, cefadroxil, caused by proton transfer in the zwitterionic protonation state. If this outlier is removed, the RMSE values for PM3/COSMO and AM1/COSMO...... drop to 1.0 ± 0.2 and 1.1 ± 0.3, whereas PM3/SMD and AM1/SMD remain at 1.5 ± 0.3 and 1.6 ± 0.3/0.4 pH units, making the COSMO-based predictions statistically better than the SMD-based predictions. For pKa calculations where a zwitterionic state is not involved or proton transfer in a zwitterionic state...

  11. Osteoporosis in water buffalo, in relation to age, clinical condition of the animal and physical-chemical bone and hepatic copper status

    Directory of Open Access Journals (Sweden)

    Washington Luiz Assunção Pereira

    2010-04-01

    Full Text Available This paper is part of a research program of metabolic nutritional diseases in water buffalo in the Humid Tropical Amazon. In that context, the objective was to study osteoporotic processes in buffalo raised in a grazing system on Marajó Island and the relation of the disease with the age as well as physical-chemical bone and hepatic copper status. One hundred and ten animals were evaluated: 39 young or juvenile and 71 adults that presented Body Condition Index from 1 to 2. One group was composed by young buffalo and another by adult animals. Based on anatomical-clinical and bone quality analyses, the animals were subdivided in two sub-groups, according to presence or absence of clinical signs of apparent osteopathic. Analysis of calcium, phosphorus, ash and bone density was performed on the middle third of the 11th right rib, and the copper concentration was determined from liver tissue. Pathological anatomical findings showed that 98.44% of juvenile animals and 96.16% of adult animals, respectively, presented some degree of osteoporosis (+, ++, +++. Low average percentages were demonstrated for phosphorus (10.69%, in ashes (60.24% and in density (1.46 g/ml. Hepatic copper presented similar low values (19.51 mg/kg. The results showed that juvenile animals presented more severe clinical sign of osteoporosis, and the pathogenesis may be related to low reserves of phosphorus in bony tissue and copper in liver tissue.

  12. Assessing the Financial Value of Patient Engagement: A Quantitative Approach from CTTI's Patient Groups and Clinical Trials Project.

    Science.gov (United States)

    Levitan, Bennett; Getz, Kenneth; Eisenstein, Eric L; Goldberg, Michelle; Harker, Matthew; Hesterlee, Sharon; Patrick-Lake, Bray; Roberts, Jamie N; DiMasi, Joseph

    2018-03-01

    While patient groups, regulators, and sponsors are increasingly considering engaging with patients in the design and conduct of clinical development programs, sponsors are often reluctant to go beyond pilot programs because of uncertainty in the return on investment. We developed an approach to estimate the financial value of patient engagement. Expected net present value (ENPV) is a common technique that integrates the key business drivers of cost, time, revenue, and risk into a summary metric for project strategy and portfolio decisions. We assessed the impact of patient engagement on ENPV for a typical oncology development program entering phase 2 or phase 3. For a pre-phase 2 project, the cumulative impact of a patient engagement activity that avoids one protocol amendment and improves enrollment, adherence, and retention is an increase in net present value (NPV) of $62MM ($65MM for pre-phase 3) and an increase in ENPV of $35MM ($75MM for pre-phase 3). Compared with an investment of $100,000 in patient engagement, the NPV and ENPV increases can exceed 500-fold the investment. This ENPV increase is the equivalent of accelerating a pre-phase 2 product launch by 2½ years (1½ years for pre-phase 3). Risk-adjusted financial models can assess the impact of patient engagement. A combination of empirical data and subjective parameter estimates shows that engagement activities with the potential to avoid protocol amendments and/or improve enrollment, adherence, and retention may add considerable financial value. This approach can help sponsors assess patient engagement investment decisions.

  13. Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice

    Directory of Open Access Journals (Sweden)

    Haage Patrick

    2010-04-01

    Full Text Available Abstract Background In patients with osteoarthritis, a detailed assessment of degenerative cartilage disease is important to recommend adequate treatment. Using a representative sample of patients, this study investigated whether MRI is reliable for a detailed cartilage assessment in patients with osteoarthritis of the knee. Methods In a cross sectional-study as a part of a retrospective case-control study, 36 patients (mean age 53.1 years with clinically relevant osteoarthritis received standardized MRI (sag. T1-TSE, cor. STIR-TSE, trans. fat-suppressed PD-TSE, sag. fat-suppressed PD-TSE, Siemens Magnetom Avanto syngo MR B 15 on a 1.5 Tesla unit. Within a maximum of three months later, arthroscopic grading of the articular surfaces was performed. MRI grading by two blinded observers was compared to arthroscopic findings. Diagnostic values as well as intra- and inter-observer values were assessed. Results Inter-observer agreement between readers 1 and 2 was good (kappa = 0.65 within all compartments. Intra-observer agreement comparing MRI grading to arthroscopic grading showed moderate to good values for readers 1 and 2 (kappa = 0.50 and 0.62, respectively, the poorest being within the patellofemoral joint (kappa = 0.32 and 0.52. Sensitivities were relatively low at all grades, particularly for grade 3 cartilage lesions. A tendency to underestimate cartilage disorders on MR images was not noticed. Conclusions According to our results, the use of MRI for precise grading of the cartilage in osteoarthritis is limited. Even if the practical benefit of MRI in pretreatment diagnostics is unequivocal, a diagnostic arthroscopy is of outstanding value when a grading of the cartilage is crucial for a definitive decision regarding therapeutic options in patients with osteoarthritis.

  14. Clinical value of IS6110-based loop-mediated isothermal amplification for detection of Mycobacterium tuberculosis complex in respiratory specimens.

    Science.gov (United States)

    Aryan, Ehsan; Makvandi, Manoochehr; Farajzadeh, Ahmad; Huygen, Kris; Alvandi, Amir-Hooshang; Gouya, Mohammad-Mehdi; Sadrizadeh, Ali; Romano, Marta

    2013-06-01

    A fundamental to global tuberculosis (TB) control is timely and accurate diagnosis of infectious cases of the disease. Among various methods, techniques based on nucleic acid amplification are the ones with promising prospects. The present study evaluates the diagnostic value of the recently developed IS6110-based loop-mediated isothermal amplification (LAMP) for detection of Mycobacterium tuberculosis complex (MTBC) in sputum specimens. In this cross-sectional study (2008-2009), IS6110-LAMP was evaluated on 101 sputum specimens from 93 highly suspected TB patients and compared to Amplicor MTB test and in-house IS6110-PCR and -nested PCR assays. Culture results or clinical recovery following anti-TB therapy was considered as a reference to prove the TB cases. The overall sensitivity of IS6110-LAMP, Amplicor, nPCR, and PCR were respectively 89.6% (69/77 specimens; 95% confidence interval [CI], 80.5-95.4%), 76.6% (59/77 specimens; CI, 65.6-85.5%), 79.2% (61/77 specimens; CI, 68.5-87.6%) and 59.7% (46/77 specimens; CI, 47.9-70.8%). The specificity and positive predictive value (PPV) were 100% for all the tests, and the negative predictive value (NPV) of IS6110-LAMP, Amplicor, nPCR, and PCR were respectively 75%, 57.1%, 60%, and 43.6%. There was an excellent overall agreement between LAMP and nPCR (k 0.828), and between LAMP and Amplicor (k 0.746), in addition to a better tolerance of IS6110-LAMP to inhibitors present in clinical specimens. The better diagnostic performance of IS6110-LAMP compared to Amplicor (p = 0.009), nPCR (p = 0.013) and PCR (p < 0.0001) besides its rapidity, simplicity, and cost-effectiveness makes it a valuable method for the detection of MTBC in clinical samples, particularly in resource-limited settings. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  15. Standardization of clinical enzyme analysis using frozen human serum pools with values assigned by the International Federation of Clinical Chemistry and Laboratory Medicine reference measurement procedures.

    Science.gov (United States)

    Tong, Qing; Chen, Baorong; Zhang, Rui; Zuo, Chang

    Variation in clinical enzyme analysis, particularly across different measuring systems and laboratories, represents a critical but long-lasting problem in diagnosis. Calibrators with traceability and commutability are imminently needed to harmonize analysis in laboratory medicine. Fresh frozen human serum pools were assigned values for alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), creatine kinase (CK) and lactate dehydrogenase (LDH) by six laboratories with established International Federation of Clinical Chemistry and Laboratory Medicine reference measurement procedures. These serum pools were then used across 76 laboratories as a calibrator in the analysis of five enzymes. Bias and imprecision in the measurement of the five enzymes tested were significantly reduced by using the value-assigned serum in analytical systems with open and single-point calibration. The median (interquartile range) of the relative biases of ALT, AST, GGT, CK and LDH were 2.0% (0.6-3.4%), 0.8% (-0.8-2.3%), 1.0% (-0.5-2.0%), 0.2% (-0.3-1.0%) and 0.2% (-0.9-1.1%), respectively. Before calibration, the interlaboratory coefficients of variation (CVs) in the analysis of patient serum samples were 8.0-8.2%, 7.3-8.5%, 8.1-8.7%, 5.1-5.9% and 5.8-6.4% for ALT, AST, GGT, CK and LDH, respectively; after calibration, the CVs decreased to 2.7-3.3%, 3.0-3.6%, 1.6-2.1%, 1.8-1.9% and 3.3-3.5%, respectively. The results suggest that the use of fresh frozen serum pools significantly improved the comparability of test results in analytical systems with open and single-point calibration.

  16. Exploring the Educational Value of Clinical Vignettes from the Society of General Internal Medicine National Meeting in the Internal Medicine Clerkship

    Science.gov (United States)

    Wofford, James L; Singh, Sonal

    2006-01-01

    INTRODUCTION Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE To explore the relevance and learning value of clinical vignettes from the SGIM national meeting in the Internal Medicine clerkship. SETTING Third year Ambulatory Internal Medicine clerkship at one academic medical center (academic year 2005 to 2006). METHODS Students were introduced to the clinical vignette and oriented to the database of clinical vignettes available through the SGIM annual meeting website. Students then reviewed 5 to 10 clinical vignettes using a worksheet, and rated the learning value of each vignette using a 5-point Likert scale (1 = least, 5 = greatest). A single investigator evaluated congruence of the vignette with the Clerkship Directors of Internal Medicine (CDIM)-SGIM curriculum to assess relevance. MAIN RESULTS A total of 42 students evaluated 371 clinical vignettes from the 2004 and 2005 meetings. The clinical vignettes were curriculum-congruent in 42.6% (n = 175), and clearly incongruent in 40.4% (n = 164). The mean rating for learning value was 3.8 (±1.0) (5 signifying greatest learning value). Curriculum-congruent vignettes had a higher mean learning value compared with curriculum-incongruent vignettes (4.0 vs 3.6, Student's t-test, P =.017). CONCLUSION The clinical vignettes presented at the national SGIM meeting offer clinical content that is relevant and of some educational value for third year clerkship students. Based on this pilot study, the educational value and strategies for their use in the clinical clerkships deserve further study. PMID:17026730

  17. Combined echo offset (Dixon) and line volume chemical shift imaging as a clinical imaging protocol

    International Nuclear Information System (INIS)

    Listerud, J.; Chan, T.; Lenkinski, R.E.; Kressel, H.Y.; Chao, P.W.

    1989-01-01

    The authors have studied the sensitivity and specificity of the line-volume chemical-shift imaging (CSI) method as compared with the Dixon method they have recently implemented on a Signa, which supports a variety of options. Potential sources or error for the Dixon method include line broadening due to susceptibility, field inhomogeneity, and errors form olefinic resonances associated with fat, which behave like water in the Dixon regime. The authors investigate whether a combined Dixon/line-volume CSI method could be used to improve the placement of the line volume and to provide higher sensitivity and specificity than does the Dixon method alone

  18. VALUE OF CLINICAL PULMONARY INFECTION SCORE IN CRITICALLY ILL PATIENTS: BETWEEN THE USE OF CHLORHEXIDINE AND PIPER BETLE LINN MOUTHWASH

    Directory of Open Access Journals (Sweden)

    Irfany Nurul Hamid

    2018-02-01

    Full Text Available Background: One of the complications of ventilator use in patients in Intensive Care Unit (ICU is Ventilator-Associated Pneumonia (VAP. Oral hygienes is one of the methods to prevent VAP. Objective: The objective of this study was to compare the value of clinical infection score (CPIS in critically ill patients after given oral hygiene using chlorhexidine and Piper betle Linn mouthwash. Methods: This was an observational study with cross-sectional study design, which consisted of two intervention groups. Thirty respondents were selected using total sampling, with 15 respondents randomly assigned in each group. Independent t-test was used for data analysis. Results: Findings showed that the mean of CPIS in the Piper betle Linn group was 3.80 and the mean of CPIS in the chlorhexidine group was 4.07. Conclusion: CPIS in the treatment group using Piper betle Linn mouthwash was lower than the mean of CPIS in the treatment group using clorhexidine.

  19. Clinical value of MSCTA in the interventional treatment of the initial origin stenotic segment of the internal carotid artery

    International Nuclear Information System (INIS)

    Qi Yueyong; Zou Liguang; Chen Lin; Sun Qingrong; Shuai Jie; Zhou Zheng; Huang Lan

    2007-01-01

    Objective: To assess the clinical value of MSCTA in the interventional treatment of the initial origin stenotic segment of internal carotid artery. Methods: Forty two patients with stenosis of initial origin stenotic segment of internal carotid artery underwent interventional treatment and MSCTA were analyzed retrospectively. Results: Forty two patients were diagnosed correctly through MSCTA. The percentages of stenotic area were measured from the multiplanar reconstruction (MPR)images of MSCTA, including mild stenosis( 70%)in 30, obstruction in 4 (>100%)and normal in 18. Plaques and endoscopic views of stenosis were delineated on MSCTA and CTVE. Conclusion: MSCTA is an accurate method for the assessment of the stenosis and plaques of the stenotic origin segment of internal carotid artery. MSCTA can be used as a convenient follow-up modality for instent restenosis. (authors)

  20. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy.

    Science.gov (United States)

    Kinahan, Paul E; Fletcher, James W

    2010-12-01

    The use of standardized uptake values (SUVs) is now common place in clinical 2-deoxy-2-[(18)F] fluoro-D-glucose (FDG) position emission tomography-computed tomography oncology imaging and has a specific role in assessing patient response to cancer therapy. Ideally, the use of SUVs removes variability introduced by differences in patient size and the amount of injected FDG. However, in practice there are several sources of bias and variance that are introduced in the measurement of FDG uptake in tumors and also in the conversion of the image count data to SUVs. In this article the overall imaging process is reviewed and estimates of the magnitude of errors, where known, are given. Recommendations are provided for best practices in improving SUV accuracy. Copyright © 2010 Elsevier Inc. All rights reserved.

  1. Case of asymmetrical arthrogryposis. A clinical study and a preliminary report on the value of CT-scanning

    Energy Technology Data Exchange (ETDEWEB)

    Hageman, G.; Vette, J.K.; Willemse, J. (University Hospital, Utrecht (Netherlands))

    1983-01-01

    Following the introduction of the conception that arthrogryposis is a symptom and not a clinical entity, a case of the very rare asymmetric form of neurogenic arthrogryposis is presented. The asymmetry of congenital contractures and weakness is associated with hemihypotrophy. The value of muscular CT-scanning prior to muscle biopsy is demonstrated. Muscular CT-scanning shows the extension of adipose tissue, which has replaced damaged muscles and therby indicates the exact site for muscle biopsy. Since orthopaedic treatment in arthrogryposis can be unrewarding due to severe muscular degeneration, preoperative scanning may provide additional important information on muscular function and thus be of benefit for surgery. The advantage of muscular CT-scanning in other forms of arthrogryposis requires further determination. The differential diagnosis with Werdnig-Hoffmann disease is discussed.

  2. The