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Sample records for discontinued treatment due

  1. Successful retreatment with grazoprevir and elbasvir for patients infected with hepatitis C virus genotype 1b, who discontinued prior treatment with NS5A inhibitor-including regimens due to adverse events.

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    Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Nakamoto, Shingo; Takahashi, Koji; Wu, Shuang; Sasaki, Reina; Haga, Yuki; Ogasawara, Sadahisa; Saito, Tomoko; Kobayashi, Kazufumi; Kiyono, Soichiro; Ooka, Yoshihiko; Suzuki, Eiichiro; Chiba, Tetsuhiro; Maruyama, Hitoshi; Moriyama, Mitsuhiko; Kato, Naoya

    2018-03-23

    Sustained virologic response (SVR) by interferon and interferon-free treatment can results in the reduction of advanced liver fibrosis and the occurrence of hepatocellular carcinoma in patients infected with hepatitis C virus (HCV). Recent interferon-free treatment for HCV shortens the duration of treatment and leads to higher SVR rates, without any serious adverse events. However, it is important to retreat patients who have had treatment-failure with HCV non-structural protein 5A (NS5A) inhibitor-including regimens. Combination of sofosbuvir and ledipasvir only leads to approximately 100% SVR rates in HCV genotype (GT1b), NS5A inhibitor-naïve patients in Japan. This combination is not an indication for severe renal disease or heart disease, and these patients should be treated or retreated with a different regimen. Retreatment with HCV non-structural protein 3/4A inhibitor, grazoprevir, and HCV NS5A inhibitor, elbasvir, successfully eradicated HCV RNA in three patients with HCV genotype 1b infection who discontinued prior interferon-free treatments including HCV NS5A inhibitors due to adverse events within 2 weeks. Retreatment with the 12-week combination regimen of grazoprevir and elbasvir is effective for HCV GT1b patients who discontinue the HCV NS5A inhibitor-including regimens within 2 weeks. The treatment response may be related to the short duration of initial treatment, which did not produce treatment-emergent RASs.

  2. Why do couples discontinue unlimited free IVF treatments?

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    Lande, Yechezkel; Seidman, Daniel S; Maman, Ettie; Baum, Micha; Hourvitz, Ariel

    2015-03-01

    Worldwide, IVF is often discontinued before a live birth is achieved due to high costs. Even when partial financial coverage is provided, often medical providers advise treatment discontinuation. In Israel, unlimited IVF is offered free of charge for a couples' first two children. Our objective was to assess the reasons couples discontinue IVF treatments before achieving two children in a completely unlimited cost-free environment. This cohort study included all primary infertile women, reason they ceased treatments. Of the 134 couples included, only 46 ceased IVF treatments without achieving two children, after performing an average of 6.2 IVF cycles to achieve their first birth. The reasons given were: lost hope of success (13), psychological burden (18), divorce (6), medical staff recommendation (5), bureaucratic difficulties (3) and general medical condition (1). The main reasons for "drop out" in our cost-free environment were as follows: psychological burden and lost hope of success. Due to high availability of treatments, medical staff recommendation was a less significant factor in our study.

  3. [Discontinuation of depression treatment from the perspective of suicide prevention].

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    Cho, Yoshinori

    2012-01-01

    It is assumed that discontinuation of treatment for depression may increase the risk of suicide. A population-based register study in Denmark did not find a lower risk among people over age 50 who followed treatment in comparison with those who discontinued treatment with antidepressants at an early stage. This result, however, does not allow us to think superficially that early discontinuation of treatment does not increase the risk of suicide. It is because the study has limitations without information of such as psychiatric diagnoses, severity of the depressed state, and reasons of discontinuation. It is safe for clinicians to aim at preventing discontinuation of treatment. Particularly, in Japan and South Korea where there is a sociocultural climate of tolerability for suicide, suicide can occur in milder depressed state and discontinuation of treatment should be taken more seriously than in Western countries.

  4. Discontinuance of ADHD Treatment in Adolescents

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    J Gordon Millichap

    2009-04-01

    Full Text Available Prevalence of ADHD drug discontinuance in adolescents and young adults was studied in the UK by using the General Practice Database for patients aged 15-21 years from 1999 to 2006.

  5. Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

    DEFF Research Database (Denmark)

    Farah, Rahmo I; Damkier, Per; Christiansen, Anders

    2018-01-01

    Montelukast, a leukotriene receptor antagonist, was marketed in 1998 as an oral supplementary treatment to patients with mild to moderate asthma. The aim of this study was to describe the early discontinuation pattern among montelukast users in Denmark in the period of 1 March 1998 to 31 December....... Early discontinuation was defined as failing to fill a second prescription for montelukast within at least a year after the initial montelukast prescription. Among 135,271 included montelukast users, 47,480 (35%) discontinued the use of montelukast after a single redeemed prescription. The trend...

  6. Metallicity at interphase boundaries due to polar catastrophe induced by charge density discontinuity

    KAUST Repository

    Albar, Arwa

    2018-02-09

    The electronic properties of interphase boundaries are of basic importance for most materials, particularly when those properties deviate strongly from the bulk behavior. We introduce a mechanism that can result in metallicity at stoichiometric interphase boundaries between semiconductors based on the idea of polar catastrophe, which is usually considered only in the context of heterostructures. To this end, we perform ab initio calculations within density functional theory to investigate the electronic states at stoichiometric SnO/SnO2 (110) interphase boundaries. In this system, one would not expect polar catastrophe to have a role according to state-of-the-art theory because the interface lacks formal charge discontinuity. However, we observe the formation of a hole gas between the semiconductors SnO and SnO2. To explain these findings, we provide a generalized theory based on the idea that the charge density discontinuity between SnO and SnO2, a consequence of lattice mismatch, drives a polar catastrophe scenario. As a result, SnO/SnO2 (110) interphase boundaries can develop metallicity depending on the grain size. The concept of metallicity due to polar catastrophe induced by charge density discontinuity is of general validity and applies to many interphase boundaries with lattice mismatch.

  7. Discontinuing treatment in children with chronic, critical illnesses.

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    Mahon, M M; Deatrick, J A; McKnight, H J; Mohr, W K

    2000-03-01

    Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

  8. Factors associated with poor satisfaction with treatment and trial discontinuation in chronic schizophrenia.

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    Schoemaker, Joep H; Vingerhoets, Ad J J M; Emsley, Robin A

    2018-06-05

    IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates. Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses. ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment. Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

  9. Early discontinuation of attention-deficit/hyperactivity disorder drug treatment: a danish nationwide drug utilization study

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    Pottegård, Anton; Bjerregaard, B. K.; Kortegaard, L. S.

    2015-01-01

    Knowledge of patterns of treatment discontinuation in attention-deficit/hyperactivity disorder (ADHD) drug treatment is of importance, for both the clinical practice and the study of long-term treatment outcomes. The purpose of this study was to describe early discontinuation of ADHD drug treatme...

  10. Passive noise control by enhancing aeroacoustic interference due to structural discontinuities in close proximity

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    Leung, R. C. K.; So, R. M. C.; Tang, S. K.; Wang, X. Q.

    2011-07-01

    In-duct devices are commonly installed in flow ducts for various flow management purposes. The structural construction of these devices indispensably creates disruption to smooth flow through duct passages so they exist as structural discontinuities in duct flow. The presence of these discontinuities provides additional possibility of noise generation. In real practice, in-duct devices do not exist alone in any duct system. Even though each in-duct device would generate its own noise, it might be possible that these devices could be properly arranged so as to strengthen the interference between individual noise; thus giving rise to an overall reduction of noise radiation in the in-duct far field. This concept of passive noise control is investigated by considering different configurations of two structural discontinuities of simple form (i.e., a cavity) in tandem in an unconfined flow and in opposing setting within a flow duct. It is known that noise generated by a cavity in unconfined domain (unconfined cavity) is strongly dependent on flow-resonant behavior within the cavity so the interference it produces is merely aeroacoustic. The objective of the present study is to verify the concept of passive noise reduction through enhancement of aeroacoustic interference due to two cavities by considering laminar flow only. A two-dimensional approach is adopted for the direct aeroacoustic calculations using a direct numerical simulation (DNS) technique. The position and geometries of the cavities and the Mach number are varied; the resultant aeroacoustic behavior and acoustic power are calculated. The numerical results are compared with a single cavity case to highlight the effect of introducing additional cavities to the aeroacoustic problem. Resonant flow oscillations occur when two unconfined cavities are very close and the associated acoustic field is very intense with no noise reduction possible. However, for duct aeroacoustics, it is found that a 7.9 db reduction

  11. Metallicity at interphase boundaries due to polar catastrophe induced by charge density discontinuity

    KAUST Repository

    Albar, Arwa; Tahini, Hassan Ali; Schwingenschlö gl, Udo

    2018-01-01

    the electronic states at stoichiometric SnO/SnO2 (110) interphase boundaries. In this system, one would not expect polar catastrophe to have a role according to state-of-the-art theory because the interface lacks formal charge discontinuity. However, we observe

  12. Discontinuous finite element treatment of duct problems in transport calculations

    International Nuclear Information System (INIS)

    Mirza, A. M.; Qamar, S.

    1998-01-01

    A discontinuous finite element approach is presented to solve the even-parity Boltzmann transport equation for duct problems. Presence of ducts in a system results in the streaming of particles and hence requires the employment of higher order angular approximations to model the angular flux. Conventional schemes based on the use of continuous trial functions require the same order of angular approximations to be used everywhere in the system, resulting in wastage of computational resources. Numerical investigations for the test problems presented in this paper indicate that the discontinuous finite elements eliminate the above problems and leads to computationally efficient and economical methods. They are also found to be more suitable for treating the sharp changes in the angular flux at duct-observer interfaces. The new approach provides a single-pass alternate to extrapolation and interactive schemes which need multiple passes of the solution strategy to acquire convergence. The method has been tested with the help of two case studies, namely straight and dog-leg duct problems. All results have been verified against those obtained from Monte Carlo simulations and K/sup +/ continuous finite element method. (author)

  13. Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia.

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    Burchert, A; Saussele, S; Eigendorff, E; Müller, M C; Sohlbach, K; Inselmann, S; Schütz, C; Metzelder, S K; Ziermann, J; Kostrewa, P; Hoffmann, J; Hehlmann, R; Neubauer, A; Hochhaus, A

    2015-06-01

    A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.

  14. BEHAVIORAL ASPECTS IN COMMUNITY ORAL HEALTH PROBLEMS: A STUDY ON DENTAL TREATMENT DISCONTINUATION

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    Felix Aryadi Joelimar

    2015-08-01

    Full Text Available The low value of F/DMF-T ration on Performed Treatment Index in Indoneisa gives an indication of great problems in dental treatment utilization. Dental treatment utilization is affected by several obstacles, the greatest among which is psychosocial obstacles. In this study the psychosocial obstacles were detected through Intrinsic Obstacles, Obstacles in Transportation, and Obstacles in Dental Clinic related to their effects on their discontinuation of dental treatments at Balkesmas Kiara, Kecamatan Senen, Jakarta Pusat. The discontinuation of dental treatments was mostly affected by Intrinsic Obstacles, through its components as Types of Cases, Dental Anxiety Scale, and Intrinsic Motivation. Generally Obstacles in Transportation had no effects, excpet its components of Travel Time and Tiredness. Obstacles in Dental Clinic had a significant effect on the discontinuation of dental treatments through the unpleasant manner of the druggist, the hot waiting room, and the high expense on drugs.

  15. Measuring persistence to hormonal therapy in patients with breast cancer: accounting for temporary treatment discontinuation.

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    Huiart, Laetitia; Ferdynus, Cyril; Dell'Aniello, Sophie; Bakiri, Naciba; Giorgi, Roch; Suissa, Samy

    2014-08-01

    Several studies have been conducted to estimate persistence to hormonal therapy among women with breast cancer (BC). Most studies focus on first treatment discontinuation. Patients, however, can have numerous periods of treatment discontinuation or treatment exposure. Our objective is to estimate persistence to tamoxifen in patients with BC while accounting for temporary treatment discontinuations and this by using multi-state (MS) models. A cohort of 10,806 women with BC having received at least one prescription of tamoxifen between 1998 and 2008 was constituted from the UK General Practice Research Database. We fitted a semi-Markov model with three states to estimate the probability of being off treatment over a 5-year period while accounting for temporary treatment discontinuations (transition between on treatment and off treatment) and competing risks (recurrence of BC or death). Non-persistence, as estimated from the MS model, ranged from 12.1% (95% confidence interval [95%CI]: 9.2-15.1) at 1 year to 14.9% (95%CI: 11.7-18.1) at 5 years. Estimations of non-persistence based on the Kaplan-Meier model were higher, i.e., 29.3% (95%CI: 28.1-30.6) at 5 years, as well as those obtained from a competing risk model, i.e., 24.0% (95%CI: 22.9-25.1). Most temporary discontinuations (94.7%) lasted less than 6 months. Temporary treatment discontinuations are frequent and should be accounted for when measuring adherence to treatment. MS models can provide a useful framework for this sort of analysis insofar as they help describe patients' complex behavior. This may help tailor interventions that improve persistence to hormonal therapy among women with BC. Copyright © 2014 John Wiley & Sons, Ltd.

  16. Fast Numerical Simulation of Focused Ultrasound Treatments During Respiratory Motion With Discontinuous Motion Boundaries.

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    Schwenke, Michael; Georgii, Joachim; Preusser, Tobias

    2017-07-01

    Focused ultrasound (FUS) is rapidly gaining clinical acceptance for several target tissues in the human body. Yet, treating liver targets is not clinically applied due to a high complexity of the procedure (noninvasiveness, target motion, complex anatomy, blood cooling effects, shielding by ribs, and limited image-based monitoring). To reduce the complexity, numerical FUS simulations can be utilized for both treatment planning and execution. These use-cases demand highly accurate and computationally efficient simulations. We propose a numerical method for the simulation of abdominal FUS treatments during respiratory motion of the organs and target. Especially, a novel approach is proposed to simulate the heating during motion by solving Pennes' bioheat equation in a computational reference space, i.e., the equation is mathematically transformed to the reference. The approach allows for motion discontinuities, e.g., the sliding of the liver along the abdominal wall. Implementing the solver completely on the graphics processing unit and combining it with an atlas-based ultrasound simulation approach yields a simulation performance faster than real time (less than 50-s computing time for 100 s of treatment time) on a modern off-the-shelf laptop. The simulation method is incorporated into a treatment planning demonstration application that allows to simulate real patient cases including respiratory motion. The high performance of the presented simulation method opens the door to clinical applications. The methods bear the potential to enable the application of FUS for moving organs.

  17. Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects.

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    Vitzthum, Virginia J; Ringheim, Karin

    2005-03-01

    Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women's tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman's ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women's health and improve the acceptability and continuation of hormonal contraceptives.

  18. Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder.

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    Wang, Hee Ryung; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

    2015-01-01

    This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Fifty-five percent of subjects (57/104) prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge.

  19. Reasons for discontinuation of subcutaneous biologic therapy in the treatment of rheumatoid arthritis: a patient perspective

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    Bolge SC

    2015-01-01

    Full Text Available Susan C Bolge,1 Amir Goren,2 Neeta Tandon1 1Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA; 2Health Outcomes Practice, Kantar Health, New York, NY, USA Objective: To examine reasons why rheumatoid arthritis patients discontinued subcutaneous (SQ anti-tumor necrosis factor (anti-TNF treatment in the past 12 months, so as to help inform successful, uninterrupted therapy.Methods: Data were collected in March and April 2011 using self-reported, internet-based questionnaires. Study inclusion criteria comprised: rheumatoid arthritis diagnosis; discontinuation of SQ anti-TNF medication (adalimumab, certolizumab, etanercept, or golimumab within the past 12 months; aged ≥18 years; United States residency; and consent to participate. Patients reported primary and other reasons for discontinuation of their most recently discontinued anti-TNF.Results: Questionnaires from 250 patients were analyzed; 72.8% were female, 80.8% were white, and median age was 51 years. Patients had discontinued etanercept (n=109, adalimumab (n=98, certolizumab (n=24, or golimumab (n=19 within the past 12 months. When prompted about their primary reason for discontinuation, lack of effectiveness (40.8% was cited most often, followed by injection experience (18.4%. Combining prompted primary and other reasons for discontinuation, 60.8% of patients reported lack of effectiveness, while 40.8% reported injection experience, which included: pain/burning/discomfort after injection (14.4%; pain/burning/discomfort during injection (13.2%; injection reactions such as redness/swelling after injection (12.4%; dislike of self-injection (11.6%; dislike of frequency of injection (10.4%; and fear of injection/needles (6.8%. Conclusion: From the patient perspective, there are unmet needs with regard to the effectiveness and injection experience associated with SQ anti-TNF medications, which may lead to discontinuation. Treatment options with a

  20. Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder

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    Juliana Belo Diniz

    2011-01-01

    Full Text Available INTRODUCTION: In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments. OBJECTIVE: This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients. METHODS: A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs were compared with a paired sample of compliant patients (n = 41. Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chisquare and Mann-Whitney tests were used when indicated. Variables presenting a p value <0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable. RESULTS: Agoraphobia was only present in one (2.4% patient who completed the twelve-week therapy, whereas it was present in six (15.0% patients who dropped out (p = 0.044. Social phobia was present in eight (19.5% patients who completed the twelve-week therapy and eighteen (45% patients who dropped out (p = 0.014. Generalized anxiety disorder was present in eight (19.5% patients who completed the twelve-week therapy and twenty (50% dropouts (p = 0.004, and somatization disorder was not present in any of the patients who completed the twelveweek therapy; however, it was present in six (15% dropouts (p = 0.010. According to the logistic regression model, treatment modality (p = 0.05, agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03 and the Beck Anxiety Inventory (p = 0.02 scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables. DISCUSSION AND CONCLUSION: Early treatment

  1. Metronomic capecitabine as second-line treatment for hepatocellular carcinoma after sorafenib discontinuation.

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    Trevisani, Franco; Brandi, Giovanni; Garuti, Francesca; Barbera, Maria Aurelia; Tortora, Raffaella; Casadei Gardini, Andrea; Granito, Alessandro; Tovoli, Francesco; De Lorenzo, Stefania; Inghilesi, Andrea Lorenzo; Foschi, Francesco Giuseppe; Bernardi, Mauro; Marra, Fabio; Sacco, Rodolfo; Di Costanzo, Giovan Giuseppe

    2018-02-01

    Metronomic capecitabine (MC) is a well-tolerated systemic treatment showing promising results in one retrospective study, as second-line therapy after sorafenib failure, in patients with hepatocellular carcinoma (HCC). 117 patients undergoing MC were compared to 112 patients, eligible for this treatment, but undergoing best supportive care (BSC) after sorafenib discontinuation for toxicity or HCC progression. The two groups were compared for demographic and clinical features. A multivariate regression analysis was conducted to detect independent prognostic factors. To balance confounding factors between the two groups, a propensity score model based on independent prognosticators (performance status, neoplastic thrombosis, causes of sorafenib discontinuation and pre-sorafenib treatment) was performed. Patients undergoing MC showed better performance status, lower tumor burden, lower prevalence of portal vein thrombosis, and better cancer stage. Median (95% CI) post-sorafenib survival (PSS) was longer in MC than in BSC patients [9.5 (7.5-11.6) vs 5.0 (4.2-5.7) months (p < 0.001)]. Neoplastic thrombosis, cause of sorafenib discontinuation, pre-sorafenib treatment and MC were independent prognosticators. The benefit of capecitabine was confirmed in patients after matching with propensity score [PSS: 9.9 (6.8-12.9) vs. 5.8 (4.8-6.8) months, (p = 0.001)]. MC lowered the mortality risk by about 40%. MC achieved better results in patients who stopped sorafenib for adverse events than in those who progressed during it [PSS: 17.3 (10.5-24.1) vs. 7.8 (5.2-10.1) months, (p = 0.035)]. Treatment toxicity was low and easily manageable with dose modulation. MC may be an efficient and safe second-line systemic therapy for HCC patients who discontinued sorafenib for toxicity or tumor progression.

  2. Time to discontinuation of atypical versus typical antipsychotics in the naturalistic treatment of schizophrenia

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    Swartz Marvin

    2006-02-01

    Full Text Available Abstract Background There is an ongoing debate over whether atypical antipsychotics are more effective than typical antipsychotics in the treatment of schizophrenia. This naturalistic study compares atypical and typical antipsychotics on time to all-cause medication discontinuation, a recognized index of medication effectiveness in the treatment of schizophrenia. Methods We used data from a large, 3-year, observational, non-randomized, multisite study of schizophrenia, conducted in the U.S. between 7/1997 and 9/2003. Patients who were initiated on oral atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine, or ziprasidone or oral typical antipsychotics (low, medium, or high potency were compared on time to all-cause medication discontinuation for 1 year following initiation. Treatment group comparisons were based on treatment episodes using 3 statistical approaches (Kaplan-Meier survival analysis, Cox Proportional Hazards regression model, and propensity score-adjusted bootstrap resampling methods. To further assess the robustness of the findings, sensitivity analyses were performed, including the use of (a only 1 medication episode for each patient, the one with which the patient was treated first, and (b all medication episodes, including those simultaneously initiated on more than 1 antipsychotic. Results Mean time to all-cause medication discontinuation was longer on atypical (N = 1132, 256.3 days compared to typical antipsychotics (N = 534, 197.2 days; p Conclusion In the usual care of schizophrenia patients, time to medication discontinuation for any cause appears significantly longer for atypical than typical antipsychotics regardless of the typical antipsychotic potency level. Findings were primarily driven by clozapine and olanzapine, and to a lesser extent by risperidone. Furthermore, only clozapine and olanzapine therapy showed consistently and significantly longer treatment duration compared to perphenazine, a medium

  3. Predictors of Relapse after Discontinuing Systemic Treatment in Childhood Autoimmune Chronic Uveitis.

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    Simonini, Gabriele; Bracaglia, Claudia; Cattalini, Marco; Taddio, Andrea; Brambilla, Alice; De Libero, Cinzia; Pires Marafon, Denise; Caputo, Roberto; Cimaz, Rolando

    2017-06-01

    To identify clinical predictors of relapse in childhood autoimmune chronic uveitis after stopping systemic treatment. A retrospective, multicenter, cohort study. Ninety-four children in remission, receiving no treatments and with at least a 6-month followup, were enrolled. A higher probability of maintaining remission after discontinuing treatment was shown in idiopathic compared with juvenile idiopathic arthritis uveitis (Mantel-Cox chi-square = 23.21) if inactivity had been obtained within 6 months from starting systemic treatment (Mantel-Cox chi-square = 24.17) and by antitumor necrosis factor-α treatment (Mantel-Cox chi-square = 6.43). Type of disease, time, and type of systemic therapy to achieve inactivity predict different duration of uveitis remission after treatment withdrawal.

  4. Host population structure impedes reversion to drug sensitivity after discontinuation of treatment.

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    Jonas I Liechti

    2017-08-01

    Full Text Available Intense use of antibiotics for the treatment of diseases such as tuberculosis, malaria, Staphylococcus aureus or gonorrhea has led to rapidly increasing population levels of drug resistance. This has generally necessitated a switch to new drugs and the discontinuation of older ones, after which resistance often only declines slowly or even persists indefinitely. These long-term effects are usually ascribed to low fitness costs of resistance in absence of the drug. Here we show that structure in the host population, in particular heterogeneity in number of contacts, also plays an important role in the reversion dynamics. Host contact structure acts both during the phase of intense treatment, leading to non-random distributions of the resistant strain among the infected population, and after the discontinuation of the drug, by affecting the competition dynamics resulting in a mitigation of fitness advantages. As a consequence, we observe both a lower rate of reversion and a lower probability that reversion to sensitivity on the population level occurs after treatment is stopped. Our simulations show that the impact of heterogeneity in the host structure is maximal in the biologically most plausible parameter range, namely when fitness costs of resistance are small.

  5. Are specific antiretrovirals associated with an increased risk of discontinuation due to toxicities or patient/physician choice in patients with hepatitis C virus coinfection?

    DEFF Research Database (Denmark)

    Mocroft, A; Rockstroh, J; Soriano, V

    2005-01-01

    clinical trials as patients with HCV are often excluded. AIMS: To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. PATIENTS/METHODS: A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific...

  6. NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS.

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    Kim, Jae Hui; Chang, Young Suk; Kim, Jong Woo

    2017-12-01

    To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis. This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed. The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043). Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.

  7. Retroviral rebound syndrome after treatment discontinuation in a 15 year old girl with HIV attracted through mother-to-child transmission: case report

    OpenAIRE

    Gisslén Magnus; Friman Vanda

    2007-01-01

    Abstract A case of a 15 year old girl with retroviral rebound syndrome after discontinuation of highly active antiretroviral treatment (HAART) due to side effects is presented. The patient was transmitted with HIV at birth by her mother. She had recovered from severe AIDS after HAART was initiated five years earlier. This is the first case reported in the literature of retroviral rebound syndrome in a vertically transmitted HIV-infected patient.

  8. Hippocampal agenesis in an individual who engaged in violent criminal behaviors after discontinuing carbamazepine and paroxetine treatment.

    Science.gov (United States)

    Hanada, Hiroaki; Akiyoshi, Jotaro; Kanehisa, Masayuki; Ishitobi, Yoshinobu; Tsuru, Jusen; Tanaka, Yoshihiro; Shimomura, Tsuyoshi; Kawano, Yoshihisa

    2013-01-01

    Antidepressant discontinuation syndrome (ADS) occurs after abrupt discontinuation of an antidepressant medication. A 23-year-old man with right hippocampal agenesis demonstrated sexual crime (hypersexuality) since the age of eight and had been successfully treated with carbamazepine since the age of 13. He had required increased doses of paroxetine and carbamazepine owing to the development of an unstable affect after quitting his job. He abruptly stopped taking his medication for 3 days and his criminal behaviors re-emerged. We examined changes in brain structure and activity before and after medication cessation, using MRI and functional MRI (fMRI). The image of a girl in a swimsuit increased activity in the thalamus only after medication discontinuation. The alteration in thalamic activity might induce hypersexuality. We conclude that a primary hypersexuality had been suppressed with carbamazepine and paroxetine treatment, and the discontinuation of the medication caused the hypersexuality. © 2012 American Academy of Forensic Sciences.

  9. Estimating Unbiased Treatment Effects in Education Using a Regression Discontinuity Design

    Directory of Open Access Journals (Sweden)

    William C. Smith

    2014-08-01

    Full Text Available The ability of regression discontinuity (RD designs to provide an unbiased treatment effect while overcoming the ethical concerns plagued by Random Control Trials (RCTs make it a valuable and useful approach in education evaluation. RD is the only explicitly recognized quasi-experimental approach identified by the Institute of Education Statistics to meet the prerequisites of a causal relationship. Unfortunately, the statistical complexity of the RD design has limited its application in education research. This article provides a less technical introduction to RD for education researchers and practitioners. Using visual analysis to aide conceptual understanding, the article walks readers through the essential steps of a Sharp RD design using hypothetical, but realistic, district intervention data and provides additional resources for further exploration.

  10. Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Wang HR

    2015-03-01

    Full Text Available Hee Ryung Wang, Young Sup Woo, Tae-Youn Jun, Won-Myong Bahk Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea Objective: This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. Methods: We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Results: Fifty-five percent of subjects (57/104 prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. Conclusion: The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge. Keywords: posttraumatic stress disorder, discontinuation, compliance, predictor

  11. Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.

    Science.gov (United States)

    Rouzé, Anahita; Loridant, Séverine; Poissy, Julien; Dervaux, Benoit; Sendid, Boualem; Cornu, Marjorie; Nseir, Saad

    2017-11-01

    The aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment. Prospective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment. In the biomarker group, early stop recommendation was determined using an algorithm based on the results of biomarkers. The primary outcome was the percentage of survivors discontinuing empirical antifungal treatment early, defined as a discontinuation strictly before day 7. A total of 109 patients were analyzed (one patient withdraw consent). Empirical antifungal treatment was discontinued early in 29 out of 54 patients in the biomarker strategy group, compared with one patient out of 55 in the routine strategy group [54% vs 2%, p strategy compared with routine strategy [median (IQR) 6 (4-13) vs 13 (12-14) days, p strategy increased the percentage of early discontinuation of empirical antifungal treatment among critically ill patients with suspected invasive Candida infection. These results confirm previous findings suggesting that early discontinuation of empirical antifungal treatment had no negative impact on outcome. However, further studies are needed to confirm the safety of this strategy. This trial was registered at ClinicalTrials.gov, NCT02154178.

  12. Effect of Discontinuous Ultrasonic Treatment on Mechanical Properties and Microstructure of Cast Al413-SiCnp Nanocomposites

    Directory of Open Access Journals (Sweden)

    M.R. Dehnavi

    2015-05-01

    Full Text Available Effects of discontinuous ultrasonic treatment on the microstructure, nanoparticle distribution, and mechanical properties of cast Al413-SiCnp nanocomposites were studied. The results showed that discontinuous ultrasonic treatment was more effective in improving the mechanical properties of the cast nanocomposites than the equally timed continuous treatment. The yield and ultimate tensile strengths of Al413-2%SiCnp nanocomposites discontinuously treated for two 20 minute periods increased by about 126% and 100% compared to those of the monolithic sample, respectively. These improvements were about 107% and 94% for the nanocomposites continuously treated for a single 40 minute period. The improvement in the mechanical properties was associated with severe refinement of the microstructure, removal of the remaining gas layers on the particles surfaces, more effective fragmentation of the remaining agglomerates as well as improved wettability and distribution of the reinforcing particles during the first stage of solidification.

  13. Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability.

    Science.gov (United States)

    Noguera, Ana; Ballesta, Patricia; Baeza, Immaculada; Arango, Celso; de la Serna, Elena; González-Pinto, Ana; Parellada, Mara; Graell, Montserrat; Moreno, Carmen; Otero, Soraya; Castro-Fornieles, Josefina

    2013-08-01

    The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects. The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up. Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU. A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.

  14. Spontaneous Healing of Corneal Perforation after Temporary Discontinuation of Erlotinib Treatment

    Directory of Open Access Journals (Sweden)

    Naoyuki Morishige

    2014-01-01

    Full Text Available Purpose: To report a case of corneal perforation associated with oral administration of erlotinib and its spontaneous healing after temporary discontinuation of drug treatment. Case Report: A 65-year-old man with metastatic lung cancer was treated with erlotinib (150 mg/day, a specific tyrosine kinase inhibitor of the epidermal growth factor receptor. He was referred to our corneal service for the treatment of bilateral corneal disorders, diagnosed with mild aqueous-deficient dry eye, and treated by insertion of punctal plugs. His corneal epithelial disorders initially improved, but subsequently worsened, as manifested by the development of bilateral corneal ulceration with corneal perforation in the right eye. The oral administration of erlotinib was interrupted in preparation for tectonic keratoplasty, but 2 days later the corneal perforation of the right eye and the bilateral epithelial defects had healed spontaneously. Treatment with erlotinib was resumed at half the initial dose, and the cornea of both eyes has remained apparently healthy. Discussion: Erlotinib may be secreted into tear fluid and thereby adversely affect the corneal epithelium. The development of corneal epithelial disorders in patients receiving this drug may be reversed by reducing its dose.

  15. Survey of reasons for discontinuation from in vitro fertilization treatment among couples attending infertility clinic

    Directory of Open Access Journals (Sweden)

    Grishma Kulkarni

    2014-01-01

    Full Text Available Background: With the increase in infertility burden, more and more couples are opting for in vitro fertilization (IVF. Despite the availability of various treatment options, the major concern that needs to be addressed is the reasons why such couples, initially motivated so strongly, drop out in fairly high numbers from IVF cycles. With this point of view the study was designed. AIM: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Settings and Design: This retrospective study was carried out among couples in the age group of 20-40 years who opted for IVF at Tertiary care hospital and a private infertility center. Materials and Methods: Medical records for 3 years (2009-2012 were taken out and included in the study for analysis. Socio-demographic details along with indication for IVF and reasons for drop-separate IVF therapy were recorded on case record form and were analyzed. Results: Twenty-one percent of the patients had tubal pathology, thus making it the commonest female related factor for indication of IVF. Oligoasthenospermia (13% was the commonest cause of male related infertility factor. Financial burden was the primary cause for terminating treatment in majority of the IVF cases. Conclusions: Financial burden (62.5% was the commonest reason for drop out among couples from IVF cycle.

  16. A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives.

    Science.gov (United States)

    Modesto, Waleska; Bahamondes, M Valeria; Bahamondes, Luis

    2014-07-01

    Does intensive counselling before insertion and throughout the first year of use have any influence on discontinuation rates due to unpredictable menstrual bleeding in users of three long-acting reversible contraceptives (LARCs)? Intensive counselling had a similar effect to routine counselling in terms of discontinuation rates due to unpredictable menstrual bleeding in new users of the contraceptives. Contraceptive efficacy and satisfaction rates are very high with LARCs, including the etonogestrel (ENG)-releasing implant, the levonorgestrel-releasing intrauterine system (LNG-IUS) and the TCu380A intrauterine device (IUD). However, unpredictable menstrual bleeding constitutes the principal reason for premature discontinuation, particularly in the cases of the ENG-implant and the LNG-IUS. A randomized clinical trial was conducted between 2011 and 2013, and involved 297 women: 98 ENG-implant users, 99 LNG-IUS users and 100 TCu380A IUD users. Women accepting each contraceptive method were randomized into two groups after the women chose their contraceptive method. Group I received routine counselling at the clinic, including information on safety, efficacy and side effects, as well as what to expect regarding bleeding disturbances. Group II received 'intensive counselling'. In addition to the information provided to those in Group I, these women also received leaflets on their chosen method and were seen by the same three professionals, the most experienced at the clinic, throughout the year of follow-up. These three professionals went over all the information provided at each consultation. Women in both groups were instructed to return to the clinic after 45 (±7) days and at 6 and 12 (±1) months after insertion. They were instructed to record all bleeding episodes on a menstrual calendar specifically provided for this purpose. Additionally, satisfaction with the method was evaluated by a questionnaire completed by the women after 12 months of use of the

  17. Regression Discontinuity and Randomized Controlled Trial Estimates: An Application to The Mycotic Ulcer Treatment Trials.

    Science.gov (United States)

    Oldenburg, Catherine E; Venkatesh Prajna, N; Krishnan, Tiruvengada; Rajaraman, Revathi; Srinivasan, Muthiah; Ray, Kathryn J; O'Brien, Kieran S; Glymour, M Maria; Porco, Travis C; Acharya, Nisha R; Rose-Nussbaumer, Jennifer; Lietman, Thomas M

    2018-08-01

    We compare results from regression discontinuity (RD) analysis to primary results of a randomized controlled trial (RCT) utilizing data from two contemporaneous RCTs for treatment of fungal corneal ulcers. Patients were enrolled in the Mycotic Ulcer Treatment Trials I and II (MUTT I & MUTT II) based on baseline visual acuity: patients with acuity ≤ 20/400 (logMAR 1.3) enrolled in MUTT I, and >20/400 in MUTT II. MUTT I investigated the effect of topical natamycin versus voriconazole on best spectacle-corrected visual acuity. MUTT II investigated the effect of topical voriconazole plus placebo versus topical voriconazole plus oral voriconazole. We compared the RD estimate (natamycin arm of MUTT I [N = 162] versus placebo arm of MUTT II [N = 54]) to the RCT estimate from MUTT I (topical natamycin [N = 162] versus topical voriconazole [N = 161]). In the RD, patients receiving natamycin had mean improvement of 4-lines of visual acuity at 3 months (logMAR -0.39, 95% CI: -0.61, -0.17) compared to topical voriconazole plus placebo, and 2-lines in the RCT (logMAR -0.18, 95% CI: -0.30, -0.05) compared to topical voriconazole. The RD and RCT estimates were similar, although the RD design overestimated effects compared to the RCT.

  18. Natalizumab Discontinuation and Treatment Strategies in Patients with Multiple Sclerosis (MS): A Retrospective Study from Two Italian MS Centers.

    Science.gov (United States)

    Lo Re, Marianna; Capobianco, Marco; Ragonese, Paolo; Realmuto, Sabrina; Malucchi, Simona; Berchialla, Paola; Salemi, Giuseppe; Bertolotto, Antonio

    2015-12-01

    Natalizumab (NTZ) discontinuation can be followed by multiple sclerosis (MS) disease reactivation. Currently no disease-modifying drug (DMD) has been shown to be able to abolish disease reactivation. The aims of the current study were: (1) to determine the frequency of MS reactivation after NTZ discontinuation; (2) to evaluate predictors of reactivation risk, and (3) to compare the effect of different treatments in reducing this risk. Data from 132 patients with MS followed-up for 2 years before NTZ treatment and 1 year after interruption were collected from two Italian MS centers and retrospectively evaluated. Overall, 72 of 132 patients (54.5%) had relapses after NTZ discontinuation and 60 of 125 patients (48%), who had magnetic resonance imaging, had radiological reactivation. Rebound was observed in 28 of 132 patients (21.2%). A higher number of relapses in the 2 years before NTZ treatment, a longer washout period, and a lower number NTZ infusions correlated with reactivation and rebound. Untreated patients (n = 37) had higher clinical and radiological activity and rebound in comparison to patients receiving DMDs. Moreover, a lower risk of relapses was found in patients treated with second-line therapies (NTZ and fingolimod) than in those treated with first-line therapies (interferon beta, glatiramer acetate, teriflunomide, azathioprine). Interestingly, no disease reactivation in off-label treatment (rituximab, autologous hematopoietic stem cell transplantation) was observed. NTZ discontinuation is a risk for MS reactivation and rebound. An alternative treatment should be promptly resumed mainly in patients with a previous very active disease course and with a shorter NTZ therapy. Second-line therapies demonstrate superiority in preventing relapses after NTZ discontinuation.

  19. Continuous biological waste gas treatment in stirred trickle-bed reactor with discontinuous removal of biomass.

    Science.gov (United States)

    Laurenzis, A; Heits, H; Wübker, S; Heinze, U; Friedrich, C; Werner, U

    1998-02-20

    A new reactor for biological waste gas treatment was developed to eliminate continuous solvents from waste gases. A trickle-bed reactor was chosen with discontinuous movement of the packed bed and intermittent percolation. The reactor was operated with toluene as the solvent and an optimum average biomass concentration of between 5 and 30 kg dry cell weight per cubic meter packed bed (m3pb). This biomass concentration resulted in a high volumetric degradation rate. Reduction of surplus biomass by stirring and trickling caused a prolonged service life and prevented clogging of the trickle bed and a pressure drop increase. The pressure drop after biomass reduction was almost identical to the theoretical pressure drop as calculated for the irregular packed bed without biomass. The reduction in biomass and intermittent percolation of mineral medium resulted in high volumetric degradation rates of about 100 g of toluene m-3pb h-1 at a load of 150 g of toluene m-3pb h-1. Such a removal rate with a trickle-bed reactor was not reported before. Copyright 1998 John Wiley & Sons, Inc.

  20. [Treatment of macroglossia due to acromegaly].

    NARCIS (Netherlands)

    Alons, K.; Berge, S.J.; Rieu, P.N.M.A.; Meijer, G.J.

    2010-01-01

    A 61-years-old woman had macroglossia due to acromegaly with complaints of dyspneu at a lying sleeping position and complaints of speech and dysphagia. At the age of 55 years she was diagnosed with acromegaly induced by a adenoma of the pituitary gland, which had been removed surgically. The

  1. Predictors of early treatment discontinuation and severe anemia in a Brazilian cohort of hepatitis C patients treated with first-generation protease inhibitors

    Directory of Open Access Journals (Sweden)

    N. Miotto

    2016-01-01

    Full Text Available The aim of this study was to determine risk factors for adverse events (AE-related treatment discontinuation and severe anemia among patients with chronic hepatitis C virus (HCV genotype 1 infection, treated with first-generation protease inhibitor (PI-based therapy. We included all patients who initiated treatment with PI-based therapy at a Brazilian university hospital between November 2013 and December 2014. We prospectively collected data from medical records using standardized questionnaires and used Epi Info 6.0 for analysis. Severe anemia was defined as hemoglobin ≤8.5 mg/dL. We included 203 patients: 132 treated with telaprevir (TVR and 71 treated with boceprevir (BOC. AE-related treatment discontinuation rate was 19.2% and anemia was the main reason (38.5%. Risk factors for treatment discontinuation were higher comorbidity index (OR=1.85, CI=1.05-3.25 for BOC, and higher bilirubin count (OR=1.02, CI=1.01-1.04 and lower BMI (OR=0.98, CI=0.96-0.99 for TVR. Severe anemia occurred in 35 (17.2% patients. Risk factors for this outcome were lower estimated glomerular filtration rate (eGFR; OR=0.95, CI=0.91-0.98 for patients treated with TVR, and higher comorbidity index (OR=2.21, CI=1.04-4.67 and ribavirin dosage (OR=0.84, CI=0.72-0.99 for those treated with BOC. Fifty-five (57.3% patients treated with TVR and 15 (27.3% patients treated with BOC achieved sustained virological response (SVR. Among patients who received TVR and interrupted treatment due to AE (n=19, only 26.3% (n=5 achieved SVR (P=0.003. Higher number of comorbidities, lower eGFR and advanced liver disease are associated with severe anemia and early treatment cessation, which may compromise SVR achievement.

  2. A longitudinal examination of alcohol pharmacotherapy adoption in substance use disorder treatment programs: patterns of sustainability and discontinuation.

    Science.gov (United States)

    Abraham, Amanda J; Knudsen, Hannah K; Roman, Paul M

    2011-07-01

    The objectives of this study were to (a) identify the patterns of disulfiram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfiram and tablet naltrexone; and (c) measure reasons for medication discontinuation. Two waves of data were collected via face-to-face structured interviews with 223 program administrators. These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfiram/tablet naltrexone with a newer AUD medication. These findings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specific training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use.

  3. Dropout in the treatment of erectile dysfunction with PDE5: a study on predictors and a qualitative analysis of reasons for discontinuation.

    Science.gov (United States)

    Carvalheira, Ana A; Pereira, Nuno Monteiro; Maroco, João; Forjaz, Vera

    2012-09-01

    Phosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment. The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology. The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment. A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%. Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%). We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment. Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow

  4. The Reasons for Discontinuation of Infliximab Treatment in Patients with Crohn's Disease: A Review of Practice at NHS Teaching Hospital

    OpenAIRE

    Krupa, Lukasz Z.; Kennedy, Hugh J.; Jamieson, Crawford P.; Fisher, Nicola; Hart, Andrew R.

    2011-01-01

    Introduction. There is little information on the reasons for discontinuing infliximab treatment in patients with Crohn's disease. The aim of this study was to document these reasons to determine if any were preventable which would allow patients to continue the therapy. Aims & Methods. A review of the medical notes was conducted at the Norfolk and Norwich University Hospital on patients with Crohn's disease treated with infliximab between 2002–2008 to determine the reasons for stopping it. Re...

  5. Substrate aggregation due to aerial hyphae during discontinuously mixed solid-state fermentation with Aspergillus oryzae: Experiments and modeling

    NARCIS (Netherlands)

    Schutyser, M.A.I.; Schutyser, M.A.I.; de Pagter, P.; Weber, F.J.; Briels, Willem J.; Boom, R.M.; Boom, R.M.; Rinzema, A.

    2003-01-01

    Solid-state fermentation (SSF) is prone to process failure due to channeling caused by evaporative cooling and the formation of an interparticle mycelium network. Mixing is needed to break the mycelium network and to avoid such failure. This study presents the first attempt to quantify and predict

  6. Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa.

    Science.gov (United States)

    Bor, Jacob; Fox, Matthew P; Rosen, Sydney; Venkataramani, Atheendar; Tanser, Frank; Pillay, Deenan; Bärnighausen, Till

    2017-11-01

    Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART). Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care. We examined the effect of immediate (versus deferred) ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306) entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count linear regression models with a data-driven bandwidth and with the algorithm for selecting the bandwidth chosen ex ante. Among patients with CD4 counts close to the 350-cells/μl threshold, having an ART-eligible CD4 count (<350 cells/μl) was associated with higher 12-month retention than not having an ART-eligible CD4 count (50% versus 32%), an intention-to-treat risk difference of 18 percentage points (95% CI 11 to 23; p < 0.001). The decision to start ART was determined by CD4 count for one in four patients (25%) presenting close to the eligibility threshold (95% CI 20% to 31%; p < 0.001). In this subpopulation, having an ART-eligible CD4 count was associated with higher 12-month retention than not having an ART-eligible CD4 count (91% versus 21%), a complier causal risk difference of 70 percentage points (95% CI 42 to 98; p < 0.001). The major limitations of the study are the potential for limited generalizability, the potential for outcome misclassification, and the absence of data on longer-term health outcomes. Patients who were eligible for immediate ART had dramatically higher retention in HIV care than patients who just missed the CD4-count eligibility cutoff. The clinical and population health benefits of offering immediate ART regardless

  7. Discontinuation of Hemodialysis in a Patient with Anti-GBM Disease by the Treatment with Corticosteroids and Plasmapheresis despite Several Predictors for Dialysis-Dependence

    Directory of Open Access Journals (Sweden)

    Yoshihide Fujigaki

    2017-01-01

    Full Text Available A 26-year-old man highly suspected of having antiglomerular basement membrane (GBM disease was treated with corticosteroid pulse therapy 9 days after initial infection-like symptoms with high procalcitonin value. The patient required hemodialysis the next day of the treatment due to oliguria. In addition to corticosteroid therapy, plasmapheresis was introduced and the patient could discontinue hemodialysis 43 days after the treatment. Kidney biopsy after initiation of hemodialysis confirmed anti-GBM disease with 86.3% crescent formation. Physician should keep in mind that active anti-GBM disease shows even high procalcitonin value in the absence of infection. To pursue recovery of renal function, the challenge of the immediate and persistent treatment with high-dose corticosteroids plus plasmapheresis for highly suspected anti-GBM disease is vitally important despite the presence of reported predictors for dialysis-dependence including oliguria and requiring hemodialysis at presentation.

  8. Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death

    DEFF Research Database (Denmark)

    Ostergaard, Kamilla; Pottegård, Anton; Hallas, Jesper

    2014-01-01

    use and followed them up for stroke recurrence, or all-cause death. Person-time was classified by antiplatelet drug use into current use, recent use (≤150 days after last use), and non-use (>150 days after last use). Lipid-lowering drug (LLD) use was classified by the same rules. We used Cox......BACKGROUND: We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality. METHODS: We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug...... proportional hazard models to calculate the adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) for the risk of recurrent stroke or death associated with discontinuation of antiplatelet or LLD drugs. RESULTS: Among 4,670 stroke patients followed up for up a median of 1.5 years, 237...

  9. Patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate HIV treatment availability

    Directory of Open Access Journals (Sweden)

    Kimmel April D

    2012-09-01

    Full Text Available Abstract Background In resource-limited settings, HIV budgets are flattening or decreasing. A policy of discontinuing antiretroviral therapy (ART after HIV treatment failure was modeled to highlight trade-offs among competing policy goals of optimizing individual and population health outcomes. Methods In settings with two available ART regimens, we assessed two strategies: (1 continue ART after second-line failure (Status Quo and (2 discontinue ART after second-line failure (Alternative. A computer model simulated outcomes for a single cohort of newly detected, HIV-infected individuals. Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity. In the Alternative strategy, discontinuation of second-line ART occurred upon detection of antiretroviral failure, specified by WHO guidelines. Those discontinuing failed ART experienced an increased risk of AIDS-related mortality compared to those continuing ART. Results At the population level, the Alternative strategy increased the mean number initiating ART annually by 1,100 individuals (+18.7% to 6,980 compared to the Status Quo. More individuals initiating ART under the Alternative strategy increased total life-years by 15,000 (+2.8% to 555,000, compared to the Status Quo. Although more individuals received treatment under the Alternative strategy, life expectancy for those treated decreased by 0.7 years (−8.0% to 8.1 years compared to the Status Quo. In a cohort of treated patients only, 600 more individuals (+27.1% died by 5 years under the Alternative strategy compared to the Status Quo. Results were sensitive to the timing of detection of ART failure, number of ART regimens, and treatment capacity. Although we believe the results robust in the short-term, this analysis reflects settings where HIV case detection occurs late in the disease course and treatment capacity and the incidence of newly detected patients are

  10. Recurrent Thrombotic Events after Discontinuation of Vitamin K Antagonist Treatment for Splanchnic Vein Thrombosis: A Multicenter Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Nicoletta Riva

    2015-01-01

    Full Text Available It is generally recommended that patients with splanchnic vein thrombosis (SVT should receive a minimum of 3 months of anticoagulant treatment. However, little information is available on the long-term risk of recurrent thrombotic events. The aim of this study was to evaluate the risk of venous and arterial thrombosis after discontinuation of vitamin K antagonist (VKA in SVT patients. Retrospective information from a cohort of SVT patients treated with VKA and followed by 37 Italian Anticoagulation Clinics, up to June 2013, was collected. Only patients who discontinued VKA and did not receive any other anticoagulant drug were enrolled in this study. Thrombotic events during follow-up were centrally adjudicated. Ninety patients were included: 33 unprovoked SVT, 27 SVT secondary to transient risk factors, and 30 with permanent risk factors. During a median follow-up of 1.6 years, 6 venous and 1 arterial thrombosis were documented, for an incidence of 3.3/100 patient-years (pt-y. The recurrence rate was highest in the first year after VKA discontinuation (8.2/100’pt-y and in patients with permanent risk factors (10.2/100’pt-y. Liver cirrhosis significantly increased the risk of recurrence. In conclusion, the rate of recurrent vascular complications after SVT is not negligible, at least in some patient subgroups.

  11. Kinetics of cardiac and vascular remodeling by spontaneously hypertensive rats after discontinuation of long-term captopril treatment

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    W.A. Rocha

    2010-04-01

    Full Text Available Angiotensin-converting enzyme inhibitors reduce blood pressure and attenuate cardiac and vascular remodeling in hypertension. However, the kinetics of remodeling after discontinuation of the long-term use of these drugs are unknown. Our objective was to investigate the temporal changes occurring in blood pressure and vascular structure of spontaneously hypertensive rats (SHR. Captopril treatment was started in the pre-hypertensive state. Rats (4 weeks were assigned to three groups: SHR-Cap (N = 51 treated with captopril (1 g/L in drinking water from the 4th to the 14th week; SHR-C (N = 48 untreated SHR; Wistar (N = 47 control rats. Subgroups of animals were studied at 2, 4, and 8 weeks after discontinuation of captopril. Direct blood pressure was recorded in freely moving animals after femoral artery catheterism. The animals were then killed to determine left ventricular hypertrophy (LVH and the aorta fixed at the same pressure measured in vivo. Captopril prevented hypertension (105 ± 3 vs 136 ± 5 mmHg, LVH (2.17 ± 0.05 vs 2.97 ± 0.14 mg/g body weight and the increase in cross-sectional area to luminal area ratio of the aorta (0.21 ± 0.01 vs 0.26 ± 0.02 μm² (SHR-Cap vs SHR-C. However, these parameters increased progressively after discontinuation of captopril (22nd week: 141 ± 2 mmHg, 2.50 ± 0.06 mg/g, 0.27 ± 0.02 μm². Prevention of the development of hypertension in SHR by using captopril during the prehypertensive period prevents the development of cardiac and vascular remodeling. Recovery of these processes follows the kinetic of hypertension development after discontinuation of captopril.

  12. Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa.

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    Jacob Bor

    2017-11-01

    Full Text Available Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART. Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care.We examined the effect of immediate (versus deferred ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306 entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count < 350 cells/μl, per South African national guidelines. Patients referred to pre-ART care were instructed to return every 6 months for CD4 monitoring. Patients initiated on ART were instructed to return at 6 and 12 months post-initiation and annually thereafter for CD4 and viral load monitoring. We assessed retention in HIV care at 12 months, as measured by the presence of a clinic visit, lab test, or ART initiation 6 to 18 months after initial CD4 test. Differences in retention between patients presenting with CD4 counts just above versus just below the 350-cells/μl threshold were estimated using local linear regression models with a data-driven bandwidth and with the algorithm for selecting the bandwidth chosen ex ante. Among patients with CD4 counts close to the 350-cells/μl threshold, having an ART-eligible CD4 count (<350 cells/μl was associated with higher 12-month retention than not having an ART-eligible CD4 count (50% versus 32%, an intention-to-treat risk difference of 18 percentage points (95% CI 11 to 23; p < 0.001. The decision to start ART was determined by CD4 count for one in four patients (25% presenting close to the eligibility threshold (95% CI 20% to 31%; p < 0.001. In this subpopulation, having an ART-eligible CD

  13. Early discontinuation

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Felde, Lina; Gichangi, Anthony

    2007-01-01

    prevalence and rate of early discontinuation of different drugs consisting of, in this study, lipid-lowering drugs, antihypertensive drugs, antidepressants, antidiabetics and drugs against osteoporosis. Material and methods This was a register study based on prescription data covering a 4-year period...... and consisting of 470,000 citizens. For each practice and group of drug, a 1-year prevalence for 2002 and the rate of early discontinuation among new users in 2002-2003 were estimated. Early discontinuation was defined as no prescriptions during the second half-year following the first prescription....... There was a positive association between the prevalence of prescribing for the specific drugs studied (antidepressants, antidiabetics, drugs against osteoporosis and lipid-lowering drugs) and early discontinuation (r = 0.29 -0.44), but not for anti-hypertensive drugs. The analysis of the association between prevalence...

  14. The influence of patient beliefs and treatment satisfaction on the discontinuation of current first-line antiretroviral regimens.

    Science.gov (United States)

    Casado, J L; Marín, A; Romero, V; Bañón, S; Moreno, A; Perez-Elías, M J; Moreno, S; Rodriguez-Sagrado, M A

    2016-01-01

    Large cohort studies have shown a high rate of first-line combination antiretroviral therapy (cART) regimen discontinuation in HIV-infected patients, attributed to characteristics of the cART regimen or toxicity. A cohort study of 274 patients receiving a first-line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0-15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen. During 474.8 person-years of follow-up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient-years [95% confidence interval (CI) 11.1-16.4 per 100 patient-years]. An efavirenz (EFV)-based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient-years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62-0.93; P satisfaction (HR 0.94; 95% CI 0.89-0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4-11.6; P patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04). Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation. © 2015 British HIV

  15. System dynamics with interaction discontinuity

    CERN Document Server

    Luo, Albert C J

    2015-01-01

    This book describes system dynamics with discontinuity caused by system interactions and presents the theory of flow singularity and switchability at the boundary in discontinuous dynamical systems. Based on such a theory, the authors address dynamics and motion mechanism of engineering discontinuous systems due to interaction. Stability and bifurcations of fixed points in nonlinear discrete dynamical systems are presented, and mapping dynamics are developed for analytical predictions of periodic motions in engineering discontinuous dynamical systems. Ultimately, the book provides an alternative way to discuss the periodic and chaotic behaviors in discontinuous dynamical systems.

  16. Effect of Discontinuation of Antihypertensive Treatment in Elderly People on Cognitive Functioning-the DANTE Study Leiden

    DEFF Research Database (Denmark)

    Moonen, Justine E F; Foster-Dingley, Jessica C; de Ruijter, Wouter

    2015-01-01

    whether discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improves cognitive, psychological, and general daily functioning. DESIGN, SETTING, AND PARTICIPANTS: A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow...... in secondary outcomes, including differences (95% CIs) in change in compound scores of the 3 cognitive domains (executive function, -0.07 [-0.29 to 0.15; P = .52], memory, 0.08 [-0.12 to 0.29; P = .43], and psychomotor speed, -0.85 [-1.72 to 0.02; P = .06]), symptoms of apathy (0.17 [-0.65 to 0.99; P = .68...

  17. Orthodontic Treatment Completion and Discontinuation in a Rural Sample from North Central Appalachia in the USA

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    Chris A. Martin

    2017-07-01

    Full Text Available BackgroundOrthodontics has inherent demands, requiring regular appointments and active patient engagement, but relatively little is established in regard to rates of completion of treatment and possible factors affecting successful completion. These factors may be particularly important for cultural minority groups, such as those in rural Appalachia, given the environmental, social, and economic complexities affecting access to and utilization of treatment.Design and methodsA naturalistic study design was employed, using retrospective data from a rural outpatient general dental office in July 2012. Chart abstraction yielded 219 (55.3% female orthodontic patients (M age = 11.0 [3.7]. Chi-square tests for independence were conducted for categorical dependent variables. For continuous variables, t-tests were conducted. A logistic multivariate regression analysis was conducted to predict completion/non-completion of treatment, with age, gender, distance traveled, type of malocclusion, and payment type as predictors.ResultsOverall, 49.8% of this sample successfully completed orthodontic treatment. Greater successful conclusion of treatment was found in self-pay patients (i.e., 74% versus those whose care was funded through Medicaid/Children’s Health Insurance Program (i.e., 34% or through private insurance (i.e., 36%. Age, gender, and distance to the office from home had no association relative to successful completion of treatment, although average one-way distance to travel for care was considerable (i.e., 38.8 miles.ConclusionRate of successful orthodontic treatment completion was low in this rural sample. Treatment outcome was related to the form of payment for services, with self-pay associated with the highest rate of successful completion.

  18. Successful retreatment with sofosbuvir plus ledipasvir for cirrhotic patients with hepatitis C virus genotype 1b, who discontinued the prior treatment with asunaprevir plus daclatasvir: A case series and review of the literature

    Science.gov (United States)

    Haga, Yuki; Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Ooka, Yoshihiko; Takahashi, Koji; Wu, Shuang; Nakamoto, Shingo; Arai, Makoto; Chiba, Tetsuhiro; Maruyama, Hitoshi; Yokosuka, Osamu; Takada, Nobuo; Moriyama, Mitsuhiko; Imazeki, Fumio; Kato, Naoya

    2018-01-01

    Background Interferon-free treatment results in higher sustained virologic response (SVR) rates, with no serious adverse events in hepatitis C virus (HCV)-infected patients. However, in some patients with treatment-failure in HCV NS5A inhibitor-including interferon-free regimens, the treatment-emergent HCV NS5A resistance-associated variants (RAVs), which are resistant to interferon-free retreatment including HCV NS5A inhibitors, are observed. In HCV-infected Japanese patients with daclatasvir and asunaprevir treatment failure, retreatment with sofosbuvir and ledipasvir could lead to only ∼70% SVR rates. Case summary Three HCV genotype (GT)-1b-infected cirrhotic patients who discontinued the combination of daclatasvir and asunaprevir due to adverse drug reactions within 4 weeks; retreatment with sofosbuvir and ledipasvir combination could result in SVR in these patients without RAVs. One HCV GT-1b-infected cirrhotic patient who discontinued the combination of daclatasvir and asunaprevir due to viral breakthrough at week 10; retreatment with sofosbuvir and ledipasvir combination for this patient with the treatment-emergent HCV NS5A RAV-Y93H resulted in viral relapse at week 4 after the end of the treatment. Conclusion Retreatment with sofosbuvir and ledipasvir is effective for HCV GT-1b patients who discontinue the combination of daclatasvir and asunaprevir within 4 weeks. The treatment response should be related to the existence of treatment-emergent HCV NS5A RAVs, but may not be related to the short duration of treatment. PMID:29435197

  19. Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment.

    Science.gov (United States)

    Geneid, Ahmed; Lindestad, Per-Åke; Granqvist, Svante; Möller, Riitta; Södersten, Maria

    2016-01-01

    To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD. © 2016 S. Karger AG, Basel.

  20. Improvement of Depression and Anxiety After Discontinuation of Long- Term Efavirenz Treatment

    NARCIS (Netherlands)

    Mothapo, K.M.; Schellekens, A.F.A.; Crevel, R. van; Keuter, M.; Grintjes-Huisman, K.; Koopmans, P.; Ven, A. van der

    2015-01-01

    Neuropsychiatric symptoms in human immunodeficiency virus (HIV)-infected patients may be a late complication of efavirenz treatment. This study: 1) assessed the level of neuropsychiatric symptoms in HIV-infected patients on long-term efavirenz therapy; 2) explored the effect of a switch to

  1. Efficacy and Safety Outcomes in Patients With Advanced Melanoma Who Discontinued Treatment With Nivolumab and Ipilimumab Because of Adverse Events: A Pooled Analysis of Randomized Phase II and III Trials.

    Science.gov (United States)

    Schadendorf, Dirk; Wolchok, Jedd D; Hodi, F Stephen; Chiarion-Sileni, Vanna; Gonzalez, Rene; Rutkowski, Piotr; Grob, Jean-Jacques; Cowey, C Lance; Lao, Christopher D; Chesney, Jason; Robert, Caroline; Grossmann, Kenneth; McDermott, David; Walker, Dana; Bhore, Rafia; Larkin, James; Postow, Michael A

    2017-12-01

    Purpose Approximately 40% of patients with advanced melanoma who received nivolumab combined with ipilimumab in clinical trials discontinued treatment because of adverse events (AEs). We conducted a retrospective analysis to assess the efficacy and safety of nivolumab plus ipilimumab in patients who discontinued treatment because of AEs. Methods Data were pooled from phase II and III trials of patients who received nivolumab 1 mg/kg plus ipilimumab 3 mg/kg, every 3 weeks for four doses, followed by nivolumab monotherapy 3 mg/kg every 2 weeks (N = 409). Efficacy was assessed in all randomly assigned patients who discontinued because of AEs during the induction phase (n = 96) and in those who did not discontinue because of AEs (n = 233). Safety was assessed in treated patients who discontinued because of AEs (n = 176) at any time and in those who did not discontinue because of AEs (n = 231). Results At a minimum follow-up of 18 months, median progression-free survival was 8.4 months for patients who discontinued treatment because of AEs during the induction phase and 10.8 months for patients who did not discontinue because of AEs ( P = .97). Median overall survival had not been reached in either group ( P = .23). The objective response rate was 58.3% for patients who discontinued because of AEs during the induction phase and 50.2% for patients who did not discontinue. The vast majority of grade 3 or 4 AEs occurred during the induction phase, with most resolving after appropriate management. Conclusion Efficacy outcomes seemed similar between patients who discontinued nivolumab plus ipilimumab treatment because of AEs during the induction phase and those who did not discontinue because of AEs. Therefore, even after discontinuation, many patients may continue to derive benefit from combination therapy.

  2. Carbohydrate metabolism during long-term growth hormone (GH) treatment and after discontinuation of GH treatment in girls with Turner syndrome participating in a randomized dose-response study. Dutch Advisory Group on Growth Hormone

    NARCIS (Netherlands)

    T.C.J. Sas (Theo); S.M.P.F. de Muinck Keizer-Schrama (Sabine); Th. Stijnen (Theo); H-J. Aanstoot (Henk-Jan); S.L.S. Drop (Stenvert)

    2000-01-01

    textabstractTo assess possible side-effects of GH treatment with supraphysiological doses on carbohydrate (CH) metabolism in girls with Turner syndrome (TS) during long term GH treatment and after discontinuation of GH treatment, the results of oral glucose tolerance

  3. Estimating the real-world effects of expanding antiretroviral treatment eligibility: Evidence from a regression discontinuity analysis in Zambia.

    Directory of Open Access Journals (Sweden)

    Aaloke Mody

    2018-06-01

    Full Text Available Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs, expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume. Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia's HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs.We analyzed antiretroviral therapy (ART-naïve adults who newly enrolled in HIV care in a network of 64 clinics operated by the Zambian Ministry of Health and supported by the Centre for Infectious Disease Research in Zambia (CIDRZ. Patients were restricted to those enrolling in a narrow window around the April 1, 2014 change to Zambian HIV treatment guidelines that raised the CD4 threshold for treatment from 350 to 500 cells/μL (i.e., August 1, 2013, to November 1, 2014. Clinical and sociodemographic data were obtained from an electronic medical record system used in routine care. We used a regression discontinuity design to estimate the effects of this change in treatment eligibility on ART initiation within 3 months of enrollment, retention in care at 6 months (defined as clinic attendance between 3 and 9 months after enrollment, and a composite of both ART initiation by 3 months and retention in care at 6 months in all new enrollees. We also performed an instrumental variable (IV analysis to quantify the effect of actually initiating ART because of this guideline change on retention. Overall, 34,857 ART-naïve patients (39.1% male, median age 34 years [IQR 28-41], median CD4 268 cells/μL [IQR 134-430] newly enrolled in HIV care during this period; 23,036 were analyzed after excluding patients around the threshold to allow for clinic

  4. Ovarian failure due to cancer treatment and fertility preservation options

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    Soheila Aminimoghaddam

    2016-04-01

    Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

  5. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

    Directory of Open Access Journals (Sweden)

    John Robotis

    2014-07-01

    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  6. Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models.

    Science.gov (United States)

    Chmielewska, M; Zycinska, K; Lenartowicz, B; Hadzik-Błaszczyk, M; Cieplak, M; Kur, Z; Wardyn, K A

    2017-01-01

    One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients' demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.

  7. A direct contact between astrocyte and vitreous body is possible in the rabbit eye due to discontinuities in the basement membrane of the retinal inner limiting membrane

    Directory of Open Access Journals (Sweden)

    A. Haddad

    2003-02-01

    Full Text Available Different from most mammalian species, the optic nerve of the rabbit eye is initially formed inside the retina where myelination of the axons of the ganglion cells starts and vascularization occurs. Astrocytes are confined to these regions. The aforementioned nerve fibers known as medullated nerve fibers form two bundles that may be identified with the naked eye. The blood vessels run on the inner surface of these nerve fiber bundles (epivascularization and, accordingly, the accompanying astrocytes lie mostly facing the vitreous body from which they are separated only by the inner limiting membrane of the retina. The arrangement of the astrocytes around blood vessels leads to the formation of structures known as glial tufts. Fragments (N = 3 or whole pieces (N = 3 of the medullated nerve fiber region of three-month-old male rabbits (Orictolagus cuniculus were fixed in glutaraldehyde followed by osmium tetroxide, and their thin sections were examined with a transmission electron microscope. Randomly located discontinuities (up to a few micrometers long of the basement membrane of the inner limiting membrane of the retina were observed in the glial tufts. As a consequence, a direct contact between the astrocyte plasma membrane and vitreous elements was demonstrated, making possible functional interactions such as macromolecular exchanges between this glial cell type and the components of the vitreous body.

  8. Plasma homovanillic acid levels and therapeutic outcome in schizophrenics: comparisons of neuroleptic-naive first-episode patients and patients with disease exacerbation due to neuroleptic discontinuance.

    Science.gov (United States)

    Akiyama, K; Tsuchida, K; Kanzaki, A; Ujike, H; Hamamura, T; Kondo, K; Mutoh, S; Miyanagi, K; Kuroda, S; Otsuki, S

    1995-11-15

    Plasma homovanillic acid (pHVA) levels were measured and the Brief Psychiatric Rating Scale (BPRS) scores were evaluated in 26 schizophrenic patients who had either never been medicated (neuroleptic-naive, first-episode subjects) or whose condition had become exacerbated following neuroleptic discontinuance (exacerbated subjects). All the subjects received medication with a fixed dose of a neuroleptic (haloperidol or fluphenazine, both 9 mg/day) for the first week and variable doses for the subsequent 4 weeks. In the neuroleptic-naive subjects, pHVA levels increased significantly 1 week after starting the protocol; this increase correlated significantly with clinical improvement of the BPRS positive symptom scores at week 5. In the neuroleptic-naive subjects, pHVA levels had declined to the baseline level by week 5. In the exacerbated subjects, there were no significant correlations between pHVA level changes at week 1 and later improvements of the BPRS positive symptom scores. These results suggest that the rise in pHVA levels occurring within 1 week after starting a fixed neuroleptic dose may predict a favorable clinical response in neuroleptic-naive schizophrenic patients.

  9. Treatment Discontinuation and Clinical Events in Type 2 Diabetes Patients Treated with Dipeptidyl Peptidase-4 Inhibitors or NPH Insulin as Third-Line Therapy

    Directory of Open Access Journals (Sweden)

    Cristiano S. Moura

    2018-01-01

    Full Text Available Objective. To compare dipeptidyl peptidase-4 (DPP-4 inhibitors with neutral protamine Hagedorn (NPH insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2 not controlled on metformin and sulfonylureas. Methods. A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations. Results. Treatment discontinuation and hypoglycemia occurred more frequently with NPH than with DPP-4 inhibitor users. In the adjusted Cox model, the use of NPH compared to that of DPP-4 inhibitors was associated with a higher risk of discontinuation (HR: 1.33; 95% CI 1.27–1.40 and hypoglycemia (HR: 2.98; 95% CI 2.72–3.28. Risk of cardiovascular events was similar across groups. Conclusions. This real-world analysis suggests that DM2 patients initiating third-line therapy with NPH have poorer control of diabetes when compared to DPP-4 inhibitor initiators.

  10.  Risk of discontinuation of nevirapine due to toxicities in antiretroviral naive and experienced HIV-infected patients with high and low CD4 counts

    DEFF Research Database (Denmark)

    Mocroft, A; Staszewski, S; Weber, R

    2007-01-01

    AND METHODS: 1,571 EuroSIDA patients started NVPc after 1/1/1999, with CD4+ T-cell counts and viral load measured in the 6 months before starting treatment, and were stratified into four groups based on CD4+ T-cell counts at initiation of NVPc (high [H], > 400/mm3 or > 250/mm3 for male or female, respectively...

  11. Early Relapse of Unresectable Gallbladder Cancer after Discontinuation of Gemcitabine Monotherapy Administered for 5 Years in a Patient Who Had Complete Response to the Treatment

    Directory of Open Access Journals (Sweden)

    Koichi Suyama

    2013-10-01

    Full Text Available The tumor shrinkage effect of gemcitabine is considered to be limited in cases of advanced gallbladder cancer, and there are few reports of complete response to gemcitabine therapy in patients with this cancer. Therefore, the treatment continuation strategy in these patients, after a complete response has been achieved, still remains to be established. Here, we present the case of a 77-year-old patient with unresectable gallbladder cancer, who after showing complete response to gemcitabine monotherapy administered for 5 years, showed early relapse within only 11 months of discontinuation of the drug. Thus, it is necessary to establish a suitable treatment continuation strategy for patients who show complete response to gemcitabine treatment.

  12. Treatment of prosthetic joint infections due to Propionibacterium

    Science.gov (United States)

    Van Hooff, Miranda L; Meis, Jacques F; Vos, Fidel; Goosen, Jon H M

    2016-01-01

    Background and purpose Currently, Propionibacterium is frequently recognized as a causative microorganism of prosthetic joint infection (PJI). We assessed treatment success at 1- and 2-year follow-up after treatment of Propionibacterium-associated PJI of the shoulder, hip, and knee. Furthermore, we attempted to determine whether postoperative treatment with rifampicin is favorable. Patients and methods We conducted a retrospective cohort study in which we included patients with a primary or revision joint arthroplasty of the shoulder, hip, or knee who were diagnosed with a Propionibacterium-associated PJI between November 2008 and February 2013 and who had been followed up for at least 1 year. Results We identified 60 patients with a Propionibacterium-associated PJI with a median duration of 21 (0.1–49) months until the occurrence of treatment failure. 39 patients received rifampicin combination therapy, with a success rate of 93% (95% CI: 83–97) after 1 year and 86% (CI: 71–93) after 2 years. The success rate was similar in patients who were treated with rifampicin and those who were not. Interpretation Propionibacterium-associated PJI treated with surgery in combination with long-term antibiotic administration had a successful outcome at 1- and 2-year follow-up irrespective of whether the patient was treated with rifampicin. Prospective studies are needed to determine whether the use of rifampicin is beneficial in the treatment of Propionibacterium-associated PJI. PMID:26414972

  13. The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary.

    Science.gov (United States)

    Llor, Carl; Moragas, Ana; Bayona, Carolina; Cots, Josep M; Molero, José M; Ribas, Joana; Fóthy, Julio Francisco; Gutiérrez, Isabel; Sánchez, Coro; Ortega, Jesús; Arranz, Javier; Botanes, Jenifer; Robles, Purificación

    2017-06-06

    Since 2011, the Spanish Society of Family Medicine has recommended general practitioners (GPs) to ask their patients to stop taking antibiotics when they suspect a viral infection. However, this practice is seldom used because uncertainty about diagnosis, and fear of consequences of discontinuing antibiotic therapy, as well as perceived pressure to continue prescribing antibiotics and potential conflict with patients are more of a concern for GPs than antibiotic resistance. The main objective of this study is to determine whether discontinuation of antibiotic therapy when a GP no longer considers it necessary has any impact on the number of days with severe symptoms. This is a multicentre, open-label, randomised controlled clinical trial. The study was conducted in 10 primary care centres in Spain. We included patients from 18 to 75 years of age with uncomplicated acute respiratory tract infections-acute rhinosinusitis, acute sore throat, influenza or acute bronchitis-who had previously taken any dose of antibiotic for antibiotic treatment or to discontinuing antibiotic therapy. A sample size of 240 patients per group was calculated on the basis of a reduction of 1 day in the duration of severe symptoms being a clinically relevant outcome. The primary outcome was the duration of severe symptoms, that is, symptoms scored 5 or 6 by means of validated symptom diaries. Secondary outcomes included antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. The study was approved by the Ethical Board of Fundació Jordi Gol i Gurina (reference number: 16/093). The findings of this trial will bedisseminated through research conferences and peer-reviewed journals. NCT02900820; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Neuropathic pain due to fibromatosis: Does anticancer treatment help?

    Directory of Open Access Journals (Sweden)

    David Mathew

    2011-01-01

    Full Text Available Desmoid fibromatosis, although histologically benign, infiltrates local structures. The involvement of neural structures can lead to difficult neuropathic pain and the escalating use of analgesics. We report a patient with desmoid fibromatosis of the chest wall causing brachial plexus infiltration. As the tumor was locally invasive and unresectable, he was treated with radiation therapy and oral tamoxifen. On follow-up, there was significant pain relief, sustained reduction in the tumor size, and reduced analgesic requirement. Antineoplastic treatments like local radiation therapy and targeted systemic therapy with hormones or other agents can be considered in the management of selected unresectable desmoid fibromatosis to improve symptom control and reduce polypharmacy.

  15. Technique for radiation treatment of exhaust gas due to combustion

    International Nuclear Information System (INIS)

    Machi, Sueo

    1978-01-01

    As the Japanese unique research in the field of preservation of environment, the technique to remove simultaneously sulphur dioxide and nitrogen oxides in exhaust gas using electron beam irradiation is noteworthy. This research was started by the experiment in the central research laboratory of Ebara Manufacturing Co., Ltd., in which it was found that the sulphur dioxide of initial concentration of 1,000 ppm was almost completely vanished when the exhaust gas of heavy oil combustion in a batch type vessel was irradiated for 9 minutes by electron beam. Based on this experiment, JAERI installed a continuous irradiation equipment with a large accelerator, and has investigated the effect of various parameters such as dose rate, irradiation temperature, total dose and agitation. This resulted in the remarkable finding that nitrogen oxides were also completely removed as well as sulphur dioxide when the exhaust gas containing both sulphur dioxide and nitrogen oxides was irradiated for a few seconds. In this case, if water of about 0.3% is added, removal rate of sulphur dioxide is greatly increased. The research group of University of Tokyo obtained other findings concerning removal rates. Then, after the pilot plant stage in Ebara Manufacturing Co., Ltd. from 1974, the test plant of exhaust gas treatment for a sintering machine, having the capacity of 3,000 Nm 3 /hr, has been constructed in Yawata Works of Nippon Steel Corp. This is now operating properly. (Wakatsuki, Y.)

  16. Vertebral Fractures After Discontinuation of Denosumab

    DEFF Research Database (Denmark)

    Cummings, Steven R; Ferrari, Serge; Eastell, Richard

    2018-01-01

    . We analyzed the risk of new or worsening vertebral fractures, especially multiple vertebral fractures, in participants who discontinued denosumab during the FREEDOM study or its Extension. Participants received ≥2 doses of denosumab or placebo Q6M, discontinued treatment, and stayed in the study ≥7...... months after the last dose. Of 1001 participants who discontinued denosumab during FREEDOM or Extension, the vertebral fracture rate increased from 1.2 per 100 participant-years during the on-treatment period to 7.1, similar to participants who received and then discontinued placebo (n = 470; 8.5 per 100....... Therefore, patients who discontinue denosumab should rapidly transition to an alternative antiresorptive treatment. Clinicaltrails.gov: NCT00089791 (FREEDOM) and NCT00523341 (Extension). © 2017 American Society for Bone and Mineral Research....

  17. Organising medication discontinuation

    DEFF Research Database (Denmark)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-01-01

    medication? Methods: Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. Results: The results show that different discontinuation cues (related to the type...... a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP’s practice and how do GPs make decisions about discontinuing...

  18. Green's function approach to neutron flux discontinuities

    International Nuclear Information System (INIS)

    Saad, E.A.; El-Wakil, S.A.

    1980-01-01

    The present work is devoted to the presentation of analytical method for the calculation of elastically and inelastically slowed down neutrons in an infinite non-absorbing medium. On the basis of the central limit theory (CLT) and the integral transform technique the slowing down equation including inelastic scattering, in terms of the Green function of elastic scattering, is solved. The Green function is decomposed according to the number of collisions. Placzec discontinuity associated with elastic scattering in addition to two discontinuities due to inelastic scattering are investigated. Numerical calculations for Fe 56 show that the elastic discontinuity produces about 41.8% change in the collision density whilst the ratio of the inelastic collision density discontinuity at qsub(o)sup(+) to the Placzec discontinuity at usub(o) + 1n 1/oc gives 55.7 percent change. (author)

  19. General practitioners' decisions about discontinuation of medication: an explorative study.

    Science.gov (United States)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-06-20

    Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.

  20. Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study.

    Science.gov (United States)

    Öhlund, Louise; Ott, Michael; Oja, Sofia; Bergqvist, Malin; Lundqvist, Robert; Sandlund, Mikael; Salander Renberg, Ellinor; Werneke, Ursula

    2018-02-07

    Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium's proven benefits concerning the prevention of severe affective episodes and suicide. Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good. Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001). Stopping lithium treatment is

  1. Ultrasonic assessment of shrinkage type discontinuities

    International Nuclear Information System (INIS)

    Hubber, John

    2010-01-01

    This investigation into ultrasonic internal discontinuities is intended to demonstrate typical examples of internal 'shrinkage' type discontinuities and its connection with the casting suitability, integrity and reliability in service. This type of discontinuity can be misinterpreted by ultrasonic technicians and can lead to the rejection of castings unnecessarily, due to the mis-characterization of fine shrinkage - discrete porosity. The samples for this investigation were taken from thirty ton heavy section ductile iron mill flange castings, manufactured by Graham Campbell Ferrum International. The sampled area was of discontinuities that were recorded for sizing on an area due to loss of back wall echo, but had acceptable reflectivity. A comparative sample was taken adjacent to the area of discrete porosity. The discontinuities found by this investigation are of a 'spongy' type, gaseous in appearance and are surrounded by acoustically sound material. All discontinuities discussed in this paper are centrally located in the through thickness of the casting. The porous nature of this type of discontinuity consisting of approximately 80-90% metal has its own residual strength, as indicated by the proof stress results which reveal a residual strength of up to 50-60% of that of the unaffected area of the casting. The affected areas are elliptical in shape and vary in density and through thickness throughout.

  2. Lower blood pressure and apathy coincide in older persons with poorer functional ability: the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden.

    Science.gov (United States)

    Moonen, Justine E F; Bertens, Anne Suzanne; Foster-Dingley, Jessica C; Smit, Roelof A J; van der Grond, Jeroen; de Craen, Anton J M; de Ruijter, Wouter; van der Mast, Roos C

    2015-01-01

    To examine the association between blood pressure (BP) measures and symptoms of apathy and depression in older adults with various levels of functional ability. Cross-sectional study using baseline data from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden. Primary care setting, the Netherlands. Community-dwelling individuals aged 75 and older (N = 430). Systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were measured during home visits. Symptoms of apathy and depression were assessed using the Apathy Scale and the Geriatric Depression Scale (GDS-15), respectively. Stratified linear regression was performed in participants with better and worse functional ability according to the median of the Groningen Activity Restriction Scale. In participants with lower functional ability, each 10-mmHg lower SBP, DBP, and MAP was associated with higher Apathy Scale scores (0.63, 0.92, and 0.94 points, respectively, all P < .005) but not with GDS-15 scores. In participants with higher functional ability, BP measures were not associated with Apathy Scale or GDS-15 scores. In older participants with poorer functional ability, lower BP was associated with more symptoms of apathy but not depression. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  3. [Surgical Treatment of Bronchial Stricture due to Endobronchial Tuberculosis: 
Results in 36 Consecutive Cases].

    Science.gov (United States)

    Ruan, Junzhong; Zhang, Tianhui; Li, Fugen; Duan, Yong; Han, Ming; Wang, Zitong

    2018-04-20

    Bronchial tuberculosis is a common complication of pulmonary tuberculosis. The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis, when the drug and endoscopic treatment were no effect. Reviewed the clinical-pathological records documenting the surgical outcomes in 36 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 2000 and February 2016. Pneumonectomy in 8 cases, lobectomy in 23 cases, sleeve resection in 5 cases. No intraoperative or early postoperative death occurred. Six patients developed complications. All 6 cases recovered well after treatment. Surgical treatment is still the recommended treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its good results. It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed.

  4. [Treatment of hyperthyroidism due to Graves' disease: what is the recommended antithyroid drug during pregnancy?].

    Science.gov (United States)

    Caron, P

    2013-05-01

    Clinical hyperthyroidism during the first trimester of pregnancy due to Graves' disease can be associated with maternal, obstetrical and fetal complications, indicating an active treatment to restore normal thyroid function. Antithyroid drugs are the first line treatment in pregnant women with hyperthyroidism. Due to the increased congenital malformations reported in neonates after first-trimester carbimazole/methimazole treatment and propylthiouracil associated hepatotoxicity, the recommended treatment for pregnant women with hyperthyroid Graves' disease is propylthiouracil during the first trimester of pregnancy and following the first trimester, consideration should be given switching to carbimazole/methimazole during the second part of gestation. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  5. Post-treatment efficacy of discontinuous treatment with 300IR 5-grass pollen sublingual tablet in adults with grass pollen-induced allergic rhinoconjunctivitis

    DEFF Research Database (Denmark)

    Didier, A; Malling, H-J; Worm, Marcel

    2013-01-01

    Sustained efficacy over three pollen seasons of pre- and co-seasonal treatment with 300IR 5-grass pollen sublingual tablet has been demonstrated in adults with moderate-severe grass pollen-associated allergic rhinoconjunctivitis.......Sustained efficacy over three pollen seasons of pre- and co-seasonal treatment with 300IR 5-grass pollen sublingual tablet has been demonstrated in adults with moderate-severe grass pollen-associated allergic rhinoconjunctivitis....

  6. A comparison of discontinuation rates of tofacitinib and biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis: a systematic review and Bayesian network meta-analysis.

    Science.gov (United States)

    Park, Sun-Kyeong; Lee, Min-Young; Jang, Eun-Jin; Kim, Hye-Lin; Ha, Dong-Mun; Lee, Eui-Kyung

    2017-01-01

    The purpose of this study was to compare the discontinuation rates of tofacitinib and biologics (tumour necrosis factor inhibitors (TNFi), abatacept, rituximab, and tocilizumab) in rheumatoid arthritis (RA) patients considering inadequate responses (IRs) to previous treatment(s). Randomised controlled trials of tofacitinib and biologics - reporting at least one total discontinuation, discontinuation due to lack of efficacy (LOE), and discontinuation due to adverse events (AEs) - were identified through systematic review. The analyses were conducted for patients with IRs to conventional synthetic disease-modifying anti-rheumatic drugs (cDMARDs) and for patients with biologics-IR, separately. Bayesian network meta-analysis was used to estimate rate ratio (RR) of a biologic relative to tofacitinib with 95% credible interval (CrI), and probability of RR being tofacitinib and biologics in the cDMARDs-IR group. In the biologics-IR group, however, TNFi (RR 0.17, 95% CrI 0.01-3.61, P[RRtofacitinib did. Despite the difference, discontinuation cases owing to LOE and AEs revealed that tofacitinib was comparable to the biologics. The comparability of discontinuation rate between tofacitinib and biologics was different based on previous treatments and discontinuation reasons: LOE, AEs, and total (due to other reasons). Therefore, those factors need to be considered to decide the optimal treatment strategy.

  7. Discontinuation Decision in Assisted Reproductive Techniques

    Directory of Open Access Journals (Sweden)

    Ashraf Moini

    2009-01-01

    Full Text Available Background: In vitro fertilization (IVF and intra cytoplasmic sperm injection (ICSI are recognizedas established and increasingly successful forms of treatment for infertility, yet significant numbersof couples discontinue treatment without achieving a live birth. This study aims to identify majorfactors that influence the decision to discontinue IVF/ICSI treatments.Materials and Methods: We studied the data of 338 couples who discontinued their infertilitytreatments after three cycles; based on medical records and phone contact. The main measure wasthe reason for stopping their treatments.Results: Economical problems were cited by 212 couples (62.7%, as their mean income wassignificantly less than other couples (p<0.0001. Lack of success was reported as a reason by229 (67.8%, from whom 165 (72% also had economical problems. Achieving independent-ART pregnancy was the reason for discontinuation in 20 (5.9% couples. Psychological stress,depression and anxiety were reported as other cessation factors by 169 (50%, 148 (43.8% and 182(53.8% couples, respectively.Conclusion: This survey suggests that the most common reasons for assisted reproductivetechnique (ART discontinuation after three cycles are: prior unsuccessful cycles, economicaland psychological problems. Therefore, the substantial proportion of couples could benefit frompsychological intervention, increasing awareness of ART outcomes and health funding to copemore adequately with failed treatments.

  8. Low body weight and type of protease inhibitor predict discontinuation and treatment-limiting adverse drug reactions among HIV-infected patients starting a protease inhibitor regimen: consistent results from a randomized trial and an observational cohort

    DEFF Research Database (Denmark)

    Kirk, O; Gerstoft, J; Pedersen, C

    2001-01-01

    OBJECTIVES: To assess predictors for discontinuation and treatment-limiting adverse drug reactions (TLADR) among patients starting their first protease inhibitor (PI). METHODS: Data on patients starting a PI regimen (indinavir, ritonavir, ritonavir/saquinavir and saquinavir hard gel) in a randomi......OBJECTIVES: To assess predictors for discontinuation and treatment-limiting adverse drug reactions (TLADR) among patients starting their first protease inhibitor (PI). METHODS: Data on patients starting a PI regimen (indinavir, ritonavir, ritonavir/saquinavir and saquinavir hard gel....... Low body weight and initiation of ritonavir relative to other PIs were associated with an increased risk of TLADRs. Very consistent results were found in a randomized trial and an observational cohort....

  9. Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Boyer, Holly; Fernandes, Patricia; Le, Chap; Yueh, Bevan

    2015-05-01

    Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (-0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT. © 2015 ARS-AAOA, LLC.

  10. Identifying the factors underlying discontinuation of triptans.

    Science.gov (United States)

    Wells, Rebecca E; Markowitz, Shira Y; Baron, Eric P; Hentz, Joseph G; Kalidas, Kavita; Mathew, Paul G; Halker, Rashmi; Dodick, David W; Schwedt, Todd J

    2014-02-01

    To identify factors associated with triptan discontinuation among migraine patients. It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs. 18%, P = .04) and were more likely to have ever used opioids for migraine treatment (57 vs. 38%, P = .006) as well as higher MIDAS (mean 63 vs. 37, P = .001) and BDI scores (mean 10.4 vs. 7.4, P = .009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs. 54%, P = .002) and were more likely to report headache resolution (53 vs. 14%, P  24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1

  11. Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation : A meta-analysis of placebo-controlled randomized trials

    NARCIS (Netherlands)

    Kaymaz, Nil; van Os, Jim; Loonen, Anton J. M.; Nolen, Willem A.

    Background: Antidepressants are effective in the prevention of relapse after remission from an acute depressive episode. It is unclear, however, to what degree duration of the continuation phase, level of abruptness of antidepressant discontinuation, or the number of previous episodes moderate the

  12. Outcomes Following Discontinuation of E. coli l-Asparaginase Upon Severe Allergic Reactions in Children With Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Yen, Hsiu-Ju; Chang, Wan-Hui; Liu, Hsi-Che; Yeh, Ting-Chi; Hung, Giun-Yi; Wu, Kang-Hsi; Peng, Ching-Tien; Chang, Yu-Hsiang; Chang, Te-Kao; Hsiao, Chih-Cheng; Sheen, Jiunn-Ming; Chao, Yu-Hua; Chang, Tai-Tsung; Chiou, Shyh-Shin; Lin, Pei-Chin; Wang, Shih-Chung; Lin, Ming-Tsan; Ho, Wan-Ling; Chen, Yu-Chieh; Liang, Der-Cherng

    2016-04-01

    Discontinuation of E. coli l-asparaginase in patients with acute lymphoblastic leukemia (ALL) is unavoidable upon severe allergic reaction. We sought to examine outcomes following E. coli l-asparaginase discontinuation due to severe allergic reactions. We evaluated the outcome of children enrolled in Taiwan Pediatric Oncology Group-2002-ALL protocol between 2002 and 2012, who had E. coli l-asparaginase discontinued due to severe allergic reactions, and compared the outcomes of those who continued with Erwinia l-asparaginase (Erwinase) with those who did not. Among 700 patients enrolled in this study, 33 patients had E. coli l-asparaginase treatment discontinued due to severe allergic reactions. Five-year overall survival did not differ significantly among the 648 patients without discontinuation (81 ± 1.6%, mean ± SE), compared to 17 patients with allergic reactions and treated with Erwinase (88 ± 7.8%) and 16 patients with allergic reactions but not treated with Erwinase (87 ± 8.6%). Among 16 patients who did not receive Erwinase, all 10 who received ≥50% of the scheduled doses of E. coli l-asparaginase before discontinuation survived without events. Erwinase treatment may not be needed for some ALL patients with severe allergy to E. coli l-asparaginase if ≥50% of prescribed doses were received and/or therapy is augmented with other agents. © 2015 Wiley Periodicals, Inc.

  13. Priapism Followed by Discontinuation of Methadone: A rare Case Report

    Directory of Open Access Journals (Sweden)

    Seyed-Ali Mostafavi

    2015-10-01

    Full Text Available Objective: Priapism is defined by persistent, painful penile erection which occurs without sexual stimulation. Methadone is used as an analgesic and is also used in detoxification and maintenance protocol for opioid dependence treatment. Here we will report a case of a male with priapism after rapid discontinuation doses of methadone.Case presentation: The case was a young married male who referred to a psychiatry clinic due to long-time spontaneous erections. The patient had no history of mental disorders, trauma or sickle cell anemia. He used to smoke opium for five years and used methadone for four years at a dose of 17 cc daily, which he abruptly discontinued. Then he often experienced spontaneous and painful erections without physical or mental stimulation that caused him shame and embarrassment .Conclusion: In this case, chronology indicates that rapid discontinuation of methadone was possibly responsible for the occurrence of priapism. This may have happened due to a compensatory reaction to methadone side effect of erectile dysfunction, followed by its rapid withdrawal.

  14. Impact of prior treatment status and reasons for discontinuation on the efficacy and safety of fingolimod: Subgroup analyses of the Fingolimod Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study.

    Science.gov (United States)

    Kremenchutzky, Marcelo; O'Connor, Paul; Hohlfeld, Reinhard; Zhang-Auberson, Lixin; von Rosenstiel, Philipp; Meng, Xiangyi; Grinspan, Augusto; Hashmonay, Ron; Kappos, Ludwig

    2014-05-01

    Fingolimod is a once-daily, oral sphingosine 1-phosphate receptor modulator approved for the treatment of relapsing multiple sclerosis. This post-hoc analysis of phase 3 FREEDOMS data assessed whether the effects of fingolimod are consistent among subgroups of patients defined by prior treatment history. Annualized relapse rate and safety profile of treatment with fingolimod 0.5mg, 1.25mg, or placebo once-daily for 24 months were analyzed in 1272 relapsing multiple sclerosis patients, by subgroups based on disease-modifying therapy history (treatment-naive; prior interferon-β or glatiramer acetate), reason for discontinuation of prior disease-modifying therapy (unsatisfactory therapeutic response or adverse events), and prior disease-modifying therapy duration. Both fingolimod doses significantly reduced annualized relapse rate in patients that received prior interferon-β or glatiramer acetate, discontinued prior disease-modifying therapy owing to unsatisfactory therapeutic effect, were treatment-naive, or had prior disease-modifying therapy duration of >1-3 years (P≤0.0301 for all comparisons vs placebo). Fingolimod 1.25mg resulted in greater reductions in annualized relapse rate in patients that discontinued prior disease-modifying therapy for adverse events or had prior disease-modifying therapy duration of ≤1 year or >3 years (P≤0.0194 vs placebo). Fingolimod demonstrated similar efficacy in relapsing multiple sclerosis patients regardless of prior treatment history. Clinicaltrials.gov identifier: NCT00289978. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  15. Treatment Failure Due to Emergence of Resistance to Carbapenem during Therapy for Shewanella algae Bacteremia

    OpenAIRE

    Kim, Dong-Min; Kang, Cheol-In; Lee, Chang Seop; Kim, Hong-Bin; Kim, Eui-Chong; Kim, Nam Joong; Oh, Myoung-don; Choe, Kang-Won

    2006-01-01

    We describe a case of bacteremia due to imipenem-susceptible Shewanella algae. Despite treatment with imipenem, the patient developed a spinal epidural abscess, from which imipenem-resistant S. algae was isolated. The development of resistance should be monitored when S. algae infection is treated with imipenem, even though the strain is initially susceptible to imipenem.

  16. Apical root resorption due to orthodontic treatment detected by cone beam computed tomography.

    Science.gov (United States)

    Castro, Iury O; Alencar, Ana H G; Valladares-Neto, José; Estrela, Carlos

    2013-03-01

    To determine the frequency of apical root resorption (ARR) due to orthodontic treatment using cone beam computed tomography (CBCT) in a sample of 1256 roots from 30 patients. All patients had Class I malocclusion with crowding. Of the 30 patients evaluated, 11 were boys and 19 were girls; their mean age was 13 years (11 to 16 years). Orthodontic treatment followed the nonextraction treatment. CBCT images were obtained before and after orthodontic treatment, and ARR was determined using Axial Guided Navigation of CBCT images. All patients had ARR. No statistically significant association was found between resorption frequency, gender, and age. ARR was detected using CBCT in 46% of all roots that underwent orthodontic treatment. CBCT was effective for detecting in vivo even minimal degrees of ARR due to orthodontic treatment and allowed three-dimensional evaluation of dental roots and visualization of palatine roots of maxillary molars. The highest frequencies and the most significant ARR occurred in incisors and distal roots of first maxillary and mandibular molars.

  17. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  18. Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

    2015-12-01

    Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

  19. Problems with Discontinuous Diffusion/Dispersion Coefficients

    Directory of Open Access Journals (Sweden)

    Stefano Ferraris

    2012-01-01

    accurate on smooth solutions and based on a special numerical treatment of the diffusion/dispersion coefficients that makes its application possible also when such coefficients are discontinuous. Numerical experiments confirm the convergence of the numerical approximation and show a good behavior on a set of benchmark problems in two space dimensions.

  20. Identification of chronic myeloid leukemia patients treated with imatinib who are potentially eligible for treatment discontinuation by assessing real-life molecular responses on the international scale in a EUTOS-certified lab.

    Science.gov (United States)

    Heinrichs, Amélie; Dessars, Barbara; El Housni, Hakim; Pluymers, Wim; Peeters, Karen; Benghiat, Fleur S; Heimann, Pierre

    2018-04-01

    A retrospective study was performed to describe molecular responses (MR) on the international scale (IS) in patients with chronic myeloid leukemia (CML) treated with imatinib in routine clinical practice in Belgium and to identify patients potentially eligible for treatment discontinuation. The analysis included 116 patients with CML in chronic phase at treatment centers sending blood samples for molecular follow-up to a single EUTOS-certified laboratory. IS MR from the last patient visit between October 2014 and April 2015 were retrospectively collected. Most patients (93.1%) had an IS MR corresponding to an optimal response per European LeukemiaNet 2013 guidelines; 53.4% (62/116) of patients were in deep molecular responses ≥MR 4.5 at their last visit (mean treatment duration: 91.0 months) among whom 36.2% (42/116) had been receiving imatinib for >5.8 years and 26.7% (31/116) for >8 years (margins of error: 8.74% and 8.05%, respectively). These patients would likely have the highest chance of staying in treatment-free remission (TFR) upon discontinuation, based on published TFR trial data. Although our study only provides a snapshot in time of a patient's last MR reported, without precise information regarding MR duration, the study settings could nevertheless support the feasibility of attempting TFR outside clinical trials in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Discontinuous Galerkin Method for Hyperbolic Conservation Laws

    KAUST Repository

    Mousikou, Ioanna

    2016-11-11

    Hyperbolic conservation laws form a special class of partial differential equations. They describe phenomena that involve conserved quantities and their solutions show discontinuities which reflect the formation of shock waves. We consider one-dimensional systems of hyperbolic conservation laws and produce approximations using finite difference, finite volume and finite element methods. Due to stability issues of classical finite element methods for hyperbolic conservation laws, we study the discontinuous Galerkin method, which was recently introduced. The method involves completely discontinuous basis functions across each element and it can be considered as a combination of finite volume and finite element methods. We illustrate the implementation of discontinuous Galerkin method using Legendre polynomials, in case of scalar equations and in case of quasi-linear systems, and we review important theoretical results about stability and convergence of the method. The applications of finite volume and discontinuous Galerkin methods to linear and non-linear scalar equations, as well as to the system of elastodynamics, are exhibited.

  2. Discontinuous Galerkin Method for Hyperbolic Conservation Laws

    KAUST Repository

    Mousikou, Ioanna

    2016-01-01

    Hyperbolic conservation laws form a special class of partial differential equations. They describe phenomena that involve conserved quantities and their solutions show discontinuities which reflect the formation of shock waves. We consider one-dimensional systems of hyperbolic conservation laws and produce approximations using finite difference, finite volume and finite element methods. Due to stability issues of classical finite element methods for hyperbolic conservation laws, we study the discontinuous Galerkin method, which was recently introduced. The method involves completely discontinuous basis functions across each element and it can be considered as a combination of finite volume and finite element methods. We illustrate the implementation of discontinuous Galerkin method using Legendre polynomials, in case of scalar equations and in case of quasi-linear systems, and we review important theoretical results about stability and convergence of the method. The applications of finite volume and discontinuous Galerkin methods to linear and non-linear scalar equations, as well as to the system of elastodynamics, are exhibited.

  3. Combination antibiotic therapy for the treatment of infective endocarditis due to enterococci.

    Science.gov (United States)

    Leone, Sebastiano; Noviello, Silvana; Esposito, Silvano

    2016-06-01

    Enterococci are common causes of infective endocarditis (IE) in both health care and community-based setting. Enterococcal IE requires bactericidal therapy for an optimal outcome. For decades, cell-wall-active antimicrobial agents (penicillins or vancomycin) in combination with aminoglycosides were the cornerstone of the treatment; however, the emergence of antibiotic resistance has significantly reduced the efficacy of these regimens. Data for this review were identified by searches of MEDLINE and references from relevant articles on antibiotic combination regimens for the treatment of enterococcal IE. Abstracts presented in scientific conferences were not searched for. New effective and safe combination treatments, including double-β-lactam and daptomycin/β-lactam combination, are proving useful for the management of IE due to enterococci.

  4. Hiccup Due to Aripiprazole Plus Methylphenidate Treatment in an Adolescent with Attention Deficit and Hyperactivity Disorder and Conduct Disorder: A Case Report.

    Science.gov (United States)

    Kutuk, Meryem Ozlem; Guler, Gulen; Tufan, Ali Evren; Kutuk, Ozgur

    2017-11-30

    Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3-4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups.

  5. Project of integrity assessment of flawed components with structural discontinuity (IAF). Data book for residual stress analysis in weld joint. Analysis model of dissimilar metal weld joint applied post weld heat treatment (PWHT)

    International Nuclear Information System (INIS)

    2012-12-01

    The project of Integrity Assessment of Flawed Components with Structural Discontinuity (IAF) was entrusted to Japan Power Engineering and Inspection Corporation (JAPEIC) from Nuclear and Industrial Safety Agency (NISA) and started from FY 2001. And then, it was taken over to Japan Nuclear Energy Safety Organization (JNES) which was established in October 2003 and carried out until FY 2007. In the IAF project, weld joints between nickel based alloys and low alloy steels around penetrations in reactor vessel, safe-end of nozzles and shroud supports were selected from among components and pipe arrangements in nuclear power plants, where high residual stresses were generated due to welding and complex structure. Residual stresses around of the weld joints were estimated by finite element analysis method (FEM) with a general modeling method, then the reasonability and the conservativeness was evaluated. In addition, for postulated surface crack of stress corrosion cracking (SCC), a simple calculation method of stress intensity factor (K) required to estimate the crack growth was proposed and the effectiveness was confirmed. JNES compiled results of the IAF project into Data Books of Residual Stress Analysis of Weld Joint, and Data Book of Simplified Stress Intensity Factor Calculation for Penetration of Reactor as typical Structure Discontinuity, respectively. Data Books of Residual Stress Analysis in Weld Joint. 1. Butt Weld Joint of Small Diameter Cylinder (4B Sch40) (JNES-RE-2012-0005), 2. Dissimilar Metal Weld Joint in Safe End (One-Side Groove Joint (JNES-RE-2012-0006), 3. Dissimilar Metal Weld Joint in Safe End (Large Diameter Both-Side Groove Joint) (JNES-RE-2012-0007), 4. Weld Joint around Penetrations in Reactor Vessel (Insert Joint) (JNES-RE-2012-0008), 5. Weld Joint in Shroud Support (H8, H9, H10 and H11 Welds) (JNES-RE-2012-0009), 6. Analysis Model of Dissimilar Metal Weld Joint Applied Post Weld Heat Treatment (PWHT) (JNES-RE-2012-0010). Data Book of

  6. Stable and high order accurate difference methods for the elastic wave equation in discontinuous media

    KAUST Repository

    Duru, Kenneth; Virta, Kristoffer

    2014-01-01

    to be discontinuous. The key feature is the highly accurate and provably stable treatment of interfaces where media discontinuities arise. We discretize in space using high order accurate finite difference schemes that satisfy the summation by parts rule. Conditions

  7. Effect of Poultry Litter Treatment (PLT) on death due to ascites in broilers.

    Science.gov (United States)

    Terzich, M; Quarles, C; Goodwin, M A; Brown, J

    1998-01-01

    The purposes of this study were to determine the effect of Poultry Litter Treatment (PLT) on levels of litter moisture, litter nitrogen, atmospheric ammonia, and death due to ascites. Data were collected from chicks raised in containment conditions that resembled commercial settings. The ascites death rate (5.9%) in broiler chicks on PLT-treated litter was significantly (chi 2 = 15.5, df = 1, P = 0.0001) lower than that (31.5%) in broiler chicks raised on untreated litter. Likewise, atmospheric ammonia levels in pens that had been treated with PLT were significantly (P litter moisture and litter nitrogen levels were not different (P > 0.05) among treatments at any sample interval.

  8. Eurycoma longifolia: Medicinal Plant in the Prevention and Treatment of Male Osteoporosis due to Androgen Deficiency

    Directory of Open Access Journals (Sweden)

    Nadia Mohd Effendy

    2012-01-01

    Full Text Available Osteoporosis in elderly men is now becoming an alarming health issue due to its relation with a higher mortality rate compared to osteoporosis in women. Androgen deficiency (hypogonadism is one of the major factors of male osteoporosis and it can be treated with testosterone replacement therapy (TRT. However, one medicinal plant, Eurycoma longifolia Jack (EL, can be used as an alternative treatment to prevent and treat male osteoporosis without causing the side effects associated with TRT. EL exerts proandrogenic effects that enhance testosterone level, as well as stimulate osteoblast proliferation and osteoclast apoptosis. This will maintain bone remodelling activity and reduce bone loss. Phytochemical components of EL may also prevent osteoporosis via its antioxidative property. Hence, EL has the potential as a complementary treatment for male osteoporosis.

  9. Delirium Associated With Fluoxetine Discontinuation: A Case Report.

    Science.gov (United States)

    Fan, Kuang-Yuan; Liu, Hsing-Cheng

    Withdrawal symptoms on selective serotonin reuptake inhibitor (SSRI) discontinuation have raised clinical attention increasingly. However, delirium is rarely reported in the SSRI discontinuation syndrome. We report a case of delirium developing after fluoxetine discontinuation in a 65-year-old female patient with major depressive disorder. She experienced psychotic depression with limited response to treatment of fluoxetine 40 mg/d and quetiapine 100 mg/d for 3 months. After admission, we tapered fluoxetine gradually in 5 days because of its limited effect. However, delirious pictures developed 2 days after we stopped fluoxetine. Three days later, we added back fluoxetine 10 mg/d. Her delirious features gradually improved, and the clinical presentation turned into previous psychotic depression state. We gradually increased the medication to fluoxetine 60 mg/d and olanzapine 20 mg/d in the following 3 weeks. Her psychotic symptoms decreased, and there has been no delirious picture noted thereafter. Delirium associated with fluoxetine discontinuation is a much rarer complication in SSRI discontinuation syndrome. The symptoms of SSRI discontinuation syndrome may be attributable to a rapid decrease in serotonin availability. In general, the shorter the half-life of any medication, the greater the likelihood patients will experience discontinuation symptoms. Genetic vulnerability might be a potential factor to explain that SSRI discontinuation syndrome also occurred rapidly in people taking long-half-life fluoxetine. The genetic polymorphisms of both pharmacokinetic and pharmacodynamic pathways might be potentially associated with SSRI discontinuation syndrome.

  10. High rates of regimen change due to drug toxicity among a cohort of South Indian adults with HIV infection initiated on generic, first-line antiretroviral treatment.

    Science.gov (United States)

    Sivadasan, Ajith; Abraham, O C; Rupali, Priscilla; Pulimood, Susanne A; Rajan, Joyce; Rajkumar, S; Zachariah, Anand; Kannangai, Rajesh; Kandathil, Abraham Joseph; Sridharan, G; Mathai, Dilip

    2009-05-01

    To determine the rates, reasons and predictors of treatment change of the initial antiretroviral treatment (ART) regimen in HIV-infected south Indian adults. In this prospective cohort study, ART-naive adults initiated on generic, fixed dose combination ART as per the National AIDS Control Organization guidelines were followed up at an academic medical center. Treatment change was defined as any event which necessitated a change in or discontinuation of the initial ART regimen. Two hundred and thirty persons with HIV infection (males 74.8% and median age 37 years) were followed up for median duration of 48 weeks. The majority (98.7%) had acquired HIV infection through the heterosexual route. Most (70.4%) had advanced IV infection (WHO clinical stage 3 or 4) and 78% had CD4+ T-lymphocyte counts below 200 cells/microL. The initial ART regimens used were: Lamivudine (3TC) with Stavudine (d4T) (in 76%) or Azidothymidine (AZT) and Nevirapine (NVP) (in 86%) or Efavirenz (EFV). The cumulative incidence of treatment change was 39.6% (91 patients). Drug toxicity (WHO grade 3 or 4) was the reason for treatment change among 62 (27%) (incidence rate 35.9/100 person-years). The most common toxicities were attributable to the thymidine analogue nucleoside reverse transcriptase inhibitors (NRTIs), d4T and AZT [lactic acidosis (8.7%), anemia (7%) and peripheral neuropathy (5.2%)]. The other toxicities were rash (3.9%) and hepatitis (1.3%) due to NVP. The mortality (4.6/100 person-years) and disease progression rates (4.1/100 person-years) were low. The ART regimens used in this study were effective in decreasing disease progression and death. However, they were associated with high rates of drug toxicities, particularly those attributable to thymidine analogue NRTI. As efforts are made to improve access to ART, treatment regimens chosen should not only be potent, but also safe.

  11. Economic costs due to workers' sick leave at wastewater treatment plants in Bulgaria.

    Science.gov (United States)

    Toseva, Elka Ilieva; Stoyanova, Rumyana; Turnovska, Tanya

    2018-03-09

    The compensatory mechanisms of social security include expenses for sick leave. The aim of the study is to determine the economic cost due to sick leave among workers in wastewater treatment plants (WWTPs), comparing with the same economic indicators of the National Social Security Institute (NSSI) in Bulgaria. The sick leave of 111 workers at 3 WWTPs was studied in the period 2012-2014 on the grounds of registered absences from work due to temporary incapacity for work. The economic indicators of the NSSI, the gross salary at WWTPs, payable social security contributions and compensatory payments for sick leave have been used for economic cost calculation for temporary incapacity of the workers. The frequency of cases and the frequency of lost days due to temporary incapacity were increased in the observed period at WWTPs and in Bulgaria, and it is significantly higher for the employed at WWTPs. The percentage share of workers equivalent to 1.66% at WWTPs have not worked for an entire year as a result of temporary incapacity in 2012, 2.76% - in 2013, and 4.61% - in 2014. The economic burden due to sick leave at WWTPs was raised from EUR 4913.02 in 2012 to EUR 16 895.80 for 2014 for employers and the NSSI. The frequency of cases and the frequency of lost days due to temporary incapacity were increased in the observed period at WWTPs and in Bulgaria, and it is significantly higher for the employed at WWTPs. The economic burden was equally distributed between employers and the NSSI. Med Pr 2018;69(2):129-141. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  12. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

    Directory of Open Access Journals (Sweden)

    Alberto Nicodemo

    2014-01-01

    Full Text Available Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

  13. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

    Science.gov (United States)

    Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Massè, Alessandro

    2014-01-01

    Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible. PMID:24707293

  14. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol-Surgical Treatment of Neurological Hip Flexion Contracture.

    Science.gov (United States)

    Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Massè, Alessandro

    2014-01-01

    Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

  15. Testing discontinuities in nonparametric regression

    KAUST Repository

    Dai, Wenlin

    2017-01-19

    In nonparametric regression, it is often needed to detect whether there are jump discontinuities in the mean function. In this paper, we revisit the difference-based method in [13 H.-G. Müller and U. Stadtmüller, Discontinuous versus smooth regression, Ann. Stat. 27 (1999), pp. 299–337. doi: 10.1214/aos/1018031100

  16. Stabilities of MHD rotational discontinuities

    International Nuclear Information System (INIS)

    Wang, S.

    1984-11-01

    In this paper, the stabilities of MHD rotational discontinuities are analyzed. The results show that the rotational discontinuities in an incompressible magnetofluid are not always stable with respect to infinitesimal perturbation. The instability condition in a special case is obtained. (author)

  17. Testing discontinuities in nonparametric regression

    KAUST Repository

    Dai, Wenlin; Zhou, Yuejin; Tong, Tiejun

    2017-01-01

    In nonparametric regression, it is often needed to detect whether there are jump discontinuities in the mean function. In this paper, we revisit the difference-based method in [13 H.-G. Müller and U. Stadtmüller, Discontinuous versus smooth regression, Ann. Stat. 27 (1999), pp. 299–337. doi: 10.1214/aos/1018031100

  18. Discontinuity formulas for multiparticle amplitudes

    International Nuclear Information System (INIS)

    Stapp, H.P.

    1976-03-01

    It is shown how discontinuity formulas for multiparticle scattering amplitudes are derived from unitarity and analyticity. The assumed analyticity property is the normal analytic structure, which was shown to be equivalent to the space-time macrocausality condition. The discontinuity formulas to be derived are the basis of multi-particle fixed-t dispersion relations

  19. A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Mia K. Markey

    2008-01-01

    Full Text Available Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor’s appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women’s perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor’s appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor’s breasts to match her preferences as much as possible.

  20. Reasons for Discontinuation of Implanon among Users in Buffalo ...

    African Journals Online (AJOL)

    USER

    African Journal of Reproductive Health March 2018; 22(1):113 ... other medical treatments: 24 participants on the anti-retroviral drugs, one on antipsychotic and anti- ... The side effects of implanon were the reason for early discontinuation of.

  1. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study.

    Science.gov (United States)

    Toyos, Rolando; McGill, William; Briscoe, Dustin

    2015-01-01

    The purpose of this study was to determine the clinical benefits of intense-pulsed-light therapy for the treatment of dry-eye disease caused by meibomian gland dysfunction (MGD). MGD is the leading cause of evaporative dry eye disease. It is currently treated with a range of methods that have been shown to be only somewhat effective, leading to the need for advanced treatment options. A retrospective noncomparative interventional case series was conducted with 91 patients presenting with severe dry eye syndrome. Treatment included intense-pulsed-light therapy and gland expression at a single outpatient clinic over a 30-month study. Pre/post tear breakup time data were available for a subset of 78 patients. For all patients, a specially developed technique for the treatment of dry eye syndrome was applied as a series of monthly treatments until there was adequate improvement in dry eye syndrome symptoms by physician judgment, or until patient discontinuation. Primary outcomes included change in tear breakup time, self-reported patient satisfaction, and adverse events. Physician-judged improvement in dry eye tear breakup time was found for 68 of 78 patients (87%) with seven treatment visits and four maintenance visits on average (medians), and 93% of patients reported post-treatment satisfaction with degree of dry eye syndrome symptoms. Adverse events, most typically redness or swelling, were found for 13% of patients. No serious adverse events were found. Although preliminary, study results of intense-pulsed-light therapy treatment for dry eye syndrome caused by meibomian gland dysfunction are promising. A multisite clinical trial with a larger sample, treatment comparison groups, and randomized controlled trials is currently underway.

  2. [Preclinical treatment of severe burn trauma due to an electric arc on an overhead railway cable].

    Science.gov (United States)

    Spelten, O; Wetsch, W A; Hinkelbein, J

    2013-09-01

    Severe burns due to electrical accidents occur rarely in Germany but represent a challenge for emergency physicians and their team. Apart from extensive burns cardiac arrhythmia, neurological damage caused by electric current and osseous injury corresponding to the trauma mechanism are also common. It is important to perform a survey of the pattern of injuries and treat acute life-threatening conditions immediately in the field. Furthermore, specific conditions related to burns must be considered, e.g. fluid resuscitation, thermal management and analgesia. In addition, a correct strategy for further medical care in an appropriate hospital is essential. Exemplified by this case guidelines for the treatment of severe burns and typical pitfalls are presented.

  3. Successful treatment of tumor-induced osteomalacia due to an intracranial tumor by fractionated stereotactic radiotherapy.

    Science.gov (United States)

    Tarasova, Valentina D; Trepp-Carrasco, Alejandro G; Thompson, Robert; Recker, Robert R; Chong, William H; Collins, Michael T; Armas, Laura A G

    2013-11-01

    Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome, characterized by tumor secretion of fibroblast growth factor-23 (FGF23) causing hypophosphatemia due to renal phosphate wasting. TIO is usually caused by small, benign, difficult-to-localize, mesenchymal tumors. Although surgery with wide excision of tumor borders is considered the "gold standard" for definitive therapy, it can be associated with considerable morbidity depending on the location. To date, radiation therapy has not been considered as an effective treatment modality in TIO. A 67-year-old female presented with multiple nontraumatic fractures, progressive bone pain, and muscle weakness for 4 years. She was found to have biochemical evidence of urinary phosphate wasting with low serum phosphorus, low-normal serum calcium, normal 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, and high serum FGF23 levels. TIO was diagnosed. Selective venous sampling for FGF23 confirmed that a 1.7-cm left frontal mass, radiographically similar to a meningioma, was the causative tumor. She declined surgery due to fear of complications and instead underwent fractionated stereotactic radiotherapy for 6 weeks. In less than 4 years after radiation therapy, she was successfully weaned off phosphorus and calcitriol, starting from 2 g of oral phosphorus daily and 1 μg of calcitriol daily. Her symptoms have resolved, and she has not had any new fractures. Stereotactic radiotherapy was an effective treatment modality for TIO in our patient. Fractionated stereotactic radiation therapy represents an alternative to surgery for patients with TIO who are not surgical candidates or who decline surgery.

  4. Successful Treatment of Tumor-Induced Osteomalacia due to an Intracranial Tumor by Fractionated Stereotactic Radiotherapy

    Science.gov (United States)

    Trepp-Carrasco, Alejandro G.; Thompson, Robert; Recker, Robert R.; Chong, William H.; Collins, Michael T.

    2013-01-01

    Context: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome, characterized by tumor secretion of fibroblast growth factor-23 (FGF23) causing hypophosphatemia due to renal phosphate wasting. TIO is usually caused by small, benign, difficult-to-localize, mesenchymal tumors. Although surgery with wide excision of tumor borders is considered the “gold standard” for definitive therapy, it can be associated with considerable morbidity depending on the location. To date, radiation therapy has not been considered as an effective treatment modality in TIO. Objective: A 67-year-old female presented with multiple nontraumatic fractures, progressive bone pain, and muscle weakness for 4 years. She was found to have biochemical evidence of urinary phosphate wasting with low serum phosphorus, low-normal serum calcium, normal 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, and high serum FGF23 levels. TIO was diagnosed. Selective venous sampling for FGF23 confirmed that a 1.7-cm left frontal mass, radiographically similar to a meningioma, was the causative tumor. She declined surgery due to fear of complications and instead underwent fractionated stereotactic radiotherapy for 6 weeks. Results: In less than 4 years after radiation therapy, she was successfully weaned off phosphorus and calcitriol, starting from 2 g of oral phosphorus daily and 1 μg of calcitriol daily. Her symptoms have resolved, and she has not had any new fractures. Conclusions: Stereotactic radiotherapy was an effective treatment modality for TIO in our patient. Fractionated stereotactic radiation therapy represents an alternative to surgery for patients with TIO who are not surgical candidates or who decline surgery. PMID:24014621

  5. Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy

    Directory of Open Access Journals (Sweden)

    Alan Wright

    2010-12-01

    Full Text Available Alan Wright, Kyle E Luedtke, Chad VanDenBergCenter for Clinical Research, Mercer University, Atlanta, Georgia, USAAbstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved by the US Food and Drug Administration for the treatment of fibromyalgia and painful diabetic neuropathy at doses of 60 mg daily. Duloxetine has been shown to significantly improve the symptoms of chronic pain associated with these disorders, as measured by the Fibromyalgia Impact Questionnaire, Brief Pain Inventory scores, the Clinical Global Impressions Scale, and other various outcome measures in several placebo-controlled, randomized, double-blind, multicenter studies. Symptom improvement generally began within the first few weeks, and continued for the duration of the study. In addition, the efficacy of duloxetine was found to be due to direct effects on pain symptoms rather than secondary to improvements in depression or anxiety. Adverse events including nausea, constipation, dry mouth, and insomnia, were mild and transient and occurred at relatively low rates. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of chronic pain associated with fibromyalgia or diabetic neuropathy, and has a predictable tolerability profile, with adverse events generally being mild to moderate.Keywords: duloxetine, chronic pain, neuropathic pain, fibromyalgia, efficacy, safety

  6. Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis

    Directory of Open Access Journals (Sweden)

    Hirokazu Honda

    2017-11-01

    Full Text Available Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO or gastric pneumatosis (GP. In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

  7. Successful Emergency Endoscopic Treatment of Gastric Outlet Obstruction due to Gastric Bezoar with Gastric Pneumatosis.

    Science.gov (United States)

    Honda, Hirokazu; Ikeya, Takashi; Kashiwagi, Erika; Okada, Shuichi; Fukuda, Katsuyuki

    2017-01-01

    Gastric bezoars are rare and are usually found incidentally. They can sometimes cause severe complications, including gastric outlet obstruction (GOO) or gastric pneumatosis (GP). In cases of bezoars with GP, the optimal treatment strategy has not yet been defined. We report the case of an 89-year-old man with a history of type 2 diabetes mellitus and hypertension who presented to our emergency room with a 2-day history of upper abdominal pain, nausea, and vomiting. Physical examination revealed no rebound tenderness or guarding, and laboratory values revealed no elevation of the serum lactate level. A computed tomography scan of the abdomen showed a dilated stomach with significant fluid collection, GOO, and GP due to a 42 × 40 mm mass composed of fat and air densities. Emergency esophagogastroduodenoscopy revealed two gastric bezoars, one of which was incarcerated in the pyloric region. We used various endoscopic devices to successfully break and remove the bezoars. We used endoscopic forceps and a water jet followed by an endoscopic snare to cut the bezoars into several pieces and remove them with an endoscopic net. Follow-up endoscopy confirmed that the gastric bezoar had been completely removed. As seen in this case, endoscopic treatment may be a safe and viable option for the extraction of gastric bezoars presenting with GOO and GP.

  8. Alteration of dentin-enamel mechanical properties due to dental whitening treatments.

    Science.gov (United States)

    Zimmerman, B; Datko, L; Cupelli, M; Alapati, S; Dean, D; Kennedy, M

    2010-05-01

    The mechanical properties of dentin and enamel affect the reliability and wear properties of a tooth. This study investigated the influence of clinical dental treatments and procedures, such as whitening treatments or etching prior to restorative procedures. Both autoclaved and non-autoclaved teeth were studied in order to allow for both comparison with published values and improved clinical relevance. Nanoindentation analysis with the Oliver-Pharr model provided elastic modulus and hardness across the dentin-enamel junction (DEJ). Large increases were observed in the elastic modulus of enamel in teeth that had been autoclaved (52.0 GPa versus 113.4 GPa), while smaller increases were observed in the dentin (17.9 GPa versus 27.9 GPa). Likewise, there was an increase in the hardness of enamel (2.0 GPa versus 4.3 GPa) and dentin (0.5 GPa versus 0.7 GPa) with autoclaving. These changes suggested that the range of elastic modulus and hardness values previously reported in the literature may be partially due to the sterilization procedures. Treatment of the exterior of non-autoclaved teeth with Crest Whitestrips, Opalescence or UltraEtch caused changes in the mechanical properties of both the enamel and dentin. Those treated with Crest Whitestrips showed a reduction in the elastic modulus of enamel (55.3 GPa to 32.7 GPa) and increase in the elastic modulus of dentin (17.2 GPa to 24.3 GPa). Opalescence treatments did not significantly affect the enamel properties, but did result in a decrease in the modulus of dentin (18.5 GPa to 15.1 GPa). Additionally, as expected, UltraEtch treatment decreased the modulus and hardness of enamel (48.7 GPa to 38.0 GPa and 1.9 GPa to 1.5 GPa, respectively) and dentin (21.4 GPa to 15.0 GPa and 1.9 GPa to 1.5 GPa, respectively). Changes in the mechanical properties were linked to altered protein concentration within the tooth, as evidenced by fluorescence microscopy and Fourier transform infrared spectroscopy. Published by Elsevier Ltd.

  9. The effect of discontinued use of antimicrobial growth promoters on the risk of therapeutic antibiotic treatment in Danish farrow-to-finish pig farms

    DEFF Research Database (Denmark)

    Vigre, Håkan; Larsen, P.B.; Andreasen, Morten

    2008-01-01

    ) the proportion of days per farm where treatment was performed (PDT) and (2) the proportion of pigs treated per day per farm at days where treatment was performed (PPT) before and after duAGPs at 68 farrow-to-finish farms. The farms were selected using, a two-stage (veterinarian/farm) convenience sampling...

  10. Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to Parkinson's disease or multiple system atrophy with observations on orthostatic hypotension

    Science.gov (United States)

    Hussain, I; Brady, C; Swinn, M; Mathias, C; Fowler, C

    2001-01-01

    multiple system atrophy reported a good erectile response and were reluctant to discontinue the medication.
CONCLUSIONS—Sidenafil citrate (50 mg) is efficacious in the treatment of erectile dysfunction in parkinsonism due to Parkinson's disease or multiple system atrophy; however, it may unmask or exacerbate hypotension in multiple system atrophy. As Parkinson's disease may be diagnostically difficult to distinguish from multiple system atrophy, especially in the early stages, we recommend measurement of lying and standing blood pressure before prescribing sildenafil to men with parkinsonism. Furthermore, such patients should be made aware of seeking medical advice if they develop symptoms on treatment suggestive of orthostatic hypotension.

 PMID:11511713

  11. Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

    Science.gov (United States)

    Smahel, Z; Müllerova, Z; Nejedly, A; Horak, I

    1998-05-01

    The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a

  12. Structural and surface changes in glassy carbon due to strontium implantation and heat treatment

    Science.gov (United States)

    Odutemowo, O. S.; Malherbe, J. B.; Prinsloo, L. C.; Njoroge, E. G.; Erasmus, R.; Wendler, E.; Undisz, A.; Rettenmayr, M.

    2018-01-01

    There are still questions around the microstructure of glassy carbon (GC), like the observation of the micropores. These were proposed to explain the low density of GC. This paper explains the effect of ion bombardment (200 keV Sr+, 1 × 1016 Sr+/cm2 at RT) on the microstructure of GC. TEM and AFM show that micropores in pristine GC are destroyed leading to densification of GC from 1.42 g/cm3 to 2.03 g/cm3. The amorphisation of glassy carbon was also not complete with graphitic strands embedded within the GC. These were relatively few, as Raman analysis showed that the Sr implantation resulted in a typical amorphous Raman spectrum. Annealing of the sample at 900 °C only resulted in a slight recovery of the GC structure. AFM and SEM analysis showed that the surface of the sample became rougher after Sr implantation. The roughness increased after the sample was annealed at 600 °C due to segregation of Sr towards the surface of the GC. SEM measurements of a sample with both implanted and un-implanted edges after annealing at 900 °C, showed that the high temperature heat treatment did not affect the surface topography of un-irradiated GC.

  13. Hemospray for treatment of acute bleeding due to upper gastrointestinal tumours.

    Science.gov (United States)

    Arena, Monica; Masci, Enzo; Eusebi, Leonardo Henry; Iabichino, Giuseppe; Mangiavillano, Benedetto; Viaggi, Paolo; Morandi, Elisabetta; Fanti, Lorella; Granata, Antonino; Traina, Mario; Testoni, Pier Alberto; Opocher, Enrico; Luigiano, Carmelo

    2017-05-01

    Hemospray is a new endoscopic haemostatic powder that can be used in the management of upper gastrointestinal bleedings. To assess the efficacy and safety of Hemospray as monotherapy for the treatment of acute upper gastrointestinal bleeding due to cancer. The endoscopy databases of 3 Italian Endoscopic Units were reviewed retrospectively and 15 patients (8 males; mean age 74 years) were included in this study. Immediate haemostasis was achieved in 93% of cases. Among the successful cases, 3 re-bled, one case treated with Hemospray and injection had a good outcome, while 2 cases died both re-treated with Hemospray, injection and thermal therapy. No complications related to Hemospray occurred. Finally, 80% of patients had a good clinical outcome at 30days and 50% at six months. Hemospray may be considered an effective and safe method for the endoscopic management of acute neoplastic upper gastrointestinal bleedings. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  14. Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry.

    Science.gov (United States)

    Strand, Vibeke; Miller, Paul; Williams, Setareh A; Saunders, Katherine; Grant, Shannon; Kremer, Joel

    2017-12-01

    Despite the availability of multiple effective therapies, discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). This study was designed to examine initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) within the Consortium of Rheumatology Researchers of North America (Corrona) RA Registry, and characterize reasons for discontinuation. Inclusion criteria were: Corrona-registered adults (≥18 years) with RA (2002-2011); age of RA onset: ≥16 years; ≥6 months' follow-up after initiation of first/subsequent bDMARD. Patients receiving both tumor necrosis factor antagonists and non-TNF antagonists were included. Treatment discontinuation was defined as first report of stopping initial therapy or initiation of new bDMARD at/between visits, using a follow-up physician questionnaire. Overall, 6209 patients met inclusion criteria and 80.7% received TNF antagonists. Median time to discontinuation/change of therapy was 25.1 months (26.5 months with TNF antagonists vs. 20.5 months with non-TNF antagonists; log-rank p < 0.0001); 82.2, 67.3, and 51.1% of patients remained on therapy at 6, 12, and 24 months, respectively. Reasons for discontinuation were captured for 49.2% of patients, including: loss of efficacy (35.8%); physician preference (27.8%); safety (20.1%); patient preference (17.9%); and no access to treatment (9.0%). Baseline factors with greatest correlation to discontinuation were modified Health Assessment Questionnaire scores, patient-reported anxiety/depression, initiation of bDMARD treatment in 2007-2010 versus 2002-2003, and Clinical Disease Activity Index scores. Almost one-third of patients in the US discontinue currently available bDMARD therapies for RA by 12 months and almost half by 24 months, most commonly due to loss of efficacy. Corrona LLC and MedImmune.

  15. Effect of discontinuation of long-term growth hormone treatment on carbohydrate metabolism and risk factors for cardiovascular disease in girls with Turner syndrome

    NARCIS (Netherlands)

    Y.K. van Pareren (Yvonne); S.M.P.F. de Muinck Keizer-Schrama (Sabine); Th. Stijnen (Theo); T.C.J. Sas (Theo); S.L.S. Drop (Stenvert)

    2002-01-01

    textabstractGH treatment increases insulin levels in girls with Turner syndrome (TS), who are already predisposed to develop diabetes mellitus and other risk factors for developing cardiovascular disease. Therefore, in the present study, we investigated carbohydrate metabolism and

  16. Discontinuation of Preventive Drugs in General Practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon

    Introduction: In Denmark about 600,000 persons are treated for hypertension and more than 300,000 people are receiving cholesterol lowering drugs. The prevalence of hypertension in people aged 80 years is 70%. For antidepressants the defined daily doses/1000 aged >80 years/day exceed 200. By far...... the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...

  17. What happens when people discontinue taking medications? Lessons from COMBINE.

    Science.gov (United States)

    Stout, Robert L; Braciszewski, Jordan M; Subbaraman, Meenakshi Sabina; Kranzler, Henry R; O'Malley, Stephanie S; Falk, Daniel

    2014-12-01

    We use intensive longitudinal data methods to illuminate processes affecting patients' drinking in relation to the discontinuation of medications within an alcohol treatment study. Although previous work has focused on broad measures of medication adherence, we focus on dynamic changes in drinking both before and after patients discontinue. We conducted secondary data analyses using the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, focused on participants who discontinued medications prior to the planned end of treatment. Using an interrupted time-series analysis, we analysed drinking in the weeks before and after discontinuation and also studied outcomes at the end of the COMBINE follow-up. Unites States of America. We describe the subsample of COMBINE participants who discontinued medications (n = 450), and compare them with those who were medication-adherent (n = 559) and with those who discontinued but had substantial missing data (n = 217). The primary outcomes were percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Medication adherence data were used to approximate the date of discontinuation. For many patients, an increase in drinking began weeks before discontinuation (PDA: F(1,4803) = 19.07, P < 0.001; PHDD: F(1,4804) = 8.58, P = 0.003) then escalated at discontinuation (PDA: F(1,446) = 5.05, P = 0.025; PHDD: F(1,446) = 4.52, P = 0.034). Among other effects, the amount of change was moderated by the reason for discontinuation (e.g. adverse event; PDA: F(2,4803) = 3.85, P = 0.021; PHDD: F(2,4804) = 5.36, P = 0.005) and also whether it occurred in the first or second half of treatment (PDA: F(1,4803) = 5.23, P = 0.022; PHDD: F(1,4804) = 8.79, P = 0.003). A patient's decision to stop taking medications during alcohol treatment appears to take place during a weeks-long process of disengagement from treatment. Patients who discontinue medications early in treatment or without

  18. Management applications of discontinuity theory

    Science.gov (United States)

    Angeler, David G.; Allen, Craig R.; Barichievy, Chris; Eason, Tarsha; Garmestani, Ahjond S.; Graham, Nicholas A.J.; Granholm, Dean; Gunderson, Lance H.; Knutson, Melinda; Nash, Kirsty L.; Nelson, R. John; Nystrom, Magnus; Spanbauer, Trisha; Stow, Craig A.; Sundstrom, Shana M.

    2015-01-01

    Human impacts on the environment are multifaceted and can occur across distinct spatiotemporal scales. Ecological responses to environmental change are therefore difficult to predict, and entail large degrees of uncertainty. Such uncertainty requires robust tools for management to sustain ecosystem goods and services and maintain resilient ecosystems.We propose an approach based on discontinuity theory that accounts for patterns and processes at distinct spatial and temporal scales, an inherent property of ecological systems. Discontinuity theory has not been applied in natural resource management and could therefore improve ecosystem management because it explicitly accounts for ecological complexity.Synthesis and applications. We highlight the application of discontinuity approaches for meeting management goals. Specifically, discontinuity approaches have significant potential to measure and thus understand the resilience of ecosystems, to objectively identify critical scales of space and time in ecological systems at which human impact might be most severe, to provide warning indicators of regime change, to help predict and understand biological invasions and extinctions and to focus monitoring efforts. Discontinuity theory can complement current approaches, providing a broader paradigm for ecological management and conservation.

  19. Oncological, surgical and functional results of the treatment of patients after hemipelvectomy due to metastases

    Directory of Open Access Journals (Sweden)

    Grzegorz Guzik

    2018-02-01

    Full Text Available Abstract Background Metastatic lesions localized in the pelvis cause pain, pathological fractures and decrease quality of patients life. Limited data are avaliable to compare the oncological, surgical and functional outcomes after different surgeries in patients with metastatic pelvic tumors. Most of the works presents the results of hemipelvectomy performed in patients with primary malignant bone tumors. The objectives of this study were to assess the outcome of patients after internal hemipelvectomy due to cancer metastases. Methods Over the period 2010–2015 at the Department of Orthopaedic Oncology in Brzozów, 34 patients with metastases to the pelvis were treated. This study group comprised of 21 men and 13 women. The mean age was 67 (range: 51–79 for men and 56 (range: 41–77 for women. The majority of the treated patients suffered from myeloma (12 patients and breast cancer (8 patients. Following the Enneking system classification guidelines, tumours were found in zone I (5 cases, zone II (18 cases, zone III (4 cases. Tumour involvement of both zones (II and III considered 7 patients. The following resections were accomplished: wide in 11 cases, marginal in 17 cases, and intralesional in 6 cases. 18 patients were postoperatively treated with 8 Gy single-dose radiotherapy. 25 patients underwent bone reconstruction using either Lumic prostheses (9 cases or the Harrington technique (16 cases. The mean follow-up period was 2.1 years (range: 1.2–6 years. The analysis covered patients’ survival, number of local recurrences, functional results and effectiveness of surgical treatment, considering the type, number and reason of complications. Results Eight patients died. Overal survival calculated with Kaplan- Meier curve was 48.2% for 34 patients. Mean survival was 3.85 years. There were no statistically significant differences in overall survival depending on the type of metastasis resection. In this group, local tumour recurrences

  20. Discontinuities and the magnetospheric phenomena

    International Nuclear Information System (INIS)

    Rajaram, R.; Kalra, G.L.; Tandon, J.N.

    1978-01-01

    Wave coupling at contact discontinuities has an important bearing on the transmission of waves from the solar wind into the magnetosphere across the cusp region of the solar wind-magnetosphere boundary and on the propagation of geomagnetic pulsations in the polar exosphere. Keeping this in view, the problems of wave coupling across a contact discontinuity in a collisionless plasma, described by a set of double adiabatic fluid equations, is examined. The magnetic field is taken normal to the interface and it is shown that total reflection is not possible for any angle of incidence. The Alfven and the magneto-acoustic waves are not coupled. The transmission is most efficient for small density discontinuities. Inhibition of the transmission of the Alfven wave by the sharp density gradients above the F2-peak in the polar exosphere appears to account for the decrease in the pulsation amplitude, on the ground, as the poles are approached from the auroral zone. (author)

  1. The structure of rotational discontinuities

    International Nuclear Information System (INIS)

    Neugebauer, M.

    1989-01-01

    This study examines the structures of a set of rotational discontinuities detected in the solar wind by the ISEE-3 spacecraft. It is found that the complexity of the structure increases as the angle θ between the propagation vector k and the magnetic field decreases. For rotational discontinuities that propagate at a large angle to the field with an ion (left-hand) sense of rotation, the magnetic hodograms tend to be flattened, in agreement with prior numerical simulations. When θ is large, angular overshoots are often observed at one or both ends of the discontinuity. When the propagation is nearly parallel to the field (i.e., when θ is small), many different types of structure are seen, ranging from straight lines, the S-shaped curves, to complex, disorganized shapes

  2. Estimation of wildfire size and risk changes due to fuels treatments

    Science.gov (United States)

    M. A. Cochrane; C. J. Moran; M. C. Wimberly; A. D. Baer; M. A. Finney; K. L. Beckendorf; J. Eidenshink; Z. Zhu

    2012-01-01

    Human land use practices, altered climates, and shifting forest and fire management policies have increased the frequency of large wildfires several-fold. Mitigation of potential fire behaviour and fire severity have increasingly been attempted through pre-fire alteration of wildland fuels using mechanical treatments and prescribed fires. Despite annual treatment of...

  3. Discontinuation of the Bulletin's menu page

    CERN Document Server

    Publications Section

    2005-01-01

    The menus of the various CERN restaurants will no longer be published in the Bulletin as of Monday 4 April (issue No. 14/2005). The menu pages are being discontinued both as a savings measure and due to the low level of interest in this section of the Bulletin. The most recent survey of Bulletin readers showed that only 13% of the people questioned regularly read the menu section, compared to between 40% and 85% in the case of the other sections. Publications Section SG/CO Tel. 79971

  4. Discontinuation of the Bulletin's menu page

    CERN Multimedia

    Publications Section

    2005-01-01

    The menus of the various CERN restaurants will no longer be published in the Bulletin as of Monday 4 April (issue No. 14/2005). The menu pages are being discontinued both as a savings measure and due to the low level of interest in this section of the Bulletin. The most recent survey of Bulletin readers showed that only 13% of the people questioned regularly read the menu section, compared to between 40% and 85% in the case of the other sections. Publications Section DSU-CO Tel. 79971

  5. Bladder outlet obstruction due to a small midline prostatic cyst - diagnostic imaging and interventional radiological treatment

    International Nuclear Information System (INIS)

    Hueppe, T.; Kopka, L.; Friedrich, M.; Kuehn, M.

    1992-01-01

    We describe a rare case of a bladder outlet obstruction due to a midline prostatic cyst. In the following clinical apperance, diagnostic imaging and therapy by CT-guided punction are reported. Differential diagnosis and therapy are discussed. (orig.) [de

  6. Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases.

    Science.gov (United States)

    Kelekis-Cholakis, Anastasia; Perry, John B; Pfeffer, Lorraine; Millete, Amy

    2016-12-01

    Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician. The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients' oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics. In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

  7. Extreme interplanetary rotational discontinuities at 1 AU

    Science.gov (United States)

    Lepping, R. P.; Wu, C.-C.

    2005-11-01

    This study is concerned with the identification and description of a special subset of four Wind interplanetary rotational discontinuities (from an earlier study of 134 directional discontinuities by Lepping et al. (2003)) with some "extreme" characteristics, in the sense that every case has (1) an almost planar current sheet surface, (2) a very large discontinuity angle (ω), (3) at least moderately strong normal field components (>0.8 nT), and (4) the overall set has a very broad range of transition layer thicknesses, with one being as thick as 50 RE and another at the other extreme being 1.6 RE, most being much thicker than are usually studied. Each example has a well-determined surface normal (n) according to minimum variance analysis and corroborated via time delay checking of the discontinuity with observations at IMP 8 by employing the local surface planarity. From the variance analyses, most of these cases had unusually large ratios of intermediate-to-minimum eigenvalues (λI/λmin), being on average 32 for three cases (with a fourth being much larger), indicating compact current sheet transition zones, another (the fifth) extreme property. For many years there has been a controversy as to the relative distribution of rotational (RDs) to tangential discontinuities (TDs) in the solar wind at 1 AU (and elsewhere, such as between the Sun and Earth), even to the point where some authors have suggested that RDs with large ∣Bn∣s are probably not generated or, if generated, are unstable and therefore very rare. Some of this disagreement apparently has been due to the different selection criteria used, e.g., some allowed eigenvalue ratios (λI/λmin) to be almost an order of magnitude lower than 32 in estimating n, usually introducing unacceptable error in n and therefore also in ∣Bn∣. However, we suggest that RDs may not be so rare at 1 AU, but good quality cases (where ∣Bn∣ confidently exceeds the error in ∣Bn∣) appear to be uncommon, and further

  8. Regge calculus from discontinuous metrics

    International Nuclear Information System (INIS)

    Khatsymovsky, V.M.

    2003-01-01

    Regge calculus is considered as a particular case of the more general system where the linklengths of any two neighbouring 4-tetrahedra do not necessarily coincide on their common face. This system is treated as that one described by metric discontinuous on the faces. In the superspace of all discontinuous metrics the Regge calculus metrics form some hypersurface defined by continuity conditions. Quantum theory of the discontinuous metric system is assumed to be fixed somehow in the form of quantum measure on (the space of functionals on) the superspace. The problem of reducing this measure to the Regge hypersurface is addressed. The quantum Regge calculus measure is defined from a discontinuous metric measure by inserting the δ-function-like phase factor. The requirement that continuity conditions be imposed in a 'face-independent' way fixes this factor uniquely. The term 'face-independent' means that this factor depends only on the (hyper)plane spanned by the face, not on it's form and size. This requirement seems to be natural from the viewpoint of existence of the well-defined continuum limit maximally free of lattice artefacts

  9. Pavement service life extension due to asphalt surface treatment interlayer : research project capsule.

    Science.gov (United States)

    2016-07-01

    The Louisiana Department of Transportation and Development (DOTD) has been : using asphalt surface treatment (AST) interlayers over soil cement base courses : as a means to mitigate shrinkage cracks from reflecting through the asphaltic : concrete (A...

  10. Estimation of wildfire size and risk changes due to fuels treatments

    Science.gov (United States)

    Cochrane, M.A.; Moran, C.J.; Wimberly, M.C.; Baer, A.D.; Finney, M.A.; Beckendorf, K.L.; Eidenshink, J.; Zhu, Z.

    2012-01-01

    Human land use practices, altered climates, and shifting forest and fire management policies have increased the frequency of large wildfires several-fold. Mitigation of potential fire behaviour and fire severity have increasingly been attempted through pre-fire alteration of wildland fuels using mechanical treatments and prescribed fires. Despite annual treatment of more than a million hectares of land, quantitative assessments of the effectiveness of existing fuel treatments at reducing the size of actual wildfires or how they might alter the risk of burning across landscapes are currently lacking. Here, we present a method for estimating spatial probabilities of burning as a function of extant fuels treatments for any wildland fire-affected landscape. We examined the landscape effects of more than 72 000 ha of wildland fuel treatments involved in 14 large wildfires that burned 314 000 ha of forests in nine US states between 2002 and 2010. Fuels treatments altered the probability of fire occurrence both positively and negatively across landscapes, effectively redistributing fire risk by changing surface fire spread rates and reducing the likelihood of crowning behaviour. Trade offs are created between formation of large areas with low probabilities of increased burning and smaller, well-defined regions with reduced fire risk.

  11. Lesions in canine stifle joints due to trochleoplasties as treatment for medial patellar luxation

    Directory of Open Access Journals (Sweden)

    Johannes Hans van der Zee

    2015-07-01

    Full Text Available Lesions in canine stifle joints after previous trochleoplasty surgery were documented. Infour clinical cases arthrotomies were performed due to stifle pain after previous trochleardeepening procedures. A small area of hyaline cartilage remained in the groove of the stiflesin cases where previous wedge trochleoplasties had been performed. All of the stifles hadsignificant areas of eburnation on the axial aspect of the medial trochlear ridge. The stifle jointsof a dog that was euthanased due to severe irreversible osteo-arthritis were photographed.The dog had undergone previous surgery for patellar luxation and cranial cruciate ligamentruptures. The trochlear grooves in this dog had almost no visible articular cartilage left.

  12. A Bayesian Nonparametric Causal Model for Regression Discontinuity Designs

    Science.gov (United States)

    Karabatsos, George; Walker, Stephen G.

    2013-01-01

    The regression discontinuity (RD) design (Thistlewaite & Campbell, 1960; Cook, 2008) provides a framework to identify and estimate causal effects from a non-randomized design. Each subject of a RD design is assigned to the treatment (versus assignment to a non-treatment) whenever her/his observed value of the assignment variable equals or…

  13. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden.

    Science.gov (United States)

    Moonen, Justine E F; Foster-Dingley, Jessica C; de Ruijter, Wouter; van der Grond, Jeroen; de Craen, Anton J M; van der Mast, Roos C

    2016-03-01

    the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials. to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment. a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01]. in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension. © The Author 2016. Published by Oxford

  14. Anti-HBV DNA vaccination does not prevent relapse after discontinuation of analogues in the treatment of chronic hepatitis B: a randomised trial--ANRS HB02 VAC-ADN.

    Science.gov (United States)

    Fontaine, H; Kahi, S; Chazallon, C; Bourgine, M; Varaut, A; Buffet, C; Godon, O; Meritet, J F; Saïdi, Y; Michel, M L; Scott-Algara, D; Aboulker, J P; Pol, S

    2015-01-01

    The antiviral efficacy of nucleos(t)ide analogues whose main limitation is relapse after discontinuation requires long-term therapy. To overcome the risk of relapse and virological breakthrough during long-term therapy, we performed a phase I/II, open, prospective, multicentre trial using a HBV envelope-expressing DNA vaccine. 70 patients treated effectively with nucleos(t)ide analogues for a median of 3 years (HBV DNA 120 IU/mL) or impossibility of stopping treatment at week 48. Reactivation occurred in 97% of each group after a median 28 days without liver failure but with an HBV DNA <2000 IU/mL in 33%; 99% of adverse reactions were mild to moderate. Immune responses were evaluated by enzyme-linked immunosorbent spot and proliferation assays: there was no difference in the percentage of patients with interferon-γ secreting cells and a specific T-cell proliferation to HBcAg but not to HBsAg after reactivation in each group. Although it is fairly well tolerated, the HBV DNA vaccine does not decrease the risk of relapse in HBV-treated patients or the rate of virological breakthrough, and does not restore the anti-HBV immune response despite effective viral suppression by analogues. NCT00536627. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. [FEDERAL CLINICAL RECOMMENDATIONS IN DIAGNOSIS, TREATMENT AND PREVENTION OF HEARING LOSS DUE TO NOISE].

    Science.gov (United States)

    Adeninskaya, E E; Bukhtiarov, I V; Bushmanov, A Iu; Dayhes, N A; Denisov, E I; Izmerov, N F; Mazitova, N N; Pankova, V B; Preobrazhenskaya, E A; Prokopenko, L V; Simonova, N I; Tavartkiladze, G A; Fedina, I N

    2016-01-01

    Noise induced hearing loss is a slowly developing hearing impairment, caused by occupational exposure to excessive noise levels, constitutes a lesion of the auditory analyzer and clinically manifested as chronic bilateral sensorineural hearing loss. Currently, there is not a treatment that provide a cure of sensorineural hearing loss. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and specific clinical symptoms of hearing loss, as well as the prevention of complications. We recommend using non-drug therapies that can improve blood flow in labyrinth, tissue and cellular metabolism.

  16. The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea.

    Science.gov (United States)

    Nam, Jin Young; Choi, Young; Kim, Juyeong; Cho, Kyoung Hee; Park, Eun-Cheol

    2017-08-15

    The relationships between breastfeeding discontinuation and cesarean section delivery, and the occurrence of postpartum depression (PPD) remain unclear. Therefore, we aimed to investigate the association of breastfeeding discontinuation and cesarean section delivery with PPD during the first 6 months after delivery. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 81,447 women who delivered during 2004-2013. PPD status was determined using the diagnosis code at outpatient or inpatient visit during the 6-month postpartum period. Breastfeeding discontinuation and cesarean section delivery were identified from prescription of lactation suppression drugs and diagnosis, respectively. Cox proportional hazards models were used to calculate adjusted hazard ratios. Of the 81,447 women, 666 (0.82%) had PPD. PPD risk was higher in women who discontinued breastfeeding than in those who continued breastfeeding (hazard ratio=3.23, Pwomen with cesarean section delivery than in those with vaginal delivery (hazard ratio=1.26, P=0.0040), and in women with cesarean section delivery who discontinued breastfeeding than in those with vaginal delivery who continued breastfeeding (hazard ratio=4.92, Pworking status, which could introduce selection bias and errors due to miscoding; and potential lack of adjustment for important confounders. Breastfeeding discontinuation and cesarean section delivery were associated with PPD during the 6-month postpartum period. Our results support the implementation of breastfeeding promoting policies, and PPD screening and treatment programs during the early postpartum period. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Hydrogen doping of Indium Tin Oxide due to thermal treatment of hetero-junction solar cells

    Energy Technology Data Exchange (ETDEWEB)

    Ritzau, Kurt-Ulrich, E-mail: kurt-ulrich.ritzau@ise.fraunhofer.de [Fraunhofer Institute for Solar Energy Systems (ISE), Heidenhofstrasse 2, 79110 Freiburg (Germany); Behrendt, Torge [Infineon Technologies, Max-Planck-Straße 5, 59581 Warstein (Germany); Palaferri, Daniele [Laboratoire Matériaux et Phénomènes Quantiques, Université Paris Diderot, Sorbonne Paris Cité, CNRS—UMR 7162, 75013 Paris (France); Bivour, Martin; Hermle, Martin [Fraunhofer Institute for Solar Energy Systems (ISE), Heidenhofstrasse 2, 79110 Freiburg (Germany)

    2016-01-29

    Indium Tin Oxide (ITO) layers in silicon hetero junction solar cells change their electrical and optical properties when exposed to temperature treatments. Hydrogen which effuses from underlying amorphous silicon layers is identified to dope the ITO layer. This leads to an additional increase in conductivity. In this way an almost isolating ITO can become degenerately doped through temperature treatments. The resulting carrier density in the range of 10{sup 20} cm{sup −3} leads to a substantial increase in free carrier absorption, which in turn leads to an increased parasitic absorption in the cell device. Thus hydrogen effusion in silicon hetero-junction (SHJ) solar cells does not only affect the degradation of amorphous silicon (a-Si:H) passivation of crystalline silicon (c-Si), but also the electrical and optical properties of both front and back ITO layers. This leads to the further design rule for SHJ solar cells, meaning that ITO properties have to be optimized in the state after modification during temperature treatment. - Highlights: • ITO is additionally doped by heat treatment of silicon hetero-junction solar cells. • The discovered effect turns an almost isolating ITO into a degenerately doped TCO. • TCO properties have to be considered as measured in the final cell.

  18. Curie Temperature and Microstructural Changes Due to the Heating Treatment of Magnetic Amorphous Materials

    Directory of Open Access Journals (Sweden)

    Gondro J.

    2016-03-01

    Full Text Available Three distinct alloys: Fe86Zr7Nb1Cu1B5, Fe82Zr7Nb2Cu1B8, and Fe81Pt5Zr7Nb1Cu1B5 were characterized both magnetically and structurally. The samples, obtained with spinning roller method as a ribbons 3 mm in width and 20 μm thick, were investigated as-quenched and after each step of a multi steps heating treatment procedure. Each sample was annealed at four steps, fifteen minutes at every temperature, starting from 573K+600K up to +700K depending on type of alloy. Mössbauer spectroscopy data and transmission electron microscope (HRE M pictures confirmed that the as-quenched samples are fully amorphous. This is not changed after the first stages of treatment heating leads to a reduction of free volumes. The heating treatment has a great influence on the magnetic susceptibilities. The treatment up to 600K improves soft magnetic properties: an χ increase was observed, from about 400 to almost 1000 for the samples of alloys without Pt, and from about 200 to 450 at maximum, for the Fe81Pt5Zr7Nb1Cu1B5. Further heating, at more elevated temperatures, leads to magnetic hardening of the samples. Curie temperatures, established from the location of Hopkinson’s maxima on the χ(T curve are in very good agreement with those obtained from the data of specific magnetization, σ(T, measured in a field of 0.75T. As a critical parameter β was chosen to be equal 0.36 for these calculations, it confirmed that the alloys may be considered as ferromagnetic of Heisenberg type. Heating treatment resulted in decreasing of TC. These changes are within a range of several K.

  19. Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer

    Directory of Open Access Journals (Sweden)

    Mihaela Mocan

    2016-01-01

    Full Text Available Hyponatremia (serum Na levels of <135 mEq/L is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.

  20. Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

    Directory of Open Access Journals (Sweden)

    Cristina Alvarez-Escola

    2016-11-01

    Full Text Available In patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH and insulin-like growth factor (IGF1 levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status. The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission.

  1. The role of CT in follow-up treatment of patients after proctectomy due to a carcinoma

    International Nuclear Information System (INIS)

    Oellinger, R.

    1986-01-01

    The results of the thesis explain the unquestionable value of computed tomography as a method for follow-up treatment. Given a suitable timing of CT examinations, and due consideration of additional information obtained e.g. by CEA assays, early detection of local recurrences is possible. (MBC) [de

  2. Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation

    Directory of Open Access Journals (Sweden)

    Amine Tarmiz

    2017-01-01

    Full Text Available Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient’s hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.

  3. [Neonatal meningitis due to Listeria monocytogenes after 3 weeks of maternal treatment during pregnancy].

    Science.gov (United States)

    Fayol, L; Beizig, S; Le Monnier, A; Lacroze, V; Simeoni, U

    2009-04-01

    We report the case of a pregnant woman with listeriosis at 26 gestational weeks followed by premature labor at 30 gestational weeks. Bacterial meningitis was suspected in the neonate with ventriculitis on sonography, a high level of protein in the cerebrospinal fluid (CSF), and an identified specific bacterial genome of Listeria monocytogenes (PCR 16S rDNA and sequencing and specific amplification of L. monocytogenes hly gene) in CSF. Neonatal meningitis was complicated with cerebral venous sinus thrombosis and ventriculomegaly. Listeriosis during pregnancy can lead to severe complications in the neonate. Thus, listeriosis should be a diagnostic concern in febrile pregnant women at any stage of pregnancy. First-line treatment is based on high-dose amoxicillin (> or =6g/day) and must be used for at least 3 weeks for treatment of listeriosis during pregnancy. If the fetus survives, longer therapy until delivery can be discussed.

  4. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  5. Post-Bypass Extensive Ascites due to Splanchnic Bypass and the Effectiveness of Hyperalimentation Treatment

    Directory of Open Access Journals (Sweden)

    Veysel Temizkan

    2013-04-01

    Full Text Available Reperfusion edema may develop in the early periods of chronic ischemic tissue reperfusion. Reperfusion edema may be represented after the splanchnic bypass with ascites, abdominal distension, and liver and kidney function impairment. In this article, we are reporting the hyperalimentation treatment and its results for the common ascites and hepatorenal syndrome, after a coeliac and superior mesenteric artery bypass. [Arch Clin Exp Surg 2013; 2(2.000: 124-128

  6. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

    Science.gov (United States)

    Cirocchi, R; Cochetti, G; Randolph, J; Listorti, C; Castellani, E; Renzi, C; Mearini, E; Fingerhut, A

    2014-10-01

    Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

  7. Subacute combined degeneration of the cord due to folate deficiency: response to methyl folate treatment.

    OpenAIRE

    Lever, E G; Elwes, R D; Williams, A; Reynolds, E H

    1986-01-01

    Subacute combined degeneration of the cord is a rare complication of folate deficiency. Disturbance of methylation reactions in nervous tissue probably underlie subacute combined degeneration of the cord arising from folate as well as vitamin B12 deficiency. Methyl tetrahydrofolate is the form in which folic acid is transported into the CNS. Therefore methyl tetrahydrofolate treatment of the neurological and psychiatric manifestations of folate deficiency would seem to be theoretically advant...

  8. Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy

    OpenAIRE

    Wright, Alan; Luedtke, Kyle E; VanDenBerg, Chad

    2010-01-01

    Alan Wright, Kyle E Luedtke, Chad VanDenBergCenter for Clinical Research, Mercer University, Atlanta, Georgia, USAAbstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved by the US Food and Drug Administration for the treatment of fibromyalgia and painful diabetic neuropathy at doses of 60 mg daily. Duloxetine has been shown to significantly improve the symptoms of chronic pain associated with these disorders, as measured by the Fibromyalgia Impact Questionnaire, Brief P...

  9. THE INFLUENCE OF CROSS-TRAINING DUE TO SPA TREATMENT IN CURRING FUNCTIONAL NEUROTIC DISORDERS

    Directory of Open Access Journals (Sweden)

    Rade Stefanović

    2006-06-01

    Full Text Available Modern civilization moves to endless automation and mechanization. This fact, in one hand, has positive effect on increase of life standard, but also carries its own risks and threats of mankind. Axelberg, famous academician, makes an interesting remark that only a hundred years ago man did 96 % of his work by himself, while today most manufacturing processes are 100% automated. Stress, lack of physical activity and bad food regime are canses of organic damages of cardiopulmonary system. Latest research, conducted in many countries, shows that for proper functioning of every organism the minimum of moving is necessary.Term neurosis was introduced in medical literature by Scottish doctor W. Cullen in 1777. By that term were considered different clinical appearances which are believed neurotic todey, but also the phenomena today considered as psychosomatic disorders of character and behavior. Pavlov’s reflexive theory is basic in treatment of some types of neurossis’ during spa treatments in Nerečinska Banja. It usually starts at the beginning of May and ends in October, but sometimes if weather is nice, it can last until the middle of November. The treatment cure last tventy-one day, doesn’t include medicaments, but only spa water, baths and massage.

  10. Investigation the effects of metallic substrate surfaces due to ion-plasma treatment

    International Nuclear Information System (INIS)

    Shulaev, V.M.; Taran, V.S.; Timoshenko, A.I.; Gasilin, V.V.

    2011-01-01

    It has been found correlation between modification effects and duration of ion-plasma cleaning the substrate surface with titanium ions. Experiments were carried out using serial vacuum-arc equipment ''Bulat-6'' at the stationary mode in non-filtered titanium plasma, which contained considerable quantity of evaporated material droplets. The polished cylinder substrates (diameter and height 9,14,20 mm) have been treated. The substrates were manufactured of stainless steel 12X18H10T and non-oxygen copper M00b. The substrates surface roughness after ion-plasma treatment has been investigated with electron microscope JEOL JSM-840 and optic interference non-contact profilograph- profilometer ''Micron-alpha''. According obtained results the surface of copper and stainless steel substrates has been treated to intensive modification, i.e. substrate surface after treatment significantly differs from initial one. During final ion-plasma treatment a number of effects occur: purification from surface oxides is accompanied with metallic surface ''contamination'' by the cathode material macrodroplets, surface micromelting accompanied by roughness increase, the surface layer annealing with noticeable decrease of hardness.

  11. Fidaxomicin in the treatment of colitis due to Clostridium difficile: preliminary results

    Directory of Open Access Journals (Sweden)

    Francesco Cortese

    2014-12-01

    Full Text Available The incidence of Clostridium difficile infections (CDI and Clostridium difficile-Associated Diarrhea (CDAD is increasing in Canada, USA, and Europe and represents a considerable clinical problem. Both naïve and hypervirulent strains can be considered as opportunistic bacteria affecting immunocompromised, antibiotic-treated, critical, or subcritical patients with a microbiota disruption. CDI arising is strictly related to antibiotic, single or combined, and/or proton pump inhibitor treatment. CDI can cause a syndrome with systemic involvement and complex treatment, sometimes requiring surgical interventions (e.g. colectomy in fulminant colitis. Antibiotic treatment with metronidazole by mouth is the first choice and generally vancomycin is administered in case of lack of effectiveness. Fidaxomicin is a new macrocyclic antibiotic for C. difficile with microflora-sparing properties. This paper reports our initial experience in 11 patients with non-responder or relapsing CDIs. Fidaxomicin was effective in 10 cases (91%. Only one patient with an active ulcerative colitis did not respond and was treated with fecal-microbiota transplantation. In two patients diarrhea persisted, but just the ulcerative colitis one was C. difficile-related. No adverse events were experienced.http://dx.doi.org/10.7175/cmi.v8i1s.956

  12. [The nonpharmacological treatment of tachyarrhythmias. The surgery of supraventricular arrhythmias not due to pre-excitation].

    Science.gov (United States)

    Viganò, M; Graffigna, A; Pagani, F; Salerno, J A

    1991-12-01

    Surgery can provide treatment for supraventricular tachyarrhythmias without operative risk and with a definite improvement of patients' quality of life. Ectopic atrial tachycardia is a rare but invalidating arrhythmia that may lead to cardiomyopathy: intraoperative mapping is necessary for the location of the location of the ectopic focus; in our experience, surgical, cryothermal or isolation ablation of the area were effective in 9 patients out of 9, with regression of the cardiomyopathy. Atrioventricular node reentry tachycardia is a reentry tachycardia which is often associated with Wolff-Parkinson-White syndrome and is amenable to surgical treatment. Discrete cryolesions around the Koch triangle are effective in interrupting the atrial inputs to the atrioventricular node and therefore the reentry mechanism: in our experience, 7 patients were successfully treated without operative mortality: 3 patients underwent surgical ablation of Kent bundles as well. Atrial fibrillation is not based on a well-defined mechanism, and therefore does not permit an electrically-guided surgical treatment. However, in case of atrial septal defect it is possible to isolate the enlarged right atrium in order to allow sinus rhythm to activate the left atrium and ventricles.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Reversal by EGTA of the enhanced secretory responsiveness of mast cells due to treatment with ouabain

    DEFF Research Database (Denmark)

    Johansen, Torben; Knudsen, T; Bertelsen, Niels Haldor

    1990-01-01

    The effect of EGTA on the enhancement by ouabain of compound 48/80-induced secretion from mast cells was compared with the effect on the Na(+)-K+ pump activity. The time-dependent secretory enhancement by ouabain was blocked by addition of EGTA to the cell suspension concomitantly with the addition...... of ouabain, and EGTA caused a large increase in the pump activity. Addition of 10 microM EGTA to ouabain-treated cells stopped but did not reverse the enhancement. The experiments show that the effect of ouabain was due to changes in a calcium pool utilized in compound 48/80-induced secretion following...

  14. Strategies for discontinuation of proton pump inhibitors

    DEFF Research Database (Denmark)

    Haastrup, Peter; Paulsen, Maja S; Begtrup, Luise M

    2014-01-01

    PURPOSE: Proton pump inhibitors (PPIs) are considered to be overprescribed. Consensus on how to attempt discontinuation is, however, lacking. We therefore conducted a systematic review of clinical studies on discontinuation of PPIs. METHODS: Systematic review based on clinical studies investigating...

  15. Metabolites change in Jatropha plants due to seed treatment with rhizobacteria and Rhizoctonia bataticola

    Directory of Open Access Journals (Sweden)

    Surender Kumar

    2013-11-01

    Full Text Available An experiment on the metabolite [salicylic acid (SA, jasmonicacid (JA, hydrocyanic acid (HCN and chitinase activity] changes owing to seed treatment with pathogen, plant growth promoting rhizobacteria (PGPRs - (P. maltophilia, P. fluorescens and Bacillus subtilis alone and in combination was conducted at Chaudhary Charan Singh, Haryana Agricultural University, Regional Research Station, Bawal. Jatropha curcas plants raised from root rot pathogen (Rhizoctonia bataticola treated seeds showed an initial increase in SA and hydrocyanic acid HCN content and an opposite trend was observed for JA level and chitinase activity. Though, PGPRs inoculation resulted in higher increase in SA level, JA level and chitinaseactivity in both the cases alone as well as in integration with pathogen, however, maximum increase in JA content was explicited in plants raised after seed treatment with P. fluorescens, the most effective rhizobacteria amongst PGPRs studied. Highest increase in HCN content (45 μg g-1 over control (24 μg g-1 was noticed for P. fluorescens followed by co-seed inoculation with P. fluorescens + pathogen (43 μg g-1 at 10 DPI. The co-seed inoculation elicited 68 units at 10 DPI whereas the pathogen challenged plants showed lower chitinase activity with 42 units. All the metabolites declinedslightly or sharply with age of the plant irrespective of inoculations.

  16. Pathological gambling and hypersexuality due to dopaminergic treatment in Parkinson' disease.

    Science.gov (United States)

    Martín Fernández, F; Martín González, T

    2009-01-01

    Prevalence of psychiatric disorders in patients suffering from Parkinson's disease varies from 12 to 90%. The most common disorder in the natural evolution of Parkinson's disease is depression. However, episodes of psychosis and hypomania are related to treatment with L-dopa and dopaminergic agents. Other recognized, although less frequent, psychiatric disorders are hypersexuality and development of certain addictive behaviors, which is compulsive gambling and overdosing of anti-Parkinson agents. A case is presented of a male patient diagnosed with Parkinson's Disease at an early age who was treated with L-dopa and a combination of dopaminergic agents. During the course of his evolution he manifested symptoms of hypersexuality and pathological gambling which were unrelated to psychotic or mood changes. A number of hospital admissions were needed into order to detect a pattern of abusive consumption of L-dopa as the main factor behind his behavior changes. The possibility of overdosage of L-dopa and dopaminergic drugs should be considered when there is pathological gambling conduct and/or hypersexuality, without psychotic or accompanying affective symptoms, in a male who develops Parkinson's disease at an early age and who undergoes treatment with these drugs and manifests motor fluctuations and dyskinesias. Early detection of the presence of these alterations, included within those described as "dopaminergic dysregulation syndrome", would allow for an early intervention on the cause behind them and would hence avoid the possible medical and social complications.

  17. Interventional treatment of severe portal hypertension due to hepatolenticular degeneration: therapeutic evaluation of 8 cases

    International Nuclear Information System (INIS)

    Zhao Hongwei; Liu Fuquan; Yue Zhendong; Wang Lei

    2011-01-01

    Objective: To evaluate the therapeutic efficacy of sclerotic embolization of esophagogastric varices (SEEV) and partial splenic embolization (PSE) in treating esophagogastric varices and portal hypertension, respectively, in patients with hepatolenticular degeneration. Methods: Eight patients with severe portal hypertension complicated with upper gastrointestinal bleeding and hypersplenism were involved in this study. White blood cell (WBC) counts, platelet counts, and portal vein pressure were determined before and after operation, the results were compared with each other. Results: No recurrence or complication occurred after operation in all patients. After the treatment (SEEV and PSE) the hepatic function showed no obvious changes. The WBC counts increased obviously in the first week after operation, and returned to normal range in 2 weeks. The platelet counts gradually returned to normal level from the second week. The portal vein pressure after operation went up a little, from (45.13±8.69) cm H 2 O to (48.63±10.48) cm H 2 O in SEEV group and to (47.88±11.43) cm H 2 O in PSE group, but the difference was of no statistic significance (P>0.05). Conclusion: Interventional therapy can reduce the portal hypertension caused by hepatolenticular degeneration. The technique is safe and effective, and is very helpful for returning to anti-copper treatment. (authors)

  18. Factors affecting IUCD discontinuation in Nepal

    DEFF Research Database (Denmark)

    Thapa, Subash; Paudel, Ishwari Sharma; Bhattarai, Sailesh

    2015-01-01

    Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115...

  19. Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

    Directory of Open Access Journals (Sweden)

    J. Zhang

    Full Text Available A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

  20. Recent results for electron scattering from biomolecules and molecules formed due to plasma treatment of biomass

    Science.gov (United States)

    Brunger, Michael

    2016-09-01

    We have been concentrating our recent experimental studies, for determining absolute cross sections, on both biomolecules (e.g. pyrimidine and benzoquinone) and molecules that result when biomass undergoes treatment by plasmas (e.g. phenol and furfural). All this work was supported and informed by computations from the Brazilian SMC groups and the Madrid IAM-SCAR group. A major rationale for these investigations was to provide cross section data for relevant modelling studies, and in this talk I will also present some results from those modelling studies. Possible further investigations will be canvassed in this presentation. Work done in conjunction with: D. B. Jones, L. Campbell, R. D. White, S. J. Buckman, M. A. P. Lima, M. C. A. Lopes, M. H. F. Bettega, M. T. do N. Varella, R. F. da Costa, G. García, P. Limão-Vieira, D. H. Madison, O. Ingólfsson and many other friends and colleagues.

  1. The indirect cost due to pulmonary Tuberculosis in patients receiving treatment in Bauchi State—Nigeria

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    Umar Nisser

    2012-05-01

    Full Text Available Objective To determine the time spent and income lost by patients and their households for seeking tuberculosis diagnosis and treatment in Bauchi State-Nigeria. Method A cross sectional study where 242 TB patients were sampled from 27 out of 67 facilities providing TB services in a north-eastern state of Nigeria. Sampling was stratified based on facility type, patients’ HIV status and gender. Results The income lost among the hospitalized group was estimated at $156/patient and about $114 in the non-hospitalized patients group. Age, gender, facility of diagnosis, level of education and occupation were significant (p-values Conclusion Tuberculosis poses causes tremendous burden in terms of time and productivity lost to both patients and their households in Bauchi State Nigeria.

  2. Radiation load of population due to treatment of children neuroblastoma by 131I-MIBG

    International Nuclear Information System (INIS)

    Hermanska, J.; Zimak, J.; Kavan, P.; Dosel, P.

    1998-01-01

    This paper describes radiation protection aspects of 131 I-MIBG treatment of children neuroblastoma. It presents and discusses dose equivalents found for two population groups: (1) family members taking care of the child treated; (2) ambulance drivers transporting children to oxygenotherapy and the staff of the Institute Aviation Medicine where the hyperbaric chamber used for oxygenotherapy resides. The time needed for single trip is about 10 minutes. The minimum dose equivalents per transportation (two ways) was 0.1 μSv, the maximum 11.4 μSv. The total value in the year 1997 was 20.8 μSv. The presented results indicate that no danger of exceeding limits of dose equivalents in sense of (1) occurs under normal conditions. The shortest recommended time interval between two therapies is 6 months

  3. Prevention and treatment of traumatic brain injury due to rapid-onset natural disasters

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    James L. Regens

    2014-04-01

    Full Text Available The prevention and treatment of traumatic brain injury (TBI attributable to rapid-onset natural disasters is a major challenge confronting disaster preparedness planners and emergency medical personnel responding to those incidents. The kinetic energy released by rapid-onset natural disasters such as earthquakes, hurricanes or typhoons, and tornadoes can cause mild, moderate or severe TBIs. As a result, neurotrauma is a major risk factor for mortality and morbidity outcomes within the spatial domain impacted by a rapid-onset natural disaster. This review article elucidates major challenges associated with immediate emergency medical response, long-term care, and prevention of post-event increases in pediatric TBIs because of child abuse when rapid-onset natural disasters occur.

  4. Endovascular treatment of thoracic aortic pseudoaneurysm due to brucellosis: a rare case report.

    Science.gov (United States)

    Wang, Shuai; Wang, Qi; Liu, Han; Sun, Siqiao; Sun, Xiwei; Zhang, Yang; Wang, Zhongying; Cheng, Zhihua

    2017-06-02

    Arterial damage is a known complication of brucellosis, but the occurrence of a thoracic aortic pseudoaneurysm secondary to brucellosis has not been previously reported. A 65-year-old Chinese man presented with a pseudoaneurysm in the descending segment of the thoracic aorta that caused symptoms of chest pain and intermittent fever. He was diagnosed with a thoracic aortic pseudoaneurysm secondary to brucellosis based on a positive brucella serology test (standard-tube agglutination test) and imaging examination (computed tomography angiography). Anti-brucellosis treatment and covered stent graft implantation were attempted to eliminate the brucellosis and pseudoaneurysm, respectively, and were ultimately successful, with no symptoms after 6 months of follow-up. Endovascular repair may be effective and safe for treating a thoracic aortic pseudoaneurysm resulting from brucellosis.

  5. Surgical treatment of hip ankylosis due to heterotopic ossification secondary to spinal cord injury.

    Science.gov (United States)

    Romero-Muñoz, L M; Barriga-Martín, A; DeJuan-García, J

    2018-02-21

    To expose our experience in the diagnostic and surgical treatment of neurogenic heterotopic ossification of the hip. We designed an observational retrospective descriptive study including 20 patients (30 hips) with neurogenic heterotopic ossification of the hip secondary to spinal cord injury attended in our institution in the last 10 years, with a minimum of one year follow-up. Medical files and imaging studies were reviewed. The study variables analyzed were: type and localization of neurogenic heterotopic ossification, pre-post excision range of motion, level and aetiology of spinal cord injury, ASIA score, smoking history, surgical approach and complications associated with surgery. A total of 20 patients were treated with resection of heterotopic ossification in 30 hips. 16 patients presented ASIA A spinal cord injury and 4 ASIA B spinal cord injury. Preoperatively all the patients had severe ankylosis in the hip that made sitting in a wheel chair and activities such as repositioning and hygiene difficult. The average postoperative motion at the follow-up evaluation was 90° in flexion, 20° of internal rotation and 40° of external rotation. Immediately after surgery all the patients followed a specific intensive physiotherapy regime for the hip and celecoxib 200 mg was administrated daily orally for a month to prevent recurrence of heterotopic bone formation. None of the patients reviewed suffered a recurrence of heterotopic bone formation. Surgical excision of hip ossification in order to achieve functional ROM of the hip is the best treatment for patients with neurogenic heterotopic ossification of the hip. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. The optimal time of discontinuing methimazole before radioiodine therapy

    International Nuclear Information System (INIS)

    Moosavi, Z.; Zakavi, R.

    2001-01-01

    Hyperthyroidism is a common disease and one of the best methods for its treatment is radioiodine therapy with Treatment with antithyroid drugs brings patients to euthyroidism before radioiodine therapy. Antithyroid drugs should be discontinued before radioiodine therapy to increase thyroid uptake. The purpose of this study was to determine the optimal time of methimazole discontinuation. One hundred eighty four patients, who were referred for radioiodine therapy were classified in 3 groups according to the duration of methimazole discontinuation before thyroid uptake (RAIU) measurement. Group 1,2 and 3 were patients who discontinued methimazole (48-72 h rs), (72-120 h rs) and more than 120 h rs before RAIU measurement, respectively. Mean thyroid uptake in group 1, 2 and 3 was (64±151.1%), (60.1±14.1%) and (59.3±12.8), respectively. No significant difference was noted in thyroid uptake between these groups (F= 1.83, P<0.16). This study shows that 48-72 h rs of methimazole discontinuation before radioiodine therapy is enough and longer term abstention is not associated with higher uptake

  7. Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis

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    Szulc Andrzej

    2007-12-01

    Full Text Available Abstract Background The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1 idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2 non treated scoliotic girls matched for age and Cobb angle. Methods Cross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years, Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI and Hump Sum were measured using surface topography. Results Cobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant. The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046. The value of angle of trunk

  8. Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia.

    Science.gov (United States)

    Galán Carrillo, Isabel; Demelo-Rodriguez, Pablo; Rodríguez Ferrero, María Luisa; Anaya, Fernando

    2015-01-01

    Severe hypertriglyceridemia (HTG) leads to major complications such as acute pancreatitis. Lipoprotein apheresis has been proposed as a therapeutic tool for decreasing triglyceride levels, although experience is limited. To describe our experience with double filtration plasmapheresis (DFPP) in patients with severe HTG and pancreatitis in the plasmapheresis unit of a tertiary hospital in Spain. We recruited 4 patients with severe HTG (triglycerides [TGs] >1000 mg/dL) and acute pancreatitis. All the patients underwent DFPP as part of their treatment. Epidemiologic and laboratory data were collected before and after each plasmapheresis session. The average TG level before plasmapheresis was 3136 mg/dL (35.44 mmol/L; range, 1306-6693 mg/dL, 14.76-75.63 mmol/L), and the average Acute Physiology And Chronic Health Evaluation (APACHE) II level before the first session was 6 (range, 3-8). All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis. The mean number of sessions was 2.1 (range, 1-3), and mean TG level after plasmapheresis was 428 mg/dL (4.84 mmol/L; range, 169-515 mg/dL; 1.91-5.82 mmol/L). After the first session, the mean decrease in TG levels was 69.16% (2169 mg/dL, range, 945-5925 mg/dL; 24.51 mmol/L, range, 10.78-66.95 mmol/L), and after the last session, TG levels fell by 89.09% (2794 mg/dL, range, 945-6198 mg/dL; 31.57 mmol/L, range, 10.68-70.04 mmol/L). None of the patients developed complications related to plasmapheresis. According to available evidence and our own experience, DFPP can be an effective and rapid treatment option in patients with severe HTG and complications. However, further research, including randomized controlled studies, is necessary. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  9. Surgical treatment of peritonitis due to typhoid fever in a Hospital in Mozambique

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    Arnulfo Gallego Mariño

    2015-07-01

    Full Text Available Background: Typhoid fever is a cause of peritonitis by perforation of the intestinal loops and provokes the death of many people; therefore it constitutes a health problem in Mozambique.Objective: To describe the patients operated on, with the diagnosis of peritonitis resulting from typhoid fever, at the surgery department of the Provincial Hospital in Quelimane, Zambezia Province, Mozambique, from November 1, 2011 to April 30, 2012.Methods: A descriptive study of the patients operated on with the diagnosis of peritonitis resulting from typhoid fever, at the hospital and period herein mentioned, was performed. The study population consisted of 96 patients who were operated on. The variables that were measured were: age, sex, onset of symptoms, total perforations, performed surgical treatment and complications.Results: Male patients of the 25 to 50 age group prevailed; most of them visited the service after 72 hours of the onset of symptoms; in 66 patients only one perforation was found and the surgical procedure mostly used was the suture of the perforation and the washout of the abdominal cavity.Conclusions: Most of the patients visited the service 72 hours after the onset of symptoms; they underwent surgery; and wound infection was the most frequent complication.

  10. Burning Mouth Syndrome due to Television Moans, an Enigma for Oral Physician: Treatment with Counseling

    Science.gov (United States)

    Gupta, Deepak; Sheikh, Soheyl; Pallagatti, Shambulingappa; Kasariya, Kartikaya; Buttan, Amit; Gupta, Maqul

    2014-01-01

    Burning mouth syndrome (BMS) is a relatively common disease that can severely affect the quality of life of the patient. It causes chronic orofacial pain or oral burning sensation even in the absence of any detectable organic cause. The etiology of BMS is complex and multifactorial. It has been associated with menopause, trigger events and even genetic polymorphisms. Although its etiology remains unclear, there is still much evidence that psychological elements like stress, anxiety or depression do play a significant role. There are several studies in the literature which only report the association of BMS with psychological factors. But to the best of our knowledge, there is no such case reported in the literature which has actually highlighted the management of such a case with psychogenic elements involved. In this case report, apart from discussing the role of psychological factors, the treatment of BMS with emphasis on counseling is also emphasized. Further, it is of interest to know that such patients with psychologically induced burning mouth syndrome have to be evaluated to their deepest details. Even their commonly overlooked gestures and habits like watching a particular television soap opera may be involved in their disease process. It can be concluded that psychological counseling in general dental practice can provide an effective cure for chronic oral burning sensation with psychological factors involved. PMID:25093058

  11. Superior Mesenteric Artery Syndrome due to a Vertebral Hemangioma and Postpartum Osteoporosis following Treatment

    Directory of Open Access Journals (Sweden)

    Mehmet Elmadag

    2015-01-01

    Full Text Available In pregnancy, advanced vertebral hemangiomas may be seen, and these require treatment. The case reported here is of a 35-year-old female in the 32nd week of pregnancy who was admitted to the orthopaedics clinic with a history of backache and difficulty walking. A burst fracture of L1 associated with a vertebral hemangioma was identified with an L3 compression fracture secondary to osteoporosis. The local kyphosis angle between T12 and L2 was 27°. Kyphotic deformity was corrected and postoperatively, the measured T12–L2 local kyphotic angle was 9°. Twelve hours postoperatively, oral nutrition was allowed, but she developed nausea and vomiting and twenty-four hours postoperatively, an electrolyte imbalance developed. Postoperatively, the patient was diagnosed with superior mesenteric artery syndrome. To the best of our knowledge, this is the first reported case of superior mesenteric artery syndrome, which occurred following the correction of a kyphotic deformity that had developed secondary to an advanced hemangioma in pregnancy.

  12. Burning Mouth Syndrome due to Television Moans, an Enigma for Oral Physician: Treatment with Counseling

    Directory of Open Access Journals (Sweden)

    Deepak Gupta

    2014-06-01

    Full Text Available Burning mouth syndrome (BMS is a relatively common disease that can severely affect the quality of life of the patient. It causes chronic orofacial pain or oral burning sensation even in the absence of any detectable organic cause. The etiology of BMS is complex and multifactorial. It has been associated with menopause, trigger events and even genetic polymorphisms. Although its etiology remains unclear, there is still much evidence that psychological elements like stress, anxiety or depression do play a significant role. There are several studies in the literature which only report the association of BMS with psychological factors. But to the best of our knowledge, there is no such case reported in the literature which has actually highlighted the management of such a case with psychogenic elements involved. In this case report, apart from discussing the role of psychological factors, the treatment of BMS with emphasis on counseling is also emphasized. Further, it is of interest to know that such patients with psychologically induced burning mouth syndrome have to be evaluated to their deepest details. Even their commonly overlooked gestures and habits like watching a particular television soap opera may be involved in their disease process. It can be concluded that psychological counseling in general dental practice can provide an effective cure for chronic oral burning sensation with psychological factors involved.

  13. Extra lethal damage due to residual incompletely repaired sublethal damage in hyperfractionated and continuous radiation treatment

    Energy Technology Data Exchange (ETDEWEB)

    Chen, J.; van de Geijn, J.; Goffman, T. (ROB, DCT, NCI, NIH, Bethesda, Maryland 20892 (US))

    1991-05-01

    In the conventional linear--quadratic model of single-dose response, the {alpha} and {beta} terms reflect lethal damage created {ital during} the delivery of a dose, from two different presumed molecular processes, one linear with dose, the other quadratic. With the conventional one-fraction-per-day (or less) regimens, the sublethal damage (SLD), presumably repairing exponentially over time, is essentially completely fixed by the time of the next dose of radiation. If this assumption is true, the effects of subsequent fractions of radiation should be independent, that is, there should be little, if any, reversible damage left from previous fractions, at the time of the next dose. For multiple daily fractions, or for the limiting case, continuous radiation, this simplification may overlook damaged cells that have had insufficient time for repair. A generalized method is presented for accounting for extra lethal damage (ELD) arising from such residual SLD for hyperfractionation and continuous irradiation schemes. It may help to predict differences in toxicity and tumor control, if any, obtained with unconventional'' treatment regimens. A key element in the present model is the finite size and the dynamic character of the pool of sublethal damage. Besides creating the usual linear and quadratic components of lethal damage, each new fraction converts a certain fraction of the existing SLD into ELD, and creates some new SLD.

  14. Extra lethal damage due to residual incompletely repaired sublethal damage in hyperfractionated and continuous radiation treatment

    International Nuclear Information System (INIS)

    Chen, J.; van de Geijn, J.; Goffman, T.

    1991-01-01

    In the conventional linear--quadratic model of single-dose response, the α and β terms reflect lethal damage created during the delivery of a dose, from two different presumed molecular processes, one linear with dose, the other quadratic. With the conventional one-fraction-per-day (or less) regimens, the sublethal damage (SLD), presumably repairing exponentially over time, is essentially completely fixed by the time of the next dose of radiation. If this assumption is true, the effects of subsequent fractions of radiation should be independent, that is, there should be little, if any, reversible damage left from previous fractions, at the time of the next dose. For multiple daily fractions, or for the limiting case, continuous radiation, this simplification may overlook damaged cells that have had insufficient time for repair. A generalized method is presented for accounting for extra lethal damage (ELD) arising from such residual SLD for hyperfractionation and continuous irradiation schemes. It may help to predict differences in toxicity and tumor control, if any, obtained with ''unconventional'' treatment regimens. A key element in the present model is the finite size and the dynamic character of the pool of sublethal damage. Besides creating the usual linear and quadratic components of lethal damage, each new fraction converts a certain fraction of the existing SLD into ELD, and creates some new SLD

  15. Daylight saving time transitions and hospital treatments due to accidents or manic episodes

    Directory of Open Access Journals (Sweden)

    Lönnqvist Jouko

    2008-02-01

    Full Text Available Abstract Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment.

  16. Daylight saving time transitions and hospital treatments due to accidents or manic episodes

    Science.gov (United States)

    Lahti, Tuuli A; Haukka, Jari; Lönnqvist, Jouko; Partonen, Timo

    2008-01-01

    Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment. PMID:18302734

  17. Hillock Formation, Metal Lifting and Voiding of an AlCu Metallization due to Temperature Treatment

    International Nuclear Information System (INIS)

    Foerster, J.; Schuderer, B.; Haeuser, M.; Kallensee, O.; Gross, Th.

    2004-01-01

    A metalstack with a layer composition of Ti/TiN/AlCu/TiN was evaluated in an AlCu metallization. Reliability results show a higher electromigration lifetime compared to a Ti/AlCu/Ti/TiN stack. During the metallization process flow large elevations were seen by optical inspection. Analysis by SEM cross sections showed different deviations. A metal lifting with void formation as consequence was found in large aluminum areas above tungsten plugs. Also voiding in the passivated Metal 2 and the unpassivated Metal 3 with a cracked anti-reflective coating as a result of the expansion of the aluminum was seen. The influence of processes with high thermal budget on the stress behaviour of the new metalstack was investigated. The final annealing was found as the process with the most critical influence. This study shows the influence of different final annealing temperatures on hillock formation and voiding using a Ti/TiN/AlCu/TiN metalstack. A reduction of the maximum temperature of the final annealing process is necessary for using the new AlCu metallization stack. The use of a surface treatment before deposition showed an optimization of the adhesion

  18. Metabolites change in Jatropha plants due to seed treatment with rhizobacteria and Rhizoctonia bataticola

    Directory of Open Access Journals (Sweden)

    Surender Kumar

    2013-12-01

    Full Text Available An experiment on the metabolite [salicylic acid (SA, jasmonic acid (JA, hydrocyanic acid (HCN and chitinase activity] changes owing to seed treatn1ent with pathogen, plant growth pron1oting rhizobacteria (PGPRs - (P. maltophilia, P. fluorescens and Bacillus subtilis alone and in combination was conducted at Chaudhary Charan Singh, Haryana Agricultural University, Regional Research Station, Bawal. Jatropha curcas plants raised from root rot pathogen (Rhizoctonia bataticola treated seeds showed an initial increase in SA and hydrocyanic acid HCN content and an opposite trend was observed for JA level and chitinase activity. Though, PGPRs inoculation resulted in higher increase in SA level, JA level and chitinase activity in both the cases alone as well as in integration with pathogen, however, maximun1 increase in JA content was explicited in plants raised after seed treatment with P. fluorescens, the most effective rhizobacteria amongst PGPRs studied. Highest increase in HCN content (45 micrograms g-1 over control (24 micrograms g-1 was noticed for P. fluorescens followed by co-seed inoculation with P. fluorescens + pathogen (43 micrograms g-1 at 10 DPL. The co-seed inoculation elicited 68 units at 10 DPI, whereas the pathogen challenged plants showed lower chitinase activity with 42 units. All the metabolites declined slightly or sharply with age of the plant irrespective of inoculations.

  19. Case report: failure under azithromycin treatment in a case of bacteremia due to Salmonella enterica Paratyphi A.

    Science.gov (United States)

    Kobayashi, Tetsuro; Hayakawa, Kayoko; Mawatari, Momoko; Mezaki, Kazuhisa; Takeshita, Nozomi; Kutsuna, Satoshi; Fujiya, Yoshihiro; Kanagawa, Shuzo; Ohmagari, Norio; Kato, Yasuyuki; Morita, Masatomo

    2014-07-20

    Limited information is available regarding the clinical efficacy of azithromycin for the treatment of enteric fever due to fluoroquinolone-resistant Salmonella Typhi and Salmonella Paratyphi among travelers returning to their home countries. We report a case of a 52-year-old Japanese man who returned from India, who developed a fever of 39°C with no accompanying symptoms 10 days after returning to Japan from a 1-month business trip to Delhi, India. His blood culture results were positive for Salmonella Paratyphi A. He was treated with 14 days of ceftriaxone, after which he remained afebrile for 18 days before his body temperature again rose to 39°C with no apparent symptoms. He was then empirically given 500 mg of azithromycin, but experienced clinical and microbiological failure of azithromycin treatment for enteric fever due to Salmonella Paratyphi A. However, the minimum inhibitory concentration (MIC) of azithromycin was not elevated (8 mg/L). He was again given ceftriaxone for 14 days with no signs of recurrence during the follow-up. There are limited data available for the treatment of enteric fever using azithromycin in travelers from developed countries who are not immune to the disease, and thus, careful follow-up is necessary. In our case, the low azithromycin dose might have contributed the treatment failure. Additional clinical data are needed to determine the rate of success, MIC, and contributing factors for success and/or failure of azithromycin treatment for both Salmonella Typhi and Salmonella Paratyphi infections.

  20. Modifications in Compacted MX-80 Bentonite Due to Thermo-Hydraulic Treatment

    International Nuclear Information System (INIS)

    Gomez-Espina, R.; Villar, M. V.

    2013-01-01

    The thermo-hydraulic tests reproduce the thermal and hydraulic conditions to which bentonite is subjected in the engineered barrier of a deep geological repository of radioactive waste. The results of thermo-hydraulic test TBT1500, which was running for approximately 1500 days, are presented. This is a continuation to the Technical Report Ciemat 1199, which presented results of test TBT500, performed under similar conditions but with duration of 500 days. In both tests the MX-80 bentonite was used with initial density and water content similar to those of the large-scale test TBT. The bentonite column was heated at the bottom at 140 degree centigrade and hydrated on top with deionized water. At the end of the test a sharp water content gradient was observed along the column, as well as an inverse dry density gradient. Hydration modified also the bentonite microstructure. Besides, an overall decrease of the smectite content with respect to the initial value took place, especially in the most hydrated areas where the percentage of interest ratified illite increased and in the longer test. On the other hand, the content of cristobalite, feldspars and calcite increased. Smectite dissolution processes (probably colloidal) occurred, particularly in the more hydrated areas and in the longer test. Due to the dissolution of low-solubility species and to the loss of exchangeable positions in the smectite, the content of soluble salts in the pore water increased with respect to the original one, especially in the longer test. The solubilized ions were transported; sodium, calcium, magnesium and sulphate having a similar mobility, which was in turn lower than that of potassium and chloride. The cationic exchange complex was also modified. (Author)

  1. Treatment of skin damage due to irradiation and post-irradiation skin tumours, at the Hornheide special clinic

    International Nuclear Information System (INIS)

    Drepper, H.

    1987-01-01

    A short precis of 54 years of history of the Hornheide special clinic for tumours, tuberculosis, and plastic surgery of face and skin is followed by a description of the current tasks of the clinic as an interdisciplinary center for plastic surgery and rehabilitation with facilities for tumour surgery, radiotherapy, skin and tissue pathology, and psychotherapy. Important special areas of this interdisciplinary cooperation are the treatment of skin disorders due to radiation and of tumours on irradiated skin, as well as treatment and plastic surgery after removal of tumours by irradiation in order to make the affected areas fit for renewed irradiation. (TRV) [de

  2. Successful treatment of massive ascites due to lupus peritonitis with hydroxychloroquine in old- onset lupus erythematosus.

    Science.gov (United States)

    Hammami, Sonia; Bdioui, Fethia; Ouaz, Afef; Loghmari, Hichem; Mahjoub, Sylvia; Saffar, Hamouda

    2014-01-01

    Systemic lupus erythematous (SLE) is an auto-immune disease with multiple organ involvements that occurs mainly in young women. Literature data suggest that serositis is more frequent in late-onset SLE. However, peritoneal serositis with massive ascites is an extremely rare manifestation. We report a case of old-onset lupus peritonitis treated successfully by Hydroxychloroquine. A 77-year-old Tunisian woman was hospitalized because of massive painful ascites. Her family history did not include any autoimmune disease. She was explored 4 years prior to admission for exudative pleuritis of the right lung without any established diagnosis. Physical examination showed only massive ascites. Laboratory investigations showed leucopenia: 3100/mm3, lymphopenia: 840/mm3 and trace protein (0.03 g/24 h). Ascitic fluid contained 170 cells mm(3) (67% lymphocytes), 46 g/L protein, but no malignant cells. The main etiologies of exudative ascites were excluded. She had markedly elevated anti-nuclear antibody (ANA) titer of 1/1600 and a significantly elevated titer of antibody to double-stranded DNA (83 IU/mL) with hypo-complementemia (C3 levl was at 67 mg/dL). Antibody against the Smith antigen was also positive. Relying on these findings, the patient was diagnosed with SLE and treated with Hydroxychloroquine 200 mg daily in combination with diuretics. One month later, there was no detectable ascitic fluid and no pleural effusions. Five months later she remained free from symptoms while continuing to take chloroquine. This case was characterized by old age of onset of SLE, the extremely rare initial presentation with lupus peritonitis and massive painful ascites with dramatic response to only hydroxychloroquine treatment.

  3. Successful treatment of canine necrolytic migratory erythema (superficial necrolytic dermatitis) due to metastatic glucagonoma with octreotide.

    Science.gov (United States)

    Oberkirchner, Ursula; Linder, Keith E; Zadrozny, Leah; Olivry, Thierry

    2010-10-01

    Necrolytic migratory erythema (NME; also known as superficial necrolytic dermatitis) is a syndrome most often associated with certain chronic liver diseases or pancreatic glucagonomas. In humans with glucagonoma-associated NME, skin lesions usually respond to octreotide, a somatostatin analogue that inhibits glucagon release. In this report an 11-year-old golden retriever dog with pancreatic glucagonoma and metastasis to the regional lymph nodes, spleen and liver was diagnosed with NME. The dog exhibited erosions, ulcers and crusts on the paws, pressure points, muzzle, periocular area and prepuce. The dog was also anorexic and had difficulty walking. Because metastasis precluded surgery, treatment was initiated with subcutaneous octreotide (2 μg/kg twice daily). Skin lesions and systemic clinical signs improved markedly within 5 days. The dosage was increased to nearly 3 μg/kg twice daily and signs almost completely resolved within 10 days. Anorexia was the major adverse effect observed. During the following month, both dosage (1-3.7 μg/kg) and frequency (two to four times daily) of the octreotide injections were adjusted to permit control of clinical signs while maintaining adequate appetite. Temporary cessation of octreotide administration resulted in the rapid recurrence of skin lesions. Resuming injections led to improvement of clinical signs within 48 h. The dog was later euthanized because of progressive metastatic disease. In conclusion, subcutaneous octreotide injections were beneficial in this dog with glucagonoma-associated NME. This somatostatin analogue could be a valuable option to treat canine patients with non-resectable or relapsing pancreatic glucagonoma-associated NME. © 2010 The Authors. Journal compilation © 2010 ESVD and ACVD.

  4. Simulation of peri-implant bone healing due to immediate loading in dental implant treatments.

    Science.gov (United States)

    Chou, Hsuan-Yu; Müftü, Sinan

    2013-03-15

    The goal of this work was to investigate the role of immediate loading on the peri-implant bone healing in dental implant treatments. A mechano-regulatory tissue differentiation model that takes into account the stimuli through the solid and the fluid components of the healing tissue, and the diffusion of pluripotent stem cells into the healing callus was used. A two-dimensional axisymmetric model consisting of a dental implant, the healing callus tissue and the host bone tissue was constructed for the finite element analysis. Poroelastic material properties were assigned to the healing callus and the bone tissue. The effects of micro-motion, healing callus size, and implant thread design on the length of the bone-to-implant contact (BIC) and the bone volume (BV) formed in the healing callus were investigated. In general, the analysis predicted formation of a continuous layer of soft tissue along the faces of the implant which are parallel to the loading direction. This was predicted to be correlated with the high levels of distortional strain transferred through the solid component of the stimulus. It was also predicted that the external threads on the implant, redistribute the interfacial load, thus help reduce the high distortional stimulus and also help the cells to differentiate to bone tissue. In addition, the region underneath the implant apex was predicted to experience high fluid stimulus that results in the development of soft tissue. The relationship between the variables considered in this study and the outcome measures, BV and BIC, was found to be highly nonlinear. A three-way analysis of variance (ANOVA) of the results was conducted and it showed that micro-motion presents the largest hindrance to bone formation during healing. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. On the stability of rotational discontinuities

    International Nuclear Information System (INIS)

    Richter, P.; Scholer, M.

    1989-01-01

    The stability of symmetric rotational discontinuities in which the magnetic field rotates by 180 degree is investigated by means of a one-dimensional self-consistent hybrid code. Rotational discontinuities with an angle Θ > 45 degree between the discontinuity normal direction and the upstream magnetic field are found to be relatively stable. The discontinuity normal is in the x direction and the initial magnetic field has finite y component only in the transition region. In the case of the ion (left-handed) sense of rotation of the tangential magnetic field, the transition region does not broaden with time. In the case of the electron (right-handed) sense of rotation, a damped wavetrain builds up in the B y component downstream of the rotational discontinuity and the discontinuity broadens with time. Rotational discontinuities with smaller angles, Θ, are unstable. Examples for a rotational discontinuity with Θ = 30 degree and the electron sense of rotation as well as a rotational discontinuity with Θ = 15 degree and the ion sense of rotation show that these discontinuities into waves. These waves travel approximately with Alfven velocity in the upstream direction and are therefore phase standing in the simulation system. The magnetic hodograms of these disintegrated discontinuities are S-shaped. The upstream portion of the hodogram is always right-handed; the downstream portion is always left-handed

  6. General Practitioners’ Decisions about Discontinuation of Medication

    DEFF Research Database (Denmark)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-01-01

    insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de......Purpose – The purpose of this paper is to investigate how general practitioners’ (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach – In total, 24 GPs were interviewed, three practices were observed and documents were...... a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value – The analysis offers new...

  7. Recent Developments on Discontinuous Precipitation

    Directory of Open Access Journals (Sweden)

    Zięba P.

    2017-06-01

    Full Text Available The discontinuous precipitation (DP belongs to a group of diffusive solid state phase transformations during which the formation of a new phase is heterogeneous and limited to a migrating reaction front (RF. The use of analytical electron microscopy provided reliable information that there is no differences in the diffusion rate at the stationary grain boundary and moving RF of DP reaction. On the other hand, the use of “in situ” transmission electron microscopy observations indicated the importance of stop-go motion or oscillatory movement of the RF.

  8. Stacking and discontinuous buffers in capillary zone electrophoresis.

    Science.gov (United States)

    Shihabi, Z K

    2000-08-01

    Discontinuous buffers for capillary zone electrophoresis (CZE) can be used under less rigid conditions compared to those for isotachophoresis for stacking. They can be prepared simply by modifying the sample itself, either by addition of small inorganic ions, low conductivity diluents, or both, and also by adjusting its pH, meanwhile injecting a large volume on the capillary. Zwitterionic and organic-based buffers such as triethanolamine and tris(hydroxymethyl)aminomethane (Tris) are well suited for stacking due to their low conductivity, provided the buffer is discontinuous as demonstrated here. A simple mechanism based on discontinuous buffers is described to explain many of the observed stacking types in CZE, pointing out the many similarities to transient isotachophoresis.

  9. Continued versus discontinued oxytocin stimulation, protocol of an rct

    DEFF Research Database (Denmark)

    Boie, Sidsel; Glavind, Julie; Uldbjerg, Niels

    Dutch Centres: AMC, Tergooi Hospital, and AMPHIA Hospital (inclusion expected late 2016) Intervention When the active phase of labour is established (defined as 6 cm dilated orificium), the women will be randomised to either: Continued Syntocinon® or Discontinued Syntocinon® (saline infusion) Primary......Problem Statement: Previous studies on induced labour suggest that, continued stimulation with Syntocinon® in the active phase of labour increases the risk of fetal distress and caesarean delivery whereas discontinued stimulation with Syntocinon® increases the risk of caesarean delivery due to lack...... of progression. No double-blind trial with a study population large enough to show differences in maternal and neonatal outcomes has ever been conducted. The purpose of the study is to investigate how the caesarean delivery rate is affected if Syntocinon® is discontinued at the onset of active phase of labour...

  10. Discontinuation of nicotine replacement therapy among smoking-cessation attempters.

    Science.gov (United States)

    Burns, Emily K; Levinson, Arnold H

    2008-03-01

    Nicotine replacement therapy (NRT) doubles successful quitting, but more than half of NRT users do not comply with optimal treatment regimens. From the 2005 Colorado state tobacco survey, quit attempters who utilized NRT (N=366) were analyzed in spring 2007. Descriptive and regression analyses were used to examine reasons for discontinuing NRT, length of time on NRT, and quit intentions. The reasons for discontinuing NRT were resuming smoking (34%), side effects (17%), NRT not helping with quitting (14%), quitting smoking (10%), and cost (5%). Poverty, age, and non-Latino minority status were associated with reasons for discontinuation other than quitting smoking. Having side effects was associated with a short duration of NRT use and 95% lower odds of intending to quit in the next month. In the first population-level study examining reasons for discontinuing NRT, general-population smokers who initiate NRT use when attempting to quit are highly likely to discontinue NRT prematurely. Age and culturally-appropriate medication management interventions may increase NRT compliance and improve cessation outcomes.

  11. Low-index discontinuity terahertz waveguides

    Science.gov (United States)

    Nagel, Michael; Marchewka, Astrid; Kurz, Heinrich

    2006-10-01

    A new type of dielectric THz waveguide based on recent approaches in the field of integrated optics is presented with theoretical and experimental results. Although the guiding mechanism of the low-index discontinuity (LID) THz waveguide is total internal reflection, the THz wave is predominantly confined in the virtually lossless low-index air gap within a high-index dielectric waveguide due to the continuity of electric flux density at the dielectric interface. Attenuation, dispersion and single-mode confinement properties of two LID structures are discussed and compared with other THz waveguide solutions. The new approach provides an outstanding combination of high mode confinement and low transmission losses currently not realizable with any other metal-based or photonic crystal approach. These exceptional properties might enable the breakthrough of novel integrated THz systems or endoscopy applications with sub-wavelength resolution.

  12. A non-conventional discontinuous Lagrangian for viscous flow

    Science.gov (United States)

    Marner, F.

    2017-01-01

    Drawing an analogy with quantum mechanics, a new Lagrangian is proposed for a variational formulation of the Navier–Stokes equations which to-date has remained elusive. A key feature is that the resulting Lagrangian is discontinuous in nature, posing additional challenges apropos the mathematical treatment of the related variational problem, all of which are resolvable. In addition to extending Lagrange's formalism to problems involving discontinuous behaviour, it is demonstrated that the associated equations of motion can self-consistently be interpreted within the framework of thermodynamics beyond local equilibrium, with the limiting case recovering the classical Navier–Stokes equations. Perspectives for applying the new formalism to discontinuous physical phenomena such as phase and grain boundaries, shock waves and flame fronts are provided. PMID:28386415

  13. Rotational discontinuities in anisotropic plasmas

    International Nuclear Information System (INIS)

    Omidi, N.

    1992-01-01

    The kinetic structure of rotational discontinuities (RDs) in anisotropic plasmas with T perpendicular /T parallel > 1 is investigated by using a one-dimensional electromagnetic hybrid code. To form the RD, a new approach is used where the plasma is injected from one boundary and reflected from the other, resulting in the generation of a traveling fast shock and an RD. Unlike the previously used methods, no a priori assumptions are made regarding the initial structure (i.e. width or sense of rotation) of the rotational discontinuity. The results show that across the RD both the magnetic field strength and direction, as well as the plasma density change. Given that such a change can also be associated with an intermediate shock, the Rankine-Hugoniot relations are used to confirm that the observed structures are indeed RDs. It is found that the thickness of RDs is a few ion inertial lengths and is independent of the rotation angle. Also, the preferred sense of rotation is in the electron sense; however, RDs with a rotation angle larger than 180 degree are found to be unstable, changing their rotation to a stable ion sense

  14. Discontinuation of anti-VEGF cancer therapy promotes metastasis through a liver revascularization mechanism

    DEFF Research Database (Denmark)

    Yang, Yunlong; Zhang, Yin; Iwamoto, Hideki

    2016-01-01

    The impact of discontinuation of anti-VEGF cancer therapy in promoting cancer metastasis is unknown. Here we show discontinuation of anti-VEGF treatment creates a time-window of profound structural changes of liver sinusoidal vasculatures, exhibiting hyper-permeability and enlarged open-pore size...

  15. Treatment of two postoperative endophthalmitis cases due to Aspergillus flavus and Scopulariopsis spp. with local and systemic antifungal therapy

    Directory of Open Access Journals (Sweden)

    Uyar Guliz

    2007-07-01

    Full Text Available Abstract Background Endophthalmitis is the inflammatory response to invasion of the eye with bacteria or fungi. The incidence of endophthalmitis after cataract surgery varies between 0.072–0.13 percent. Treatment of endophthalmitis with fungal etiology is difficult. Case Presentation Case 1: A 71-year old male diabetic patient developed postoperative endophthalmitis due to Aspergillus flavus. The patient was treated with topical amphotericin B ophthalmic solution, intravenous (IV liposomal amphotericin-B and caspofungin following vitrectomy. Case 2: A 72-year old male cachectic patient developed postoperative endophthalmitis due to Scopulariopsis spp. The patient was treated with topical and IV voriconazole and caspofungin. Conclusion Aspergillus spp. are responsible of postoperative fungal endophthalmitis. Endophthalmitis caused by Scopulariopsis spp. is a very rare condition. The two cases were successfully treated with local and systemic antifungal therapy.

  16. Successful Treatment of PD Peritonitis Due to Morganella morganii Resistant to Third-Generation Cephalosporins - A Case Report.

    Science.gov (United States)

    Keskar, Vaibhav; Biyani, Mohan; Amin, Syed Obaid; Knoll, Greg

    2017-01-01

    Morganella morganii is a rare cause of peritonitis in patients on peritoneal dialysis (PD). Most of the reported cases have resorted to a switch to hemodialysis. We herein report a case of peritonitis due to M. morganii resistant to third-generation cephalosporins, which was treated successfully with intraperitoneal (IP) tobramycin followed by oral ciprofloxacin. Early microbiologic diagnosis is essential in the treatment of peritonitis from rare microorganisms such as Morganella morganii , and appropriate antibiotic therapy is the key to avoiding catheter loss and subsequent switch to hemodialysis. Copyright © 2017 International Society for Peritoneal Dialysis.

  17. Comparative clinical study of the effect of LLLT in the immediate and late treatments of hypoesthesia due to surgical procedures

    Science.gov (United States)

    Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Pinheiro, Antonio L. B.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Takamoto, Marcia; Siqueira, Jose T.; Dias, Pedro; Campos, Roberto A. d. C.

    2002-06-01

    We evaluated the effect of LLLT in 68 patients who presented hypoesthesia due to odontological surgery procedures: dental implant surgeries (N=51); extraction of impacted lower third molars (N=10); endodontics in lower first molars (N=7). Lesions treated within 30 days after the nerve injury had occurred were part of the immediate group, and lesions with more than 30 days from the occurrence of the injury were part of the late group. Treatments were carried out with an infrared diode laser of 40 mW-830nm, continuous wave emission, spot size 3 mm2, and a total dosage of 18 joules per session in a contact mode of application, 20 sessions altogether. The efficacy of laser therapy in peripheral nerve regeneration is also related to the degree of the peripheral nerve lesion, and not only to the lesion duration. LLLT resulted in neurosensory functional improvement in both immediate and late treatments of hypoesthesia.

  18. Olanzapine and Betamethasone Are Effective for the Treatment of Nausea and Vomiting due to Metastatic Brain Tumors of Rectal Cancer

    Directory of Open Access Journals (Sweden)

    M. Suzuki

    2014-01-01

    Full Text Available Brain lesions originating from metastasis of colorectal cancer represent 3-5% of all brain metastases and are relatively rare. Of all distant metastases of colorectal cancer, those to the liver are detected in 22-29% of cases, while those to the lungs are detected in 8-18% of cases. In contrast, brain metastasis is quite rare, with a reported incidence ranging from 0.4 to 1.8%. Treatments for metastatic brain tumors include surgery, radiotherapy, chemotherapy and supportive care with steroids, etc. Untreated patients exhibit a median survival of only approximately 1 month. The choice of treatment for brain metastasis depends on the number of lesions, the patient's general condition, nerve findings and presence of other metastatic lesions. We herein report the case of a 78-year-old male who presented with brain metastases originating from rectal carcinoma. He suffered from nausea, vomiting, anorexia and vertigo during body movement. He received antiemetics, glycerol and whole brain radiation therapy; however, these treatments proved ineffective. Olanzapine therapy was started at a dose of 1.25 mg every night. The persistent nausea disappeared the next day, and the frequency of vomiting subsequently decreased. The patient was able to consume solid food. Olanzapine is an antipsychotic that has recently been used as palliative therapy for refractory nausea and vomiting in patients receiving chemotherapy. We consider that olanzapine was helpful as a means of supportive care for the treatment of nausea and vomiting due to brain metastasis.

  19. Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins.

    Science.gov (United States)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-07-07

    Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP's practice and how do GPs make decisions about discontinuing medication? Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. The results show that different discontinuation cues (related to the type of consultation, medical records and the patient) create situations of dissonance that can lead to the GP considering the option of discontinuation. We also show that there is a lot of ambiguity in situations of discontinuing and that some GPs trialled discontinuing as means of generating more information that could be used to deal with the ambiguity. We conclude that the practice of discontinuation should be conceptualised as a continually evaluative process and one that requires sustained reflection through a culture of systematically scheduled check-ups, routinely eliciting the patient's experience of taking drugs and trialling discontinuation. Some policy recommendations are offered including supporting GPs with lists or handbooks that directly address discontinuation and by developing more person centred clinical guidelines that discuss discontinuation more explicitly.

  20. Compromised local control due to treatment interruptions and late treatment breaks in early glottic cancer: Population-based outcomes study supporting need for intensified treatment schedules

    International Nuclear Information System (INIS)

    Groome, Patti A.; O'Sullivan, Brian; Mackillop, William J.; Jackson, Lynda D.; Schulze, Karleen M.Math.; Irish, Jonathan C.; Warde, Padraig R.; Schneider, Ken M.; Mackenzie, Robert G.; Hodson, D. Ian; Hammond, J. Alex; Gulavita, Sunil P.P.; Eapen, Libni J.; Dixon, Peter F. M.B.; Bissett, Randy J.

    2006-01-01

    Purpose: This population-based study describes the treatment of early glottic cancer in Ontario, Canada and assesses whether treatment variations were associated with treatment effectiveness. Methods and Materials: We studied 491 T1N0 and 213 T2N0 patients. Data abstracted from charts included age, sex, stage, treatment details, disease control, and survival. Results: The total dose ranged from 50 to 70 Gy, and the daily dose ranged from 1.9 to 2.8 Gy. In 90%, treatment duration was between 25 and 50 days. Field sizes, field reductions, beam arrangement, and beam energy varied. Late treatment breaks occurred in 13.6% of T1N0 and 27.1% of T2N0 cases. Local control was comparable to other reports for T1N0 (82% at 5 years), but was only 63.2% in T2N0. Variables associated with local failure in T1N0 were age less than 49 years (relative risk [RR], 3.21; 95% confidence interval [CI], 1.49-6.90) and >3 treatment interruption days (RR, 2.43; 95% CI, 1.00-5.91). In T2N0, these were field reduction (RR, 2.33; 95% CI, 1.23-4.42) and late treatment breaks (RR, 2.19; 95% CI, 1.09-4.41). Conclusion: Some aspects of treatment for early glottic cancer were associated with worse local control. Problems with protracted treatment are of particular concern, underscoring the need for randomized studies to intensify radiotherapy

  1. Mass flow of antibiotics in a wastewater treatment plant focusing on removal variations due to operational parameters.

    Science.gov (United States)

    Marx, Conrad; Günther, Norbert; Schubert, Sara; Oertel, Reinhard; Ahnert, Markus; Krebs, Peter; Kuehn, Volker

    2015-12-15

    Wastewater treatment plants (WWTPs) are not designed to purposefully eliminate antibiotics and therefore many previous investigations have been carried out to assess their fate in biological wastewater treatment processes. In order to consolidate previous findings regarding influencing factors like the solid and hydraulic retention time an intensive monitoring was carried out in a municipal WWTP in Germany. Over a period of 12months daily samples were taken from the in- and effluent as well as diverse sludge streams. The 14 selected antibiotics and one metabolite cover the following classes: cephalosporins, diaminopyrimidines, fluoroquinolones, lincosamide, macrolides, penicillins, sulfonamides and tetracyclines. Out of the 15 investigated substances, the removal of only clindamycin and ciprofloxacin show significant correlations to SRT, temperature, HRT and nitrogen removal. The dependency of clindamycin's removal could be related to the significant negative removal (i.e. production) of clindamycin in the treatment process and was corrected using the human metabolite clindamycin-sulfoxide. The average elimination was adjusted from -225% to 3% which suggests that clindamycin can be considered as an inert substance during the wastewater treatment process. Based on the presented data, the mass flow analysis revealed that macrolides, clindamycin/clindamycin-sulfoxide and trimethoprim were mainly released with the effluent, while penicillins, cephalosporins as well as sulfamethoxazole were partly degraded in the studied WWTP. Furthermore, levofloxacin and ciprofloxacin are the only antibiotics under investigation with a significant mass fraction bound to primary, excess and digested sludge. Nevertheless, the sludge concentrations are highly inconsistent which leads to questionable results. It remains unclear whether the inconsistencies are due to insufficiencies in sampling and/or analytical determination or if the fluctuations can be considered reasonable for

  2. Clinical application of bilateral uterine arterial chemoembolization in the treatment of massive hemorrhage due to cesarean scar pregnancy

    International Nuclear Information System (INIS)

    Wan Jun; Gu Weijin; Wang Haiyun; Ye Lei; Wang Wei; Zhang Lei; Ji Lihua

    2009-01-01

    Objective: To investigate the clinical application of bilateral uterine arterial chemoembolization in treating massive hemorrhage due to uterine scar pregnancy after cesarean section. Methods: Sixteen patients with massive hemorrhage due to cesarean scar pregnancy were enrolled in the study, the mean blood loss was (2 200 ± 1 400) ml. With Seldinger technique, abdominal angiography by using a pig-tail catheter was carried out. When bilateral uterine arterial bleeding was confirmed, selective or super-selective catheterization was employed and bilateral uterine arterial chemoembolization with infusion of 5-Fu or methotrexate (MTX) together with gelatin sponge via the catheters was conducted. The clinical results were observed. Results: The technical success was achieved in all 16 patients. No recurrent bleeding occurred during a follow-up of 3-6 months. Conclusion: The emergency bilateral uterine arterial chemoembolization is a safe and effective treatment for massive hemorrhage due to cesarean scar pregnancy with no serious complications, therefore, this technique is worth being used in clinical practice. (authors)

  3. DIFFICULTY IN BREATHING DUE TO ACCIDENTAL EXPOSURE TO HYPOCHLORITE SOLUTION IN ENDODONTIC TREATMENTREATHING DUE TO ACCIDENTAL EXPOSURE TO HYPOCHLORITE SOLUTION IN ENDODONTIC TREATMENT

    Directory of Open Access Journals (Sweden)

    Buddiwati Punta

    2006-04-01

    Full Text Available An important phase of endodontic treatment is the irrigation of the root canal system. Desirable functions of irrigation are antimicrobial activity, dissolution of necrotic tissue, and non toxicity to the periradicular tissue. Toxicity of NaOCl solution on vital tissue is still controversial. Severe complications may occur if this solution is inadvertently exposed to the oral mucosa, and it is very hazardous. The purpose of this paper is to caution dentists on the hazards of using NaOCl irrigation in endodontic treatment. A case is presented in which 2.5% NaOCl solution was accidentally streaming into the patient's throat because the irrigating needle was not securely attached to the syringe, with the result that the patient had difficulty in breathing. The patient was promptly taken to a pulmonologist, internist, and ENT. The patient was given dexamethasone 10 mg iv injection, delladryl 1 cc iv, and nebulizer with 1 ampoule of steroid, 1 ampoule of ventolin and 5 cc NaCl 3x within 24 hours, and after 24 hours the condition was increased. From this case it is concluded that the 2.5% NaOCl solution is very alkaline and irritating, resulting in deem of the larynx and plugging up of the respiratory system. Clinicians need to be cautious in using NaOCl solution to avoid endangering the patient's life.

  4. Discontinuities during UV writing of waveguides

    DEFF Research Database (Denmark)

    Svalgaard, Mikael; Harpøth, Anders; Andersen, Marc

    2005-01-01

    UV writing of waveguides can be hampered by discontinuities where the index change process suddenly shuts down. We show that thermal effects may account for this behaviour.......UV writing of waveguides can be hampered by discontinuities where the index change process suddenly shuts down. We show that thermal effects may account for this behaviour....

  5. Special discontinuities in nonlinearly elastic media

    Science.gov (United States)

    Chugainova, A. P.

    2017-06-01

    Solutions of a nonlinear hyperbolic system of equations describing weakly nonlinear quasitransverse waves in a weakly anisotropic elastic medium are studied. The influence of small-scale processes of dissipation and dispersion is investigated. The small-scale processes determine the structure of discontinuities (shocks) and a set of discontinuities with a stationary structure. Among the discontinuities with a stationary structure, there are special ones that, in addition to relations following from conservation laws, satisfy additional relations required for the existence of their structure. In the phase plane, the structure of such discontinuities is represented by an integral curve joining two saddles. Special discontinuities lead to nonunique self-similar solutions of the Riemann problem. Asymptotics of non-self-similar problems for equations with dissipation and dispersion are found numerically. These asymptotics correspond to self-similar solutions of the problems.

  6. Aflibercept: a review of its use in the treatment of choroidal neovascularization due to age-related macular degeneration

    Directory of Open Access Journals (Sweden)

    Balaratnasingam C

    2015-12-01

    Full Text Available Chandrakumar Balaratnasingam,1–3 Elona Dhrami-Gavazi,1,2,4 Jesse T McCann,1,2,4,5 Quraish Ghadiali,1,2 K Bailey Freund1,2,4,5 1Vitreous-Retina-Macula Consultants of New York, NY, USA; 2LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA; 3Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, WA, Australia; 4Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA; 5Department of Ophthalmology, New York University School of Medicine, New York, NY, USA Abstract: Choroidal neovascularization (CNV due to age-related macular degeneration (AMD is an important cause of visual morbidity globally. Modern treatment strategies for neovascular AMD achieve regression of CNV by suppressing the activity of key growth factors that mediate angiogenesis. Vascular endothelial growth factor (VEGF has been the major target of neovascular AMD therapy for almost two decades, and there have been several intravitreally-administered agents that have enabled anatomical restitution and improvement in visual function with continual dosing. Aflibercept (EYLEA®, initially named VEGF Trap-eye, is the most recent anti-VEGF agent to be granted US Food and Drug Administration approval for the treatment of neovascular AMD. Biologic advantages of aflibercept include its greater binding affinity for VEGF, a longer intravitreal half-life relative to other anti-VEGF agents, and the capacity to antagonize growth factors other than VEGF. This paper provides an up-to-date summary of the molecular mechanisms mediating CNV. The structural, pharmacodynamic, and pharmacokinetic advantages of aflibercept are also reviewed to rationalize the utility of this agent for treating CNV. Results of landmark clinical investigations, including VIEW 1 and 2 trials, and other important studies are then summarized and used to

  7. Prediction of DVH parameter changes due to setup errors for breast cancer treatment based on 2D portal dosimetry

    International Nuclear Information System (INIS)

    Nijsten, S. M. J. J. G.; Elmpt, W. J. C. van; Mijnheer, B. J.; Minken, A. W. H.; Persoon, L. C. G. G.; Lambin, P.; Dekker, A. L. A. J.

    2009-01-01

    Electronic portal imaging devices (EPIDs) are increasingly used for portal dosimetry applications. In our department, EPIDs are clinically used for two-dimensional (2D) transit dosimetry. Predicted and measured portal dose images are compared to detect dose delivery errors caused for instance by setup errors or organ motion. The aim of this work is to develop a model to predict dose-volume histogram (DVH) changes due to setup errors during breast cancer treatment using 2D transit dosimetry. First, correlations between DVH parameter changes and 2D gamma parameters are investigated for different simulated setup errors, which are described by a binomial logistic regression model. The model calculates the probability that a DVH parameter changes more than a specific tolerance level and uses several gamma evaluation parameters for the planning target volume (PTV) projection in the EPID plane as input. Second, the predictive model is applied to clinically measured portal images. Predicted DVH parameter changes are compared to calculated DVH parameter changes using the measured setup error resulting from a dosimetric registration procedure. Statistical accuracy is investigated by using receiver operating characteristic (ROC) curves and values for the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values. Changes in the mean PTV dose larger than 5%, and changes in V 90 and V 95 larger than 10% are accurately predicted based on a set of 2D gamma parameters. Most pronounced changes in the three DVH parameters are found for setup errors in the lateral-medial direction. AUC, sensitivity, specificity, and negative predictive values were between 85% and 100% while the positive predictive values were lower but still higher than 54%. Clinical predictive value is decreased due to the occurrence of patient rotations or breast deformations during treatment, but the overall reliability of the predictive model remains high. Based on our

  8. Reversible brain inactivation induces discontinuous gas exchange in cockroaches.

    Science.gov (United States)

    Matthews, Philip G D; White, Craig R

    2013-06-01

    Many insects at rest breathe discontinuously, alternating between brief bouts of gas exchange and extended periods of breath-holding. The association between discontinuous gas exchange cycles (DGCs) and inactivity has long been recognised, leading to speculation that DGCs lie at one end of a continuum of gas exchange patterns, from continuous to discontinuous, linked to metabolic rate (MR). However, the neural hypothesis posits that it is the downregulation of brain activity and a change in the neural control of gas exchange, rather than low MR per se, which is responsible for the emergence of DGCs during inactivity. To test this, Nauphoeta cinerea cockroaches had their brains inactivated by applying a Peltier-chilled cold probe to the head. Once brain temperature fell to 8°C, cockroaches switched from a continuous to a discontinuous breathing pattern. Re-warming the brain abolished the DGC and re-established a continuous breathing pattern. Chilling the brain did not significantly reduce the cockroaches' MR and there was no association between the gas exchange pattern displayed by the insect and its MR. This demonstrates that DGCs can arise due to a decrease in brain activity and a change in the underlying regulation of gas exchange, and are not necessarily a simple consequence of low respiratory demand.

  9. Historical transformation and epistemological discontinuity

    Directory of Open Access Journals (Sweden)

    Močnik Rastko

    2013-01-01

    Full Text Available Starting from recent formulas of EU bureaucracy for subordinating scientific and educational apparatuses to the needs of the capital and to the requests of its political representatives, the article analyses the interconnection between the historical transformation of the ideological state apparatuses (universities, higher education institutions, research institutes etc. and the epistemological discontinuity provoked by the triumph of technosciences. The hypothesis to be tested is the following: While the crisis of West European-North American capitalism requires an ever tighter submission of ideological state apparatuses, and especially of scientific and academic apparatuses to the needs of the capital, theoretical practices in the humanities and social sciences have come to the point where they entered into an open conflict with the domination of the capital and have, as a consequence, started to subvert their own institutional supports in the ideological apparatuses of the capitalist state. For this purpose, the article reconsiders social sciences as a compromise formation and, eventually, reassesses the historical materialism as a non-Cartesian modern science.

  10. The interventional treatment for biliary recurrent obstruction after palliative T tube drainage in patients with obstruction due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Han Xinwei; Li Yongdong; Guan Sheng; Wu Gang; Xing Gusheng; Ma Bo

    2002-01-01

    Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice

  11. MILD INDUCED HYPOTHERMIA AND PERCUTANEOUS CORONARYINTERVENTION IN THE TREATMENT OF PATIENT WITH PREHOSPITALCARDIAC ARREST DUE TO ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Milena Stojić

    2008-06-01

    We report on a 48-year old male who suffered out-of-hospital cardiac arrest one hour afteronset of chest pain. Bystander basic life support was not provided. On arrival of prehospital emergency medical team ventricular fibrillation (VF was documented. Followingchest compression and defibrillation spontaneous circulation was established. 12-lead EKGrevealed STEMI. Since patient remained comatose despite successful re-establishment ofspontaneous circulation MIH was immediately started. Upon hospital admission urgentcoronary angiography and successful primary percutaneous intervention were performed.Because of impending cardiogenic shock intra-aortic balloon pump was inserted. Hypothermia with target body temperature between 32 and 34 degrees C was maintainedfor 24 hours. Standard intensive care procedures were employed. The patient survivedhospital discharge without any neurological deficit and lives normal life without anysymptoms of left ventricular dysfunction for more than 250 days.Discussion Early aggressive and combined treatment of comatose survivors with sudden cardiacarrest due to STEMI proves to be safe, feasible and efficient in preventing neurologicaldamage

  12. Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-08-01

    There have been numerous reports of granulomatous diseases developing in patients receiving anti-tumour necrosis factor (TNF) therapy. Herein, we report a patient who developed sarcoidosis 6 months after discontinuation of etanercept. To date, all reported cases have occurred in patients undergoing ongoing treatment with TNF blockers with resolution on its discontinuation. A 47-year-old man was diagnosed with seropositive rheumatoid arthritis (RA) in 2003. He was initially treated with methotrexate and corticosteroids. In 2005, adalimumab was added due to ongoing disease activity. However, he had persistent low-grade synovitis of bilateral wrist joints and remained oral glucocorticoids dependent. In October 2008, adalimumab was switched to etanercept with marginal benefit; however, etanercept was continued until March 2009. Rituximab was discontinued due to an immediate allergic reaction. In September 2009, he developed bilateral ankle synovitis with erythema nodosum. Further investigations (chest X-ray and CT scan of thorax) revealed new development of bilateral hilar lymphadenopathy and interstitial nodular changes typical of sarcoidosis. His baseline therapy of methotrexate was continued. His recent repeat chest X-ray and CT scan of thorax (March 2010) has shown significant spontaneous resolution of his mediastinal lymphadenopathy and pulmonary nodules. Apart from the initial brief course of NSAIDs, his sarcoidosis resolved spontaneously without requiring any further therapy. For his rheumatoid arthritis, he has been recently commenced on abatacept and his baseline therapy of methotrexate has been continued. It remains speculative as to whether the concurrence of RA and sarcoidosis is purely serendipitous, or is related to an immunodysregulatory state attributable to TNF blockade.

  13. Comparison the efficacy of ceftazidime and imipenem in treatment of neutropenic febrile due to chemotherapy in cancer patients

    Directory of Open Access Journals (Sweden)

    Zahra fotokian

    2009-08-01

    Full Text Available Introduction: In cancer patients various infections were developed due to severe neutropeniaresulted from chemotherapy. There is controversy between initial monotherapy or multidrugprescription. The purpose of this study was to compare the efficacy of ceftazidime and imipenem incontrol of fever in cancer patients with febrile neutropenia.Materials ands Methods: 40 patients with cancer, fever and neutropenia (PMN<500, withoutrecognized source of infection, were selected using the convenience and consecutive method. Using arandom sampling, twenty patients were treated with imipenem (500mg Iv/Q8hr and others withceftazidime (2mg Iv/Q8hr. The criteria for positive response to the drugs were: fever disappearanceduring maximally 72 hours lasted for up to 24 hours, and increased neutrophil counts more than500/ml.Results: Our results show that 60% and 55% patients with ceftazidime and imipenem were cured,respectively. 40% patients treated with ceftazidime and 45% patients treated with imipenem neededanother antibiotic therapy at the same time. No significant relationship was found between differenttypes of drug regime among the groups.Conclusion: Findings of this study indicate that ceftazidime and imipenem have similar efficacy intreatment of febrile neutropenic patients. Due to more availability and lower cost of ceftazidime thanimipenem, ceftazidime is suggested as first line treatment in febrile neutropenia.

  14. Sm2Fe17Nx with discontinuous nitrogen profiles

    International Nuclear Information System (INIS)

    Skomski, R.; Kobayashi, K.; Brennan, S.; Coey, J.M.D.

    1995-01-01

    Microprobe analysis and theoretical calculations based on Hooke's law are used to investigate Sm 2 Fe 17 N x nitrides produced by N 2 and NH 3 interstitial modification. In the case of molecular nitrogen, stress and strain as well as Curie temperature, magnetization and anisotropy exhibit a smooth spatial variation, while nitrogen overloading due to the presence of ammonia leads to large excess strain and lattice incoherency. Discontinuous nitrogen profiles are associated with the occurrence of microcracks. ((orig.))

  15. Modelling the variation in rectal dose due to inter-fraction rectal wall deformation in external beam prostate treatments

    International Nuclear Information System (INIS)

    Booth, Jeremy; Zavgorodni, Sergei

    2005-01-01

    Prostate radiotherapy inevitably deposits radiation dose in the rectal wall, and the dose delivered to prostate is limited by the expected rectal complications. Accurate evaluation of the rectal dose is non-trivial due to a number of factors. One of these is variation of the shape and position of the rectal wall (with respect to the clinical target volume (CTV)), which may differ daily from that taken during planning CT acquisition. This study uses data currently available in the literature on rectal wall motion to provide estimates of mean population rectal wall dose. The rectal wall geometry is characterized by a population mean radius of the rectum as well as inter-patient and inter-fraction standard deviations in rectum radius. The model is used to evaluate the range of inter-fraction and inter-patient rectal dose variations. The simulation of individual patients with full and empty rectum in the planning CT scan showed that large variations in rectal dose (>15 Gy) are possible. Mean calculated dose accounting for treatment and planning uncertainties in the rectal wall surface was calculated as well as the map of planning dose over/underpredictions. It was found that accuracy of planning dose is dependent on the CTV-PTV margin size with larger margins producing more accurate estimates. Over a patient population, the variation in rectal dose is reduced by increasing the number of pre-treatment CT scans

  16. CURRENT OPPORTUNITIES FOR COMBINATION TREATMENT OF LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA IN MEN

    Directory of Open Access Journals (Sweden)

    G. R. Kasyan

    2016-01-01

    Full Text Available Lower urinary tract symptoms (LUTS associated with benign prostatic hyperplasia (BPH are widely presented, particularly among elderly men. It was commonly accepted that LUTS are directly or indirectly connected with the prostate. Recent studies have shown that mild andsevere forms of LUTS may have a different etiology, such as, bladder related problems: overactive bladder (OAB/detrusor overactivity or, conversely, an underactive bladder due to compromised contractions of the detrusor. There are three main groups of LUTS: storage symptoms, voiding symptoms and post-micturition symptoms. Patients with LUTS/BPH who are not sufficiently respond to monotherapy with alpha-blockers should receive additional treatment with M‑anticholinergics in accordance with the European urological guidelines. Current studies show that up to 65% of patients with LUTS/BPH with symptoms of urgency and frequency do not have sufficient reduction of symptoms after 3 months of treatment with alphablocker as monotherapy. Until recently, alpha-blockers and M‑anticholinergic medications were prescribed in combination therapy as a two separate pills. Vesomni is a combination of antimuscarinic drug solifenacin 6 mg with α1‑blocker tamsulosin OCAS 0.4 mg in one tablet. It is developed to relieve storage (urgency and frequency and voiding symptoms in men with LUTS/BPH. Solifenacin suppresses the overactivity of the detrusor and reduces storage symptoms. Tamsulosin OCAS relaxes smooth muscle of the prostate, prostatic urethra and bladder neck, and eliminates most voiding symptoms and, to a lesser extent, storage symptoms.

  17. Over-extending reduction combined with unilateral approach percutaneous vertebroplasty for the treatment of vertebral compression fractures due to osteoporosis

    International Nuclear Information System (INIS)

    Wei Xinjian; Ji Xianghui; Cao Fei; Zhang Fuhua

    2012-01-01

    Objective: To assess the clinical effect of over-extending reduction combined with percutaneous vertebroplasty (PVP) in treating vertebral compression fractures caused by osteoporosis. Methods: A total of 16 patients with vertebral compression fractures due to osteoporosis were treated with over-extending reduction by using traction on the operation table, and then PVP through trans-single-pedicular approach was performed on the fractured vertebra. The visual analogue scale (VAS) was used to evaluate the clinical effectiveness. The preoperative and postoperative heights of the fractured vertebral body were determined, and the vertebral height recovery ratio was calculated. Results: Technical success was achieved in 20 vertebrae of 16 cases. Bone cement leakage was observed in front of the vertebral body (n=5), in the side of vertebral body (n=20) and within the intervertebral (n=2). After the treatment VAS score decreased from preoperative 8.5±1.2 to postoperative 2.5±1.4. The vertebral height recovery ratio was (40.1±23.5)%. After the surgery, the VAS score and the vertebral height were significantly improved (P<0.05). Conclusion: The over-extending reduction combined with PVP through trans-single-pedicular approach is an effective treatment for vertebral compression fractures caused by osteoporosis. (authors)

  18. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  19. Role of carglumic acid in the treatment of acute hyperammonemia due to N-acetylglutamate synthase deficiency

    Directory of Open Access Journals (Sweden)

    Häberle J

    2011-08-01

    Full Text Available Johannes HäberleKinderspital Zürich, Abteilung Stoffwechsel, Zürich, SwitzerlandAbstract: N-acetylglutamate synthase (NAGS deficiency is a rare inborn error of metabolism affecting ammonia detoxification in the urea cycle. The product of NAGS is N-acetylglutamate which is the absolutely required allosteric activator of the first urea cycle enzyme carbamoylphosphate synthetase 1. In defects of NAGS, the urea cycle function can be severely affected resulting in fatal hyperammonemia in neonatal patients or at any later stage in life. NAGS deficiency can be treated with a structural analog of N-acetylglutamate, N-carbamyl-L-glutamate, which is available for enteral use as a licensed drug. Since NAGS deficiency is an extremely rare disorder, reports on the use of N-carbamyl-L-glutamate are mainly based on single patients. According to these, the drug is very effective in treating acute hyperammonemia by avoiding the need for detoxification during the acute metabolic decompensation. Also during long-term treatment, N-carbamyl-L-glutamate is effective in maintaining normal plasma ammonia levels and avoiding the need for additional drug therapy or protein-restricted diet. Open questions remain which concern the optimal dosage in acute and long-term use of N-carbamyl-L-glutamate and potential additional disorders in which the drug might also be effective in treating acute hyperammonemia. This review focuses on the role of N-carbamyl-L-glutamate for the treatment of acute hyperammonemia due to primary NAGS deficiency but will briefly discuss the current knowledge on the role of N-carbamyl-L-glutamate for treatment of secondary NAGS deficiencies.Keywords: carglumic acid, carbamylglutamate, N-carbamyl-L-glutamate, N-acetylglutamate synthase deficiency, NAGS deficiency, hyperammonemia

  20. Increments in plasma homovanillic acid concentrations after neuroleptic discontinuation are associated with worsening of schizophrenic symptoms.

    Science.gov (United States)

    Khan, R S; Amin, F; Powchik, P; Knott, P; Goldstein, M; Apter, S; Kerman, B; Jaff, S; Davidson, M

    1990-01-01

    1. Thirty-two male schizophrenic patients participated in this study. 2. Plasma concentrations of the dopamine metabolite, homovanillic acid (pHVA) were assessed once on neuroleptic medication and twice a week for a maximum of six weeks after its discontinuation. 3. Psychiatric symptomatology was assessed once on neuroleptic medication and once a week for a maximum of six weeks after its discontinuation, using the brief psychiatric rating scale (BPRS). 4. pHVA and total BPRS score increased significantly after discontinuation of neuroleptic as compared to baseline. 5. The magnitude of pHVA and BPRS increments after discontinuation of neuroleptic correlated significantly. 6. Results of this study suggest that worsening of schizophrenic symptoms after discontinuation of neuroleptic treatment is associated with increased pHVA concentrations.

  1. Discontinuation of antimicrobials and costs of treating patients with infection

    OpenAIRE

    Oliveira, Adriana Cristina de; Paula, Adriana Oliveira de

    2012-01-01

    OBJECTIVE: To evaluate the repercussions of discontinuation the cost with the antimicrobial treatment of patients with bloodstream infection. METHODS: A historical cohort study conducted in the intensive care unit of a hospital in Belo Horizonte (MG). The population included 62 patients with bloodstream infection caused by Staphylococcus aureus. Data were collected between March/2007 and March/2011 from patients' medical records, Commission of Hospital Infection Control and Sector of Costs, w...

  2. Signal integrity analysis on discontinuous microstrip line

    International Nuclear Information System (INIS)

    Qiao, Qingyang; Dai, Yawen; Chen, Zipeng

    2013-01-01

    In high speed PCB design, microstirp lines were used to control the impedance, however, the discontinuous microstrip line can cause signal integrity problems. In this paper, we use the transmission line theory to study the characteristics of microstrip lines. Research results indicate that the discontinuity such as truncation, gap and size change result in the problems such as radiation, reflection, delay and ground bounce. We change the discontinuities to distributed parameter circuits, analysed the steady-state response and transient response and the phase delay. The transient response cause radiation and voltage jump.

  3. Trapped particles at a magnetic discontinuity

    Science.gov (United States)

    Stern, D. P.

    1972-01-01

    At a tangential discontinuity between two constant magnetic fields a layer of trapped particles can exist, this work examines the conditions under which the current carried by such particles tends to maintain the discontinuity. Three cases are examined. If the discontinuity separates aligned vacuum fields, the only requirement is that they be antiparallel. With arbitrary relative orientations, the field must have equal intensities on both sides. Finally, with a guiding center plasma on both sides, the condition reduces to a relation which is also derivable from hydromagnetic theory. Arguments are presented for the occurrence of such trapped modes in the magnetopause and for the non-existence of specular particle reflection.

  4. Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

    Directory of Open Access Journals (Sweden)

    ZHANG Lei

    2015-03-01

    Full Text Available ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32 and non-bleeding group (n=206. Univariate analysis (t test or chi-square test and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT, activated partial thromboplastin time (APTT, and presence of diabetes (all P<0.05. The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

  5. Discontinuous Galerkin for the Radiative Transport Equation

    KAUST Repository

    Guermond, Jean-Luc; Kanschat, Guido; Ragusa, Jean C.

    2013-01-01

    This note presents some recent results regarding the approximation of the linear radiative transfer equation using discontinuous Galerkin methods. The locking effect occurring in the diffusion limit with the upwind numerical flux is investigated and a correction technique is proposed.

  6. Neural networks with discontinuous/impact activations

    CERN Document Server

    Akhmet, Marat

    2014-01-01

    This book presents as its main subject new models in mathematical neuroscience. A wide range of neural networks models with discontinuities are discussed, including impulsive differential equations, differential equations with piecewise constant arguments, and models of mixed type. These models involve discontinuities, which are natural because huge velocities and short distances are usually observed in devices modeling the networks. A discussion of the models, appropriate for the proposed applications, is also provided. This book also: Explores questions related to the biological underpinning for models of neural networks\\ Considers neural networks modeling using differential equations with impulsive and piecewise constant argument discontinuities Provides all necessary mathematical basics for application to the theory of neural networks Neural Networks with Discontinuous/Impact Activations is an ideal book for researchers and professionals in the field of engineering mathematics that have an interest in app...

  7. Discontinuous Galerkin for the Radiative Transport Equation

    KAUST Repository

    Guermond, Jean-Luc

    2013-10-11

    This note presents some recent results regarding the approximation of the linear radiative transfer equation using discontinuous Galerkin methods. The locking effect occurring in the diffusion limit with the upwind numerical flux is investigated and a correction technique is proposed.

  8. Factors Influencing Contraceptive Choice and Discontinuation ...

    African Journals Online (AJOL)

    Erah

    2010-03-30

    women indicated that their HIV status dictated contraceptive decisions, particularly with ... Women reported method discontinuation because of side effects, having met desired parity, ...... Washington, D.C., 2009. ... Accessed March 30, 2010.

  9. Remediation in Situ of Hydrocarbons by Combined Treatment in a Contaminated Alluvial Soil due to an Accidental Spill of LNAPL

    Directory of Open Access Journals (Sweden)

    Ettore Trulli

    2016-10-01

    Full Text Available Soil contamination represents an environmental issue which has become extremely important in the last decades due to the diffusion of industrial activities. Accidents during transport of dangerous materials and fuels may cause severe pollution. The present paper describes the criteria of the actions which were operated to remediate the potential risk and observed negative effects on groundwater and soil originating from an accidental spill of diesel fuel from a tank truck. With the aim to evaluate the quality of the involved environmental matrices in the “emergency” phase, in the following “safety” operation and during the remediation action, a specific survey on hydrocarbons, light and heavy, was carried out in the sand deposits soil. Elaboration of collected data allows us to observe the movement of pollutants in the unsaturated soil. The remediation action was finalized to improve the groundwater and soil quality. The former was treated by a so called “pump and treat” system coupled with air sparging. A train of three different technologies was applied to the unsaturated soil in a sequential process: soil vapour extraction, bioventing and enhanced bioremediation. Results showed that the application of sequential remediation treatments allowed us to obtain a state of quality in unsaturated soil and groundwater as required by Italian law.

  10. Plants used in the treatment of leishmanial ulcers due to Leishmania (Viannia braziliensis in an endemic area of Bahia, Brazil

    Directory of Open Access Journals (Sweden)

    Flávio França

    1996-06-01

    Full Text Available This paper records the plants used in the treatment of cutaneous leishmaniasis due to Leishmania (Viannia braziliensis (L(Vb among the rural population of a cocoa- producing coastal area of Bahia state, Brazil. An enquiry conducted among a hundred patients identified 49 plant species used to treat skin ulceration caused by this Leishmania species. The principal plants used are caju-branco (Anacardium occidentale - Anacardiaceae, used by 65% of the population, folha-fogo (Clidemia hirta - Melastomataceae 39%, alfavaca-grossa (Plectranthus amboinicus - Lamiaceae 33%, mastruz (Chenopodium ambrosioides - Chenopodiaceae 31%, erva-de-santa-maria (Solatium americanum - Solanaceae (25% and transagem (Plantago major - Plantaginaceae. 2%.Este trabalho relata as plantas usadas no tratamento da leishmaniose cutânea, causada por Leishmania (Viannia braziliensis (L(Vb, na população rural da faixa litorânea produtora de cacau do estado da Bahia, Brasil. Um inquérito realizado entre 100 pacientes, identificou 49 espécies de plantas usadas para tratar úlceras de pele causadas por esta espécie de Leishmânia. As principais plantas usadas foram o cajueiro-branco (Anacardium occidentale - Anacardiaceae usado por 65% da população, a folha-fogo (Clidemia hirta - Melastomataceae 39%, a alfavaca-grossa (Plectranthus amboinicus - Lamiaceae 33%, o mastruz (Chenopodium ambrosioides - henopodiaceae 31%, a erva-de-santa-maria (Solanum americanum - Solanaceae 25% e a transagem (Plantago major - Plantaginaceae 2%.

  11. Area Regge calculus and discontinuous metrics

    International Nuclear Information System (INIS)

    Wainwright, Chris; Williams, Ruth M

    2004-01-01

    Taking the triangle areas as independent variables in the theory of Regge calculus can lead to ambiguities in the edge lengths, which can be interpreted as discontinuities in the metric. We construct solutions to area Regge calculus using a triangulated lattice and find that on a spacelike or timelike hypersurface no such discontinuity can arise. On a null hypersurface however, we can have such a situation and the resulting metric can be interpreted as a so-called refractive wave

  12. Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

    Science.gov (United States)

    Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

    2016-04-01

    To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

  13. Management applications of discontinuity theory | Science ...

    Science.gov (United States)

    1.Human impacts on the environment are multifaceted and can occur across distinct spatiotemporal scales. Ecological responses to environmental change are therefore difficult to predict, and entail large degrees of uncertainty. Such uncertainty requires robust tools for management to sustain ecosystem goods and services and maintain resilient ecosystems. 2.We propose an approach based on discontinuity theory that accounts for patterns and processes at distinct spatial and temporal scales, an inherent property of ecological systems. Discontinuity theory has not been applied in natural resource management and could therefore improve ecosystem management because it explicitly accounts for ecological complexity. 3.Synthesis and applications. We highlight the application of discontinuity approaches for meeting management goals. Specifically, discontinuity approaches have significant potential to measure and thus understand the resilience of ecosystems, to objectively identify critical scales of space and time in ecological systems at which human impact might be most severe, to provide warning indicators of regime change, to help predict and understand biological invasions and extinctions and to focus monitoring efforts. Discontinuity theory can complement current approaches, providing a broader paradigm for ecological management and conservation This manuscript provides insight on using discontinuity approaches to aid in managing complex ecological systems. In part

  14. The influence of traditional medicine and religion on discontinuation of ART in an urban informal settlement in Nairobi, Kenya.

    Science.gov (United States)

    Unge, Christian; Ragnarsson, Anders; Ekström, Anna Mia; Indalo, Dorcus; Belita, Alice; Carter, Jane; Ilako, Festus; Södergård, Björn

    2011-07-01

    The objective of this study was to explore the influence of traditional medicine and religion on discontinuation of antiretroviral therapy (ART) in one of Africa's largest informal urban settlement, Kibera, in Nairobi, Kenya. Semi-structured face-to-face interviews were conducted with 20 patients discontinuing the African Medical and Research Foundation (AMREF) ART program in Kibera due to issues related to traditional medicine and religion. Traditional medicine and religion remain important in many people's lives after ART initiation, but these issues are rarely addressed in a positive way during ART counseling. Many patients found traditional medicine and their religious beliefs to be in conflict with clinic treatment advice. Patients described a decisional process, prior to the actual drop-out from the ART program that involved a trigger event, usually a specific religious event, or a meeting with someone using traditional medicine that influenced them to take the decision to stop ART. Discontinuation of ART could be reduced if ART providers acknowledged and addressed the importance of religious issues and traditional medicine in the lives of patients, especially in similar resource-poor settings. Telling patients not to mix ART and traditional medicine appeared counter-productive in this setting. Introducing an open discussion around religious beliefs and the pros and cons of traditional medicine as part of standard counseling, may prevent drop-out from ART when side effects or opportunistic infections occur.

  15. Estimation of tumour dose enhancement due to gold nanoparticles during typical radiation treatments: a preliminary Monte Carlo study

    International Nuclear Information System (INIS)

    Cho, S H

    2005-01-01

    A recent mice study demonstrated that gold nanoparticles could be safely administered and used to enhance the tumour dose during radiation therapy. The use of gold nanoparticles seems more promising than earlier methods because of the high atomic number of gold and because nanoparticles can more easily penetrate the tumour vasculature. However, to date, possible dose enhancement due to the use of gold nanoparticles has not been well quantified, especially for common radiation treatment situations. Therefore, the current preliminary study estimated this dose enhancement by Monte Carlo calculations for several phantom test cases representing radiation treatments with the following modalities: 140 kVp x-rays, 4 and 6 MV photon beams, and 192 Ir gamma rays. The current study considered three levels of gold concentration within the tumour, two of which are based on the aforementioned mice study, and assumed either no gold or a single gold concentration level outside the tumour. The dose enhancement over the tumour volume considered for the 140 kVp x-ray case can be at least a factor of 2 at an achievable gold concentration of 7 mg Au/g tumour assuming no gold outside the tumour. The tumour dose enhancement for the cases involving the 4 and 6 MV photon beams based on the same assumption ranged from about 1% to 7%, depending on the amount of gold within the tumour and photon beam qualities. For the 192 Ir cases, the dose enhancement within the tumour region ranged from 5% to 31%, depending on radial distance and gold concentration level within the tumour. For the 7 mg Au/g tumour cases, the loading of gold into surrounding normal tissue at 2 mg Au/g resulted in an increase in the normal tissue dose, up to 30%, negligible, and about 2% for the 140 kVp x-rays, 6 MV photon beam, and 192 Ir gamma rays, respectively, while the magnitude of dose enhancement within the tumour was essentially unchanged. (note)

  16. Early developed ASD (adjacent segmental disease) in patients after surgical treatment of the spine due to cancer metastases.

    Science.gov (United States)

    Guzik, Grzegorz

    2017-05-12

    The causes of ASD are still relatively unknown. Correlation between clinical status of patients and radiological MRI findings is of primary importance. The radiological classifications proposed by Pfirmann and Oner are most commonly used to assess intradiscal degenerative changes. The aim of the study was to assess the influence of the extension of spine fixation on the risk of developing ASD in a short time after surgery. A total of 332 patients with spinal tumors were treated in our hospital between 2010 and 2013. Of these patients, 287 underwent surgeries. A follow-up MRI examination was performed 12 months after surgical treatment. The study population comprised of 194 patients. Among metastases, breast cancer was predominant (29%); neurological deficits were detected in 76 patients. Metastases were seen in the thoracic (45%) and lumbar (30%) spine; in 25% of cases, they were of multisegmental character. Pathological fractures concerned 88% of the patients. Statistical calculations were made using the χ2 test. Statistical analysis was done using the Statistica v. 10 software. A p value ASD were noted in only seven patients. Two patients had symptoms of nerve root irritation in the lumbar spine. Twenty-two patients (11%) were diagnosed with ASD according to the MRI classifications by Oner, Rijt, and Ramos, while the more sensitive Pfirmann classification allowed to detect the disease in 46 patients (24%). Healthy or almost healthy discs of Oner type I correlated with the criteria of Pfirmann types II and III. The percentage of the incidence of ASD diagnosed 1 year after the surgery using the Pfirmann classifications was significantly higher than diagnosed according to the clinical examination. The incidence of ASD in patients after spine surgeries due to cancer metastases does not differ between the study groups. ASD detectability based on clinical signs is significantly lower than ASD detectability based on MR images according to the system by Pfirrmann et

  17. High-order dynamic modeling and parameter identification of structural discontinuities in Timoshenko beams by using reflection coefficients

    Science.gov (United States)

    Fan, Qiang; Huang, Zhenyu; Zhang, Bing; Chen, Dayue

    2013-02-01

    Properties of discontinuities, such as bolt joints and cracks in the waveguide structures, are difficult to evaluate by either analytical or numerical methods due to the complexity and uncertainty of the discontinuities. In this paper, the discontinuity in a Timoshenko beam is modeled with high-order parameters and then these parameters are identified by using reflection coefficients at the discontinuity. The high-order model is composed of several one-order sub-models in series and each sub-model consists of inertia, stiffness and damping components in parallel. The order of the discontinuity model is determined based on the characteristics of the reflection coefficient curve and the accuracy requirement of the dynamic modeling. The model parameters are identified through the least-square fitting iteration method, of which the undetermined model parameters are updated in iteration to fit the dynamic reflection coefficient curve with the wave-based one. By using the spectral super-element method (SSEM), simulation cases, including one-order discontinuities on infinite- and finite-beams and a two-order discontinuity on an infinite beam, were employed to evaluate both the accuracy of the discontinuity model and the effectiveness of the identification method. For practical considerations, effects of measurement noise on the discontinuity parameter identification are investigated by adding different levels of noise to the simulated data. The simulation results were then validated by the corresponding experiments. Both the simulation and experimental results show that (1) the one-order discontinuities can be identified accurately with the maximum errors of 6.8% and 8.7%, respectively; (2) and the high-order discontinuities can be identified with the maximum errors of 15.8% and 16.2%, respectively; and (3) the high-order model can predict the complex discontinuity much more accurately than the one-order discontinuity model.

  18. Fluoroscopically-guided transforaminal epidural steroid injection for the treatment of sciatica due to herniated nucleus pulposus

    International Nuclear Information System (INIS)

    Liu Xiao; Wang Jianhui; Duan Zhaohui; Xu Zhitao; Shu Xiaomin; Qiu Ronghua

    2009-01-01

    Objective: To discuss the therapeutic benefit of fluoroscopically-guided lumbar transforaminal epidural steroid injections (TFESI) in treating patients with sciatica due to a herniated nucleus pulposus. Methods: From October 2004 to November 2007, fluoroscopically-guided lumbar TFESI as performed in 79 patients (41 males and 38 females with a mean age of 45.75 years,ranged from 20 to 70 years) with sciatica due to a herniated nucleus pulposus. Patients had a symptomatic course of disease from 8 weeks to 22 years and showed no response to conservative treatment. The diagnosis was confirmed by computed tomography or magnetic resonance imaging. TFESI was performed at patient's request. Additional injections, up to 3 times, were given with an interval of 7 or 10 days. The injection medicine consisted of 25 mg of prednisolone acetate and (9-14) ml of 0.5% lidocaine. Patients were evaluated by an independent observer and received questionnaires before the initial injection and at 6,12 months after TFESI. Questionnaires included an eleven points visual analog scale (VAS) and a five points patient satisfaction scale. A successful outcome required a patient satisfaction scale score of 3 (very good) or 4(excellent) and a reduction on the VAS score of 2 or more points after TFESI. Pain relief was classified as 'excellent' when the pain was completely resolved or diminished by 5 points or more, as 'good' when a diminution of pain was 2 points or more, as 'fair' and 'poor' when a diminution of pain was 1 point or less, or even an increase in pain. Results: Twenty-nine patients received single injection, 22 patients received two, 15 patients received three and 13 patients received four times of injection, with a mean of 1.96 times per patient. The mean VAS scores were 6.5(ranged 3.5-9.5) before and 3.8(ranged 0-9.5) 6 months after the procedure. Pain relief was graded as excellent in 35 patients (44.3%), good in 26 patients(32.9%), fair in 10 patients(12.7%), and poor in 8

  19. Severe isolated tricuspid insufficiency due to tricuspid papillary muscle rupture after a fall from a horse: treatment with port access minimally invasive cardiac surgery.

    Science.gov (United States)

    Öz, Kürsad; Mayeran, Yousef; Van Praet, Frank; Codens, Jose; Vanerman, Hugo

    2014-04-01

    We report on the successful treatment of tricuspid valve insufficiency due to blunt chest injury using port-access minimally invasive cardiac surgery. The optimal surgical treatment of traumatic valvular insufficiency is discussed, including a brief review of the relevant literature.

  20. Mammographic density changes following discontinuation of tamoxifen in premenopausal women with oestrogen receptor-positive breast cancer.

    Science.gov (United States)

    Kim, Won Hwa; Cho, Nariya; Kim, Young-Seon; Yi, Ann

    2018-04-06

    To evaluate the changes in mammographic density after tamoxifen discontinuation in premenopausal women with oestrogen receptor-positive breast cancers and the underlying factors METHODS: A total of 213 consecutive premenopausal women with breast cancer who received tamoxifen treatment after curative surgery and underwent three mammograms (baseline, after tamoxifen treatment, after tamoxifen discontinuation) were included. Changes in mammographic density after tamoxifen discontinuation were assessed qualitatively (decrease, no change, or increase) by two readers and measured quantitatively by semi-automated software. The association between % density change and clinicopathological factors was evaluated using univariate and multivariate regression analyses. After tamoxifen discontinuation, a mammographic density increase was observed in 31.9% (68/213, reader 1) to 22.1% (47/213, reader 2) by qualitative assessment, with a mean density increase of 1.8% by quantitative assessment compared to density before tamoxifen discontinuation. In multivariate analysis, younger age (≤ 39 years) and greater % density decline after tamoxifen treatment (≥ 17.0%) were independent factors associated with density change after tamoxifen discontinuation (p density change with a mean density increase of 1.8%, which was associated with younger age and greater density change after tamoxifen treatment. • Increased mammographic density after tamoxifen discontinuation can occur in premenopausal women. • Mean density increase after tamoxifen discontinuation was 1.8%. • Density increase is associated with age and density decrease after tamoxifen.

  1. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system

    International Nuclear Information System (INIS)

    Gladstone, D. J.; Li, S.; Jarvis, L. A.; Hartford, A. C.

    2011-01-01

    Purpose: The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Methods: Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Results: Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. Conclusions: The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  2. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Gladstone, D. J.; Li, S.; Jarvis, L. A.; Hartford, A. C. [Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 (United States); Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 and Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania 19104 (United States); Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756 (United States)

    2011-07-15

    Purpose: The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Methods: Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Results: Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. Conclusions: The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  3. 27 CFR 555.128 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Discontinuance of business. Where an explosive materials business or operations is discontinued and succeeded by... such facts and shall be delivered to the successor. Where discontinuance of the business or operations...

  4. 27 CFR 478.57 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Licenses § 478.57 Discontinuance of business. (a) Where a firearm or ammunition business is either discontinued or succeeded by a new owner, the owner of the business discontinued or succeeded shall within 30...

  5. Predictors of adalimumab drug survival in psoriasis differ by reason for discontinuation: long-term results from the Bio-CAPTURE registry.

    Science.gov (United States)

    van den Reek, J M P A; Tummers, M; Zweegers, J; Seyger, M M B; van Lümig, P P M; Driessen, R J B; van de Kerkhof, P C M; Kievit, W; de Jong, E M G J

    2015-03-01

    Drug survival is an indicator for treatment success; insight in predictors associated with drug survival is important. To analyse the long-term drug survival for adalimumab in patients with psoriasis treated in daily practice and (II) to identify predictors of prolonged drug survival for adalimumab split for different reasons of discontinuation. Data were extracted from a prospective psoriasis cohort and analysed using Kaplan-Meier survival curves split for reasons of discontinuation. Baseline predictors associated with longer drug survival were identified using multivariate Cox-regression analysis. One hundred and sixteen patients were included with a total of 208 patient-years. Overall drug survival was 76% after 1 year and 52% after 4.5 years. In patients who stopped due to ineffectiveness, longer drug survival was associated with the absence of specific comorbidities (P = 0.03). In patients who stopped due to side-effects, longer drug survival was associated with male gender (P = 0.02). Predictors of adalimumab drug survival in psoriasis differ by reason for discontinuation. Strong, specific predictors can lead to patient-tailored treatment. © 2014 European Academy of Dermatology and Venereology.

  6. Continuous and discontinuous transitions to synchronization.

    Science.gov (United States)

    Wang, Chaoqing; Garnier, Nicolas B

    2016-11-01

    We describe how the transition to synchronization in a system of globally coupled Stuart-Landau oscillators changes from continuous to discontinuous when the nature of the coupling is moved from diffusive to reactive. We explain this drastic qualitative change as resulting from the co-existence of a particular synchronized macrostate together with the trivial incoherent macrostate, in a range of parameter values for which the latter is linearly stable. In contrast to the paradigmatic Kuramoto model, this particular state observed at the synchronization transition contains a finite, non-vanishing number of synchronized oscillators, which results in a discontinuous transition. We consider successively two situations where either a fully synchronized state or a partially synchronized state exists at the transition. Thermodynamic limit and finite size effects are briefly discussed, as well as connections with recently observed discontinuous transitions.

  7. Seismic Observations Indicating That the 2015 Ogasawara (Bonin) Earthquake Ruptured Beneath the 660 km Discontinuity

    Science.gov (United States)

    Kuge, Keiko

    2017-11-01

    The termination of deep earthquakes at a depth of 700 km is a key feature for understanding the physical mechanism of deep earthquakes. The 680 km deep 30 May 2015, Ogasawara (Bonin) earthquake (Mw 7.9) and its aftershocks were recorded by seismic stations at distances from 7° to 19°. Synthetic seismograms indicate that the P waveforms depend on whether the earthquake is located above or below the 660 km discontinuity. In this study, I show that broadband recordings indicate that the 2015 earthquake may have occurred below the 660 km velocity discontinuity. Recordings of the P wave from the strongest aftershock lack evidence for wave triplication expected when a subhorizontal discontinuity underlies the hypocenter. Theoretical waveforms computed with a 660 km discontinuity above the aftershock and mainshock match the observed waveforms more accurately. These observations may indicate earthquake ruptures due to mantle minerals other than olivine or strong deformation of the 660 km phase transition.

  8. Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance).

    Science.gov (United States)

    Bluethmann, Shirley M; Alfano, Catherine M; Clapp, Jonathan D; Luta, George; Small, Brent J; Hurria, Arti; Cohen, Harvey J; Sugarman, Steven; B Muss, Hyman; Isaacs, Claudine; Mandelblatt, Jeanne S

    2017-10-01

    To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p cognition was not related to discontinuation in the other periods. Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

  9. Quantum field theory near surfaces of discontinuity

    International Nuclear Information System (INIS)

    Onishi, H.T.

    1981-01-01

    This work deals with the problem of a quantized scalar field propagating near a surface of discontinuity. The proper time formalism is employed to express the Green's function and stress tensor as proper time integrals of a transformation function. The transformation function is calculated by a WKB approximation which exhibits the essential singularities generated by the high frequency behavior of waves propagating near the surface. Two singularities are present, the usual direct singularity and an additional reflected singularity generated by the high frequency behavior of waves reflected by the discontinuity. The stress tensor is calculated by dimensional continuation. The results are employed to analyze energy generated by the surface

  10. News and views in discontinuous phase transitions

    Science.gov (United States)

    Nagler, Jan

    2014-03-01

    Recent progress in the theory of discontinuous percolation allow us to better understand the the sudden emergence of large-scale connectedness both in networked systems and on the lattice. We analytically study mechanisms for the amplification of critical fluctuations at the phase transition point, non-self-averaging and power law fluctuations. A single event analysis allow to establish criteria for discontinuous percolation transitions, even on the high-dimensional lattice. Some applications such as salad bowl percolation, and inverse fragmentation are discussed.

  11. MHD intermediate shock discontinuities: Pt. 1

    International Nuclear Information System (INIS)

    Kennel, C.F.; Blandford, R.D.; Coppi, P.

    1989-01-01

    Recent numerical investigations have focused attention once more on the role of intermediate shocks in MHD. Four types of intermediate shock are identified using a graphical representation of the MHD Rankine-Hugoniot conditions. This same representation can be used to exhibit the close relationship of intermediate shocks to switch-on shocks and rotational discontinuities. The conditions under which intermediate discontinuities can be found are elucidated. The variations in velocity, pressure, entropy and magnetic-field jumps with upstream parameters in intermediate shocks are exhibited graphically. The evolutionary arguments traditionally advanced against intermediate shocks may fail because the equations of classical MHD are not strictly hyperbolic. (author)

  12. Supportive treatment in weight-losing cancer patients due to the additive adverse effects of radiation treatment and/or chemotherapy

    International Nuclear Information System (INIS)

    Erkurt, E.; Tunali, C.; Erkisi, M.

    2000-01-01

    The reversal of anorexia and weight loss especially in patients with advanced cancer suffering from radiation treatment (RT) -related complications and debilitated further during RT would be a welcome relief. The purpose of this study is to evaluate the feasibility of supportive treatment with megestrol acetate (MA) in the weight-losing cancer patients increasingly experiencing anorexia, smell, taste, and weight loss due to the additive adverse effects of RT plus or minus chemotherapy and how MA changes the additive role of the severity of RT reactions on such patients. From June 1997 to October 1998, 100 eligible patients were enrolled on a randomized, placebo-controlled clinical trial. Of the 100 patients, 46 received MA during RT and 4 after the end of the RT, and 50 received placebo for 3 months. Subjective parameters were assessed by a brief questionnaire form based on scoring from 1 to 5, according to the degree of the loss or change for each parameter of malnutrition, appetite, taste and smell developed by the researchers. At the end of the study a statistically significant weight gain was achieved in the patient group receiving MA compared to the placebo group (+ 3 to + 5 kg versus -3.7 to -5.9 kg, p=0.000). Significant improvements were seen in performance status p=0.000), appetite (p=0.000), malnutrition (p=0.000), loss of taste (p=0.000) and smell qualities (p=0.02) in the MA group compared to the placebo group. In the MA group there was no statistically significant difference related to the weight changes according to the grade of either the acute or late RT effects (p=0.65 and 0.07, respectively). Whereas, in the placebo group a statistically significant additive effect of the acute and late RT effects was detected on weight loss (p=0.008 and 0.007, respectively). It was observed no side-effects of MA in a 3-month time follow-up. The use of MA 480 mg/day during RT was effective in reversing anorexia and weight loss in spite of the acute RT effects, and

  13. Supportive treatment in weight-losing cancer patients due to the additive adverse effects of radiation treatment and/or chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Erkurt, E.; Tunali, C. [Cukurova University Medical Faculty, Dept. of Radiation Oncology, Balcali-Adana (Turkey); Erkisi, M. [Cukurova University Medical Faculty, Dept. of Medical Oncology (Turkey)

    2000-12-01

    The reversal of anorexia and weight loss especially in patients with advanced cancer suffering from radiation treatment (RT) -related complications and debilitated further during RT would be a welcome relief. The purpose of this study is to evaluate the feasibility of supportive treatment with megestrol acetate (MA) in the weight-losing cancer patients increasingly experiencing anorexia, smell, taste, and weight loss due to the additive adverse effects of RT plus or minus chemotherapy and how MA changes the additive role of the severity of RT reactions on such patients. >From June 1997 to October 1998, 100 eligible patients were enrolled on a randomized, placebo-controlled clinical trial. Of the 100 patients, 46 received MA during RT and 4 after the end of the RT, and 50 received placebo for 3 months. Subjective parameters were assessed by a brief questionnaire form based on scoring from 1 to 5, according to the degree of the loss or change for each parameter of malnutrition, appetite, taste and smell developed by the researchers. At the end of the study a statistically significant weight gain was achieved in the patient group receiving MA compared to the placebo group (+ 3 to + 5 kg versus -3.7 to -5.9 kg, p=0.000). Significant improvements were seen in performance status (p=0.000), appetite (p=0.000), malnutrition (p=0.000), loss of taste (p=0.000) and smell qualities (p=0.02) in the MA group compared to the placebo group. In the MA group there was no statistically significant difference related to the weight changes according to the grade of either the acute or late RT effects (p=0.65 and 0.07, respectively). Whereas, in the placebo group a statistically significant additive effect of the acute and late RT effects was detected on weight loss (p=0.008 and 0.007, respectively). It was observed no side-effects of MA in a 3-month time follow-up. The use of MA 480 mg/day during RT was effective in reversing anorexia and weight loss in spite of the acute RT effects

  14. First-line antiretroviral drug discontinuations in children.

    Directory of Open Access Journals (Sweden)

    Melony Fortuin-de Smidt

    Full Text Available There are a limited number of paediatric antiretroviral drug options. Characterising the long term safety and durability of different antiretrovirals in children is important to optimise management of HIV infected children and to determine the estimated need for alternative drugs in paediatric regimens. We describe first-line antiretroviral therapy (ART durability and reasons for discontinuations in children at two South African ART programmes, where lopinavir/ritonavir has been recommended for children <3 years old since 2004, and abacavir replaced stavudine as the preferred nucleoside reverse transcriptase inhibitor in 2010.We included children (<16 years at ART initiation who initiated ≥3 antiretrovirals between 2004-2014 with ≥1 follow-up visit on ART. We estimated the incidence of first antiretroviral discontinuation using Kaplan-Meier analysis. We determined the reasons for antiretroviral discontinuations using competing risks analysis. We used Cox regression to identify factors associated with treatment-limiting toxicity.We included 3579 children with median follow-up duration of 41 months (IQR 14-72. At ART initiation, median age was 44 months (IQR 13-89 and median CD4 percent was 15% (IQR 9-21%. At three and five years on ART, 72% and 26% of children respectively remained on their initial regimen. By five years on ART, the most common reasons for discontinuations were toxicity (32%, treatment failure (18%, treatment simplification (5%, drug interactions (3%, and other or unspecified reasons (18%. The incidences of treatment limiting toxicity were 50.6 (95% CI 46.2-55.4, 1.6 (0.5-4.8, 2.0 (1.2-3.3, and 1.3 (0.6-2.8 per 1000 patient years for stavudine, abacavir, efavirenz and lopinavir/ritonavir respectively.While stavudine was associated with a high risk of treatment-limiting toxicity, abacavir, lopinavir/ritonavir and efavirenz were well-tolerated. This supports the World Health Organization recommendation to replace stavudine with

  15. Stress-assisted discontinuous precipitation during creep of Ti3Al-Nb alloys

    International Nuclear Information System (INIS)

    Rowe, R.G.; Hall, E.L.

    1991-01-01

    Stress-assisted discontinuous precipitation was observed during creep of Ti-25Al-12.5Nb at. pct and associated with microstructures in which large primary creep strains were observed earlier. It was found that a large shift between the equilibrium beta(0) (B2) phase composition at the heat treatment temperature and disordered beta (bcc) phase at the creep temperature provided a driving force for discontinuous precipitation of disordered beta phase. Applied stress accelerated the growth of discontinuous beta phase at grain boundaries perpendicular to the principal stress axis, but did not produce a significant shift in composition. The difference between beta and ordered beta phase boundaries in the Ti-Al-Nb system at 650 C and 1040 C suggests that discontinuous precipitation or related dissolution should occur in all Ti3Al-Nb alloys. 11 refs

  16. Changes in digestibility and cell - wall constituents of some agricultural by-products due to gamma irradiation and urea treatments

    International Nuclear Information System (INIS)

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

    2000-01-01

    The effects of different doses of gamma irradiation (0. 100, 150, 200 KGy) or different concentrations of urea (0, 2, 3, and 5 g urea/100 g DM) on in-vitro organic matter digestibility (JVOMD), digestible energy (IVDE), gross energy (GE) nd cell-wall constituents: neutral-detergent fibre, acid-detergent fibre and acid=detergent lignin, have been evaluated in wheat straw, cotton seed shell, peanut shell, soybean shell, extracted olive cake and extracted unpeeled sunflower seeds. The results indicated that gamma irradiation or urea treatments increased the digestible energy values significantly. (p<0.05) and these were attributed to the increases IVOMD and decreases cell-wall constituents of treated samples. The experimental agricultural by-products do not respond to the treatments in the same amount in increasing the IVOMD. There was no significant effect of irradiation and urea treatments on GE. Combined treatments had slightly less effect in increasing IVDE as the addition of both effects. The treatment of 200 KGy and 5% urea resulted in a larger increase in the digestible energy and a better effect by reducing the concentration of the cell-wall constituents even more than what occurred using a single treatment. However, the combination of irradiation with urea treatments could reduce the applied irradiation doses for increasing the IVDE in some studied agricultural by-products. (author)

  17. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of 131I in Hyperthyroidism

    International Nuclear Information System (INIS)

    Kartamihardja, A. Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended

  18. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of (131)I in Hyperthyroidism.

    Science.gov (United States)

    Kartamihardja, A Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended.

  19. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of 131I in Hyperthyroidism

    Science.gov (United States)

    Kartamihardja, A. Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended. PMID:27134556

  20. Structured population dynamics: continuous size and discontinuous stage structures.

    Science.gov (United States)

    Buffoni, Giuseppe; Pasquali, Sara

    2007-04-01

    A nonlinear stochastic model for the dynamics of a population with either a continuous size structure or a discontinuous stage structure is formulated in the Eulerian formalism. It takes into account dispersion effects due to stochastic variability of the development process of the individuals. The discrete equations of the numerical approximation are derived, and an analysis of the existence and stability of the equilibrium states is performed. An application to a copepod population is illustrated; numerical results of Eulerian and Lagrangian models are compared.

  1. Improvement in pulmonary functions and clinical parameters due to addition of breathing exercises in asthma patients receiving optimal treatment

    Directory of Open Access Journals (Sweden)

    Dipti Agarwal

    2017-01-01

    Conclusions: Breathing exercises provided significant improvements in spirometric parameters and significant reduction in breathlessness, wheezing, and nocturnal symptoms as well as requirements of rescue medicines in asthma patients who were receiving optimal asthma treatment.

  2. Can growth hormone treatment improve growth in children with severe growth failure due to anorexia nervosa? A preliminary pilot study

    Directory of Open Access Journals (Sweden)

    Juliane Léger

    2017-11-01

    Full Text Available Background/Aims: Growth failure is a difficult but key aspect of care in children with anorexia nervosa (AN. The effects of hGH therapy have not been studied. The aim was to investigate the effect of hGH treatment on height velocity (HV in children with AN. Methods: We carried out a retrospective observational study. Ten girls diagnosed with AN at 10.0 ± 1.9 years, with prolonged severe growth failure (HV < 2.5 cm/year for at least 18 months at the age of 13.3 ± 1.1 years and delayed puberty after nutritional rehabilitation, were treated with hGH (0.040 mg/kg/day from a bone age of 10.9 ± 1.7 years until they reached adult height. Height and HV were measured before treatment and at 12-month intervals during treatment. Results: Mean body mass index SDS remained unchanged, but HV increased significantly, from a median of 1.0 (0.7–2.1 to 7.1 (6.0–9.5 cm/year after one year (P < 0.002 and 5.6 (4.8–6.2 cm/year after two years of treatment. Height SDS increased from −2.2 ± 1.3 to −1.6 ± 1.3 after one year (P < 0.002 and −1.1 ± 1.5 after two years of GH treatment. Adult height (−0.1 ± 1.0 SDS was close to target height after 3.6 ± 1.4 years of GH treatment. Serum IGF-I levels increased significantly during treatment (P < 0.01. The treatment was well tolerated. Conclusions: This proof-of-concept study shows that hGH treatment is associated with significant improvements in linear growth in adolescents with AN and severe growth failure. A randomized placebo-controlled trial is required to determine the ultimate impact of GH treatment in patients with this severe, rare condition.

  3. Celecoxib for the treatment of mild-to-moderate depression due to acute brucellosis: a double-blind, placebo-controlled, randomized trial.

    Science.gov (United States)

    Jafari, S; Ashrafizadeh, S-G; Zeinoddini, A; Rasoulinejad, M; Entezari, P; Seddighi, S; Akhondzadeh, S

    2015-08-01

    Depression is a debilitating complication of brucellosis and how best to treat this is a matter of debate. Inflammatory processes are involved in the pathogenesis of both brucellosis and depression. Therefore, we hypothesized that celecoxib could be beneficial for the treatment of depression due to brucellosis. Forty outpatients with depression due to brucellosis with a Hamilton Depression Rating Scale score (HDRS) brucellosis when compared with placebo. © 2015 John Wiley & Sons Ltd.

  4. Percutaneous Vertebroplasty Versus Conservative Treatment and Rehabilitation in Women with Vertebral Fractures due to Osteoporosis: A Prospective Comparative Study.

    Science.gov (United States)

    Macías-Hernández, Salvador Israel; Chávez-Arias, Daniel David; Miranda-Duarte, Antonio; Coronado-Zarco, Roberto; Diez-García, María Pilar

    2015-01-01

    Percutaneous vertebroplasty is commonly used in the management of osteoporosis-related vertebral fractures, although there is controversy on its superiority over conservative treatment. Here we compare pain and function in women with vertebral osteoporotic fractures who underwent percutaneous vertebroplasty versus conservative treatment with a protocolized rehabilitation program. A longitudinal and comparative prospective study was conducted. Women ≥ 60 years of age with a diagnosis of osteoporosis who had at least one vertebral thoracic or lumbar compression fracture were included and divided into two groups, conservative treatment or vertebroplasty. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pain and function, respectively, as the outcome measures. We included 31 patients, 13 (42%) treated with percutaneous vertebroplasty and 18 (58%) with conservative treatment. Baseline clinical characteristics, bone densitometry and fracture data were similar in both groups. At baseline, VAS was 73.1 ± 28.36 in the vertebroplasty group and 68.6 ± 36.1 mm in the conservative treatment group (p = 0.632); at three months it was 33.11 ± 10.1 vs. 42 ± 22.21 mm (p = 0.111); and at 12 months, 32.3 ± 11.21 vs. 36.1 ± 12.36 mm (p = 0.821). The ODI at baseline was 83% in the vertebroplasty group vs. 85% for conservative management (p = 0.34); at three months, 36 vs. 39% (p = 0.36); and at 12 months, 29.38 vs. 28.33% (p = 0.66). Treatment with percutaneous vertebroplasty had no advantages over conservative treatment for pain and function in this group of women ≥ 60 years of age with osteoporosis.

  5. [Effect of antenatal spiramycin treatment on the frequency of retinochoroiditis due to congenital toxoplasmosis in a Colombian cohort].

    Science.gov (United States)

    Zuluaga, Liliana María; Hernández, John Camilo; Castaño, Carlos Felipe; Donado, Jorge Hernando

    2017-04-01

    Gestational toxoplasmosis is frequent and severe. There is still debate about the benefits of treatment against ocular manifestations in the newborn. Spiramycin treatment is used for this purpose, unfortunately prenatal diagnosis is sometimes delayed and pregnant women are not treated. To describe the relationship between treatment with spiramycin during pregnancy in mothers with gestational toxoplasmosis and development of ocular toxoplasmosis in newborns. We conducted a descriptive study of a case series. We evaluated a prospective cohort of patients diagnosed with gestational toxoplasmosis during three years at the Retinology Service at the Clínica Universitaria Bolivariana in Medellín. Gestational toxoplasmosis was found in 23 mothers; 15 (65%) were treated during pregnancy with 3 g per day of spiramycin, eight (35%) patients were untreated. In the treated group just one newborn developed ocular toxoplasmosis (6.6%), in contrast with five (62.5%) of the eight patients who did not receive treatment. These results suggest that pregnancy treatment reduces the relative risk of ocular toxoplasmosis in the newborn by 96% (95% CI: 33 - 100%). Only two (14%) of the patients who were evaluated, had nervous system involvement related to toxoplasmosis in CT scan or cerebral ultrasound. These two patients also developed ocular pathology and were diagnosed at the time of birth, so they did not received antenatal treatment. A protective effect was found against the ocular involvement in patients whose mother received treatment with spiramycin (OR=0.04;95% CI: 0.00-0.67), p<0.01 (Fisher's Exact Test).

  6. Regression Discontinuity Designs Based on Population Thresholds

    DEFF Research Database (Denmark)

    Eggers, Andrew C.; Freier, Ronny; Grembi, Veronica

    In many countries, important features of municipal government (such as the electoral system, mayors' salaries, and the number of councillors) depend on whether the municipality is above or below arbitrary population thresholds. Several papers have used a regression discontinuity design (RDD...

  7. Mechanics of interfaces and evolving discontinuities

    NARCIS (Netherlands)

    De Borst, René; Remmers, Joris J C; Verhoosel, Clemens V.; Needleman, Alan; Zingoni, A.

    2013-01-01

    The two main approaches to the modelling of discontinuities are reviewed concisely, followed by a discussion of cohesive models for fracture. Emphasis is put on a novel approach to incorporate triaxiality into cohesive-zone models, and on the representation of cohesive crack models by phase-field

  8. Hybridized Multiscale Discontinuous Galerkin Methods for Multiphysics

    Science.gov (United States)

    2015-09-14

    local approximation spaces of the hybridizable discontinuous Galerkin methods with precomputed phases which are solutions of the eikonal equation in...geometrical optics. Second, we propose a systematic procedure for computing multiple solutions of the eikonal equation. Third, we utilize the eigenvalue

  9. Discontinuous precipitation in copper base alloys

    Indian Academy of Sciences (India)

    Discontinuous precipitation (DP) is associated with grain boundary migration in the wake of which alternate plates of the precipitate and the depleted matrix form. Some copper base alloys show DP while others do not. In this paper the misfit strain parameter, , has been calculated and predicted that if 100 > ± 0.1, DP is ...

  10. Trial discontinuation: lessons for future trial design?

    NARCIS (Netherlands)

    V.J.A.A. Nuij (Veerle); C.J. de Haar (Colin); C.J. van der Woude (Janneke)

    2012-01-01

    textabstractBackground: The current therapeutic arsenal still does not fulfill the therapeutic needs of inflammatory bowel disease patients. Although new drugs are constantly being developed, many will never reach the market. In this review we will search for reasons for discontinuing promising

  11. Controlling chaos in discontinuous dynamical systems

    International Nuclear Information System (INIS)

    Danca, Marius-F.

    2004-01-01

    In this paper we consider the possibility to implement the technique of changes in the system variables to control the chaos introduced by Gueemez and Matias for continuous dynamical systems to a class of discontinuous dynamical systems. The approach is realized via differential inclusions following the Filippov theory. Three practical examples are considered

  12. Forecasting Technological Discontinuities in the ICT Industry

    DEFF Research Database (Denmark)

    Hoisl, Karin; Stelzer, Tobias; Biala, Stefanie

    2015-01-01

    in the ICT industry. The conjoint approach allows for a simulation of the forecasting process and considers utility trade-offs. The results show that for both types of experts the perceived benefit of users most highly contributes to predicting technological discontinuities. Internal experts assign more...

  13. 77 FR 26185 - POSTNET Barcode Discontinuation

    Science.gov (United States)

    2012-05-03

    ... discontinue POSTNET barcodes for automation letter and flat price eligibility. There were six comments... on each piece, to facilitate processing by presort companies. We added language to specifically allow..., with or without prepayment of postage, for return to the address on the reply piece. If postage is...

  14. Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study.

    Science.gov (United States)

    Kubo, Satoshi; Yamaoka, Kunihiro; Amano, Koichi; Nagano, Shuji; Tohma, Shigeto; Suematsu, Eiichi; Nagasawa, Hayato; Iwata, Kanako; Tanaka, Yoshiya

    2017-08-01

    To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  15. Second tyrosine kinase inhibitor discontinuation attempt in patients with chronic myeloid leukemia.

    Science.gov (United States)

    Legros, Laurence; Nicolini, Franck E; Etienne, Gabriel; Rousselot, Philippe; Rea, Delphine; Giraudier, Stéphane; Guerci-Bresler, Agnès; Huguet, Françoise; Gardembas, Martine; Escoffre, Martine; Ianotto, Jean-Christophe; Noël, Marie-Pierre; Varet, Bruno R; Pagliardini, Thomas; Touitou, Irit; Morisset, Stéphane; Mahon, Francois-Xavier

    2017-11-15

    Several studies have demonstrated that approximately one-half of patients with chronic myeloid leukemia (CML) who receive treatment with tyrosine kinase inhibitors (TKIs) and achieve and maintain a deep molecular response (DMR) are able to successfully discontinue therapy. In patients who have a molecular relapse, a DMR is rapidly regained upon treatment re-initiation. The authors report the results from RE-STIM, a French observational, multicenter study that evaluated treatment-free remission (TFR) in 70 patients who re-attempted TKI discontinuation after a first unsuccessful attempt. After the second TKI discontinuation attempt, the trigger for treatment re-introduction was the loss of a major molecular response in all patients. The median follow-up was 38.3 months (range, 4.7-117 months), and 45 patients (64.3%) lost a major molecular response after a median time off therapy of 5.3 months (range, 2-42 months). TFR rates at 12, 24, and 36 months were 48% (95% confidence interval [CI], 37.6%-61.5%), 42% (95% CI, 31.5%-55.4%), and 35% (95% CI, 24.4%-49.4%), respectively. No progression toward advanced-phase CML occurred, and no efficacy issue was observed upon TKI re-introduction. In univariate analysis, the speed of molecular relapse after the first TKI discontinuation attempt was the only factor significantly associated with outcome. The TFR rate at 24 months was 72% (95% CI, 48.8%-100%) in patients who remained in DMR within the first 3 months after the first TKI discontinuation and 36% (95% CI, 25.8%-51.3%) for others. This study is the first to demonstrate that a second TKI discontinuation attempt is safe and that a first failed attempt at discontinuing TKI does not preclude a second successful attempt. Cancer 2017;123:4403-10. © 2017 American Cancer Society. © 2017 American Cancer Society.

  16. Excursions in fluvial (dis)continuity

    Science.gov (United States)

    Grant, Gordon E.; O'Connor, James E.; Safran, Elizabeth

    2017-01-01

    Lurking below the twin concepts of connectivity and disconnectivity are their first, and in some ways, richer cousins: continuity and discontinuity. In this paper we explore how continuity and discontinuity represent fundamental and complementary perspectives in fluvial geomorphology, and how these perspectives inform and underlie our conceptions of connectivity in landscapes and rivers. We examine the historical roots of continuum and discontinuum thinking, and how much of our understanding of geomorphology rests on contrasting views of continuity and discontinuity. By continuum thinking we refer to a conception of geomorphic processes as well as geomorphic features that are expressed along continuous gradients without abrupt changes, transitions, or thresholds. Balance of forces, graded streams, and hydraulic geometry are all examples of this perspective. The continuum view has played a prominent role in diverse disciplinary fields, including ecology, paleontology, and evolutionary biology, in large part because it allows us to treat complex phenomena as orderly progressions and invoke or assume equilibrium processes that introduce order and prediction into our sciences.In contrast the discontinuous view is a distinct though complementary conceptual framework that incorporates non-uniform, non-progressive, and non-equilibrium thinking into understanding geomorphic processes and landscapes. We distinguish and discuss examples of three different ways in which discontinuous thinking can be expressed: 1) discontinuous spatial arrangements or singular events; 2) specific process domains generally associated with thresholds, either intrinsic or extrinsic; and 3) physical dynamics or changes in state, again often threshold-linked. In moving beyond the continuous perspective, a fertile set of ideas comes into focus: thresholds, non-equilibrium states, heterogeneity, catastrophe. The range of phenomena that is thereby opened up to scientific exploration similarly expands

  17. Cost consequences due to reduced ulcer healing times - analyses based on the Swedish Registry of Ulcer Treatment.

    Science.gov (United States)

    Öien, Rut F; Forssell, Henrik; Ragnarson Tennvall, Gunnel

    2016-10-01

    Resource use and costs for topical treatment of hard-to-heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard-to-heal ulcers who healed between 2009 and 2012. Per-patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 1·4 to 1·6 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard-to-heal ulcers can be reduced with well-developed treatment strategies resulting in shortened healing times as shown in RUT. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  18. [Treatment of non-neurogenic masculine urinary incontinence due to overactive bladder: a review by the LUTS committee of the French Urological Association].

    Science.gov (United States)

    Lebdai, S; Haillot, O; Azzouzi, A R; Benchikh, A; Campeggi, A; Cornu, J-N; Delongchamps, N B; Dumonceau, O; Faix, A; Fourmarier, M; Lukacs, B; Mathieu, R; Misrai, V; Robert, G; de La Taille, A; Descazeaud, A

    2014-07-01

    To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder. A systematic review was conducted using PubMed/MEDLINE with the following keywords: "overactive bladder", "male urinary incontinence", "urgency", "antimuscarinic", "onabotulinumtoxinA", "neurostimulation", "cystoplasty". Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively -71% vs. -40%, P masculine population exclusively. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Toxic keratopathy due to abuse of topical anesthetic drugs.

    Science.gov (United States)

    Yeniad, Baris; Canturk, Serife; Esin Ozdemir, Fatma; Alparslan, Nilufer; Akarcay, Koray

    2010-06-01

    To describe 8 cases of toxic keratopathy due to abuse of topical anesthetic drugs. Clinical findings from patients with toxic keratopathy were investigated retrospectively. Two patients had toxic keratopathy bilaterally. Five of 8 patients had an ocular history of a corneal foreign body, 1 had basal membrane dystrophy, 1 had ultraviolet radiation, and 1 had chemical burn. All patients had undergone psychiatric consultation. Four patients had anxiety disorder and 1 had bipolar disease. Clinical signs were improved in all patients with discontinuation of topical anesthetic drug use along with adjunctive psychiatric treatment. Penetrating keratoplasty was performed in 2 patients. Toxic keratopathy due to topical anesthetic abuse is a curable disease. Early diagnosis and prevention of topical anesthetic drug use are the most important steps in the treatment of this condition. As these patients commonly exhibit psychiatric disorders, adjunctive psychiatric treatment may help to break the chemical addiction.

  20. Discontinuation of furosemide decreases PaCO(2) in patients with COPD.

    NARCIS (Netherlands)

    Brijker, F.; Heijdra, Y.F.; Elshout, F.J.J. van den; Folgering, H.T.M.

    2002-01-01

    STUDY OBJECTIVE: To evaluate whether the discontinuation of furosemide treatment resulted in a decrease in PaCO(2) and an increase in daytime and nocturnal oxygenation. BACKGROUND: Furosemide is widely prescribed in patients with COPD for the treatment of peripheral edema. It is known that

  1. Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

    Directory of Open Access Journals (Sweden)

    Yooseok Shin

    2016-02-01

    Full Text Available During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

  2. Feasibility of adjunct therapeutic hypothermia treatment for hyperammonemia and encephalopathy due to urea cycle disorders and organic acidemias.

    Science.gov (United States)

    Lichter-Konecki, Uta; Nadkarni, Vinay; Moudgil, Asha; Cook, Noah; Poeschl, Johannes; Meyer, Michael T; Dimmock, David; Baumgart, Stephen

    2013-08-01

    Children with urea cycle disorders (UCDs) or organic acidemias (OAs) and acute hyperammonemia and encephalopathy are at great risk for neurological injury, developmental delay, intellectual disability, and death. Nutritional support, intravenous alternative pathway therapy, and dialysis are used to treat severe hyperammonemia associated with UCDs and nutritional support and dialysis are used to treat severe hyperammonemia in OAs. Brain protective treatment while therapy is initiated may improve neurological and cognitive function for the lifetime of the child. Animal experiments and small clinical trials in hepatic encephalopathy caused by acute liver failure suggest that therapeutic hypothermia provides neuroprotection in hyperammonemia associated encephalopathy. We report results of an ongoing pilot study that assesses if whole body cooling during rescue treatment of neonates with acute hyperammonemia and encephalopathy is feasible and can be conducted safely. Adjunct whole body therapeutic hypothermia was conducted in addition to standard treatment in acutely encephalopathic, hyperammonemic neonates with UCDs and OAs requiring dialysis. Therapeutic hypothermia was initiated using cooling blankets as preparations for dialysis were underway. Similar to standard therapeutic hypothermia treatment for neonatal hypoxic ischemic encephalopathy, patients were maintained at 33.5°C±1°C for 72h, they were then slowly rewarmed by 0.5°C every 3h over 18h. In addition data of age-matched historic controls were collected for comparison. Seven patients were cooled using the pilot study protocol and data of seven historic controls were reviewed. All seven patients survived the initial rescue and cooling treatment, 6 patients were discharged home 2-4weeks after hospitalization, five of them feeding orally. The main complication observed in a majority of patients was hypotension. Adjunct therapeutic hypothermia for neonates with UCDs and OAs receiving standard treatment was

  3. Hemoperitoneum due to ruptured paraumbilical vein in a cirrhotic patient with portal hypertension : treatment by means of coil embolization

    International Nuclear Information System (INIS)

    Lee, Jong Myeong; Kim, Hyung Lyul; Lee, Young Hwan; Lee, So Hyun; Kim, Jong Kun

    2000-01-01

    The paraumbilical vein is one of the anastomotic channels between the portal and systemic circulatory systems, and rupture of the intra-abdominal varix is an unusual complication of portal hypertension that can lead to life-threatening hemoperitoneum. We experienced a case of hemoperitoneum due to a ruptured paraumbilical vein revealed by ultrasonography (US), computed tomography (CT) and percutaneous transhepatic portography. The last mentioned demonstrated a dilated paraumbilical vein draining two branches of the left portal vein into the right external iliac vein, and we performed coil embolization at the site at which the presumed site of paraumbilical vein was presumed to cause hemoperitoneum. We describe this this unusual case of hemoperitoneum due to a ruptured paraumbilical vein in a known liver cirrhosis patient in whom portal hypertension was treated by means of coil embolization. (author)

  4. [Osteoporosis fracture in a male patient secondary to hypogonadism due to androgen deprivation treatment for prostate cancer].

    Science.gov (United States)

    Verdú Solans, J; Roig Grau, I; Almirall Banqué, C

    2014-01-01

    A 84 year-old patient, in therapy with androgen deprivation during the last 5 years due a prostate cancer, is presented with a osteoporotic fracture of the first lumbar vertebra. The pivotal role of the primary care physician, in the prevention of the osteoporosis secondary to the hypogonadism in these patients, is highlighted. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  5. Transcatheter Treatment of “Pulmonary Artery Hypertension” due to Patent Ductus Arteriosus and Pulmonary Artery Stenosis

    OpenAIRE

    Gaio, Gianpiero; Santoro, Giuseppe; D'Alto, Michele; Palladino, Maria Teresa; Russo, Maria Giovanna; Caianiello, Giuseppe; Calabrò, Raffaele

    2006-01-01

    The association between large, left-sided patent ductus arteriosus and severe, peripheral, right pulmonary artery stenosis with no other cardiac malformation is an unreported condition that might be misdiagnosed as pulmonary hypertension due to long-standing ductal shunt. A 57-year-old man with supposed hypertensive patent ductus arteriosus underwent confirmatory cardiac catheterization. At angiography, a severe pre-hilar right pulmonary artery stenosis (peak pressure gradient, 65 mmHg) was f...

  6. Thrombolytic treatment given at the and of the first week of stroke due to pulmonary embolism in a patient with middlee cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2014-08-01

    Full Text Available Thrombolytic treatment is the most effective and commonly used method into firs 4,5 hours of acute ischemic stroke and massive pulmonary embolism. It is known that thrombolytic treatment is definitely contraindicated in cases who had an ischemic stroke into last three months. In this paper, it was reported that thrombolytic treatment had given for pulmonary embolism which developed one week after stroke in a case with stroke due to middle cerebral artery occlusion. Here, we presented a case which is rarely seen and required difficulty in deciding.

  7. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  8. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland; Morel, Olivier

    2009-01-01

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  9. Thalidomide for treatment of gastrointestinal bleedings due to angiodysplasia : a case report in acquired von Willebrand syndrome and review of the literature

    NARCIS (Netherlands)

    Engelen, E T; van Galen, K P M; Schutgens, R E G

    INTRODUCTION: Acquired von Willebrand syndrome is a rare bleeding disorder and treatment of the associated gastrointestinal (GI) bleeding due to angiodysplasia is challenging. AIM: The aim of this study was to present a new case on the successful use of thalidomide in a patient with acquired von

  10. Rigorous treatment of the non-ohmic d.c. conductivity due to phonon-assisted tunneling from localized to extended states

    International Nuclear Information System (INIS)

    Majernikova, E.

    1984-03-01

    A quantitative treatment of the non-ohmic current response due to delocalization of shallow localized electrons in a model of a disordered solid is given. A phonon-assisted tunneling in electric field from shallow localized to extended states is confirmed as a mechanism leading to the dependence which was experimentally found for chalcogenide glasses. (author)

  11. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

    Directory of Open Access Journals (Sweden)

    Tanaka Motoyuki

    2012-08-01

    Full Text Available Abstract We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249

  12. Pathological femoral fractures due to osteomalacia associated with adefovir dipivoxil treatment for hepatitis B: a case report

    Science.gov (United States)

    2012-01-01

    We present a case of a 62-year-old man who underwent total hip arthroplasty for treatment of pathologic femoral neck fracture associated with adefovir dipivoxil-induced osteomalacia. He had a 13-month history of bone pain involving his shoulders, hips, and knee. He received adefovir dipivoxil for treatment of lamivudine-resistant hepatitis B virus infection for 5 years before the occurrence of femoral neck fracture. Orthopedic surgeons should be aware of osteomalacia and pathological hip fracture caused by drug-induced renal dysfunction, which results in Fanconi’s syndrome. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1600344696739249 PMID:22906214

  13. Acute abdomen in early pregnancy due to ovarian torsion following successful in vitro fertilization treatment

    Directory of Open Access Journals (Sweden)

    Hsing-Chun Tsai

    2015-08-01

    Conclusion: Ovarian hyperstimulation during IVF–embryo transfer treatment is a risk factor for developing adnexal torsion. Early diagnosis and prompt surgical intervention is the only way to protect the ovary and preserve the pregnancy. Laparoscopic surgery in early pregnancy causes no harm to the fetus and should be encouraged once the diagnosis is confirmed. Delaying surgery may induce serious infection and jeopardize the lives of both the fetus and mother.

  14. Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch

    OpenAIRE

    Lionberger, David

    2010-01-01

    David R Lionberger1, Michael J Brennan21Southwest Orthopedic Group, Houston, TX, USA; 2Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USAAbstract: The objective of this article is to review published clinical data on diclofenac epolamine topical patch 1.3% (DETP) in the treatment of acute soft tissue injuries, such as strains, sprains, and contusions. Review of published literature on topical nonsteroidal anti-inflammatory drugs (NSAIDs), diclofenac, and DETP in patients with ac...

  15. ATP Synthase Deficiency due to TMEM70 Mutation Leads to Ultrastructural Mitochondrial Degeneration and Is Amenable to Treatment

    Directory of Open Access Journals (Sweden)

    Anne K. Braczynski

    2015-01-01

    Full Text Available TMEM70 is involved in the biogenesis of mitochondrial ATP synthase and mutations in the TMEM70 gene impair oxidative phosphorylation. Herein, we report on pathology and treatment of ATP synthase deficiency in four siblings. A consanguineous family of Roma (Gipsy ethnic origin gave birth to 6 children of which 4 were affected presenting with dysmorphic features, failure to thrive, cardiomyopathy, metabolic crises, and 3-methylglutaconic aciduria as clinical symptoms. Genetic testing revealed a homozygous mutation (c.317-2A>G in the TMEM70 gene. While light microscopy was unremarkable, ultrastructural investigation of muscle tissue revealed accumulation of swollen degenerated mitochondria with lipid crystalloid inclusions, cristae aggregation, and exocytosis of mitochondrial material. Biochemical analysis of mitochondrial complexes showed an almost complete ATP synthase deficiency. Despite harbouring the same mutation, the clinical outcome in the four siblings was different. Two children died within 60 h after birth; the other two had recurrent life-threatening metabolic crises but were successfully managed with supplementation of anaplerotic amino acids, lipids, and symptomatic treatment during metabolic crisis. In summary, TMEM70 mutations can cause distinct ultrastructural mitochondrial degeneration and almost complete deficiency of ATP synthase but are still amenable to treatment.

  16. Radiation dermatitis due to catheter ablation used in the treatment of arrhythmia. A report of two cases

    International Nuclear Information System (INIS)

    Nagano, Tohru; Kosaka, Hiroshi; Shimoura, Shinichi; Tsuru, Kenta; Yamagami, Nao; Ikeda, Tetsuya; Nishigori, Chikako; Yoshida, Akihiro

    2004-01-01

    We report 2 cases of radiation dermatitis caused by catheter ablation for treatment of atrial fibrillation resisitant to conventional therapies. Case 1, 50-year-old male underwent pulmonary veins ablation for treatment of atrial fibrillation. Cumulative fluoroscopic imaging time of 370 min was required. Case 2, 74-year-old female also underwent pulmonary veins ablation for treatment of atrial fibrillation. Cumulative fluoroscopic imaging time of 550 min was required. Since dose rate used for imaging is 20∼80 mGy/min, accumulated skin doses were estimated as 7.4∼29.6 Gy and 5.6∼22.4 Gy, respectively. Two weeks after their last ablation, brown, painful macule and plaque appeared on the outer side of their right upper arms. To our knowledge, the risk of overexposure to X-ray in cases of PTCA (percutaneous transluminal coronary angioplasty) for ischemic heart diseases has been well known, but little is known about the risk of catheter ablation. The location of radiation dermatitis caused by catheter ablation (CA) is rather different from that of PTCA. It is critical for cardiologists and dermatologists to observe and find the symptoms of acute radiation dermatitis in order to avoid repeated overexposure to X-ray. (author)

  17. The Use of a Combined Regimen of GnRH Agonist Plus a Low-Dose Oral Contraceptive Improves the Spontaneous Pulsatile LH Secretory Characteristics in Patients with Polycycstic Ovary Disease After Discontinuation of Treatment

    OpenAIRE

    Genazzani, Alessandro D.; Battaglia, Cesare; Gamba, Ombretta; Petraglia, Felice; Malavasi, Barbara; Genazzani, Andrea R.

    2000-01-01

    Purpose: The fertility rate in women with polycystic ovarydisease (PCOD) is influenced by the type of treatmentreceived. The present study evaluated the possiblecorrelation between treatment and pulsatile release ofgonadotropins.

  18. Repeat LISS treatment for femoral shaft fractures due to hardware failure: a retrospective analysis of eleven cases.

    Science.gov (United States)

    Li, Xu; Xu, Xian; Liu, Lin; Shao, Qin; Wu, Wei

    2013-10-01

    To evaluate the effectiveness of a replating technique having a less-invasive stabilization system (LISS) for femoral shaft fractures due to LISS failure in adults. There were 11 patients with hardware failure of LISS for femoral shaft fractures, on an average of 50 days after the primary operation. The failed implants were removed, and the fractures were replated with a LISS following the rationale of biological osteosynthesis. Radiological fracture union and incidence of postoperative complications were employed to evaluate the effectiveness of this replating technique for femoral shaft fractures. Operative duration including removing failed hardware and replating fractures averaged 81.5 min, with an average blood loss of 330 ml. Patients had an average follow-up of 25.7 months. Radiological evaluation indicated that fracture union occurred in an average of 4.4 months in all patients. The length and alignment of the affected limb were satisfactory, and hardware failure did not recur. The replating technique with LISS for femoral shaft fractures due to hardware failure of LISS can obtain satisfactory results when the appropriate rationale of biological osteosynthesis and functional exercise is followed.

  19. Estimating evapotranspiration change due to forest treatment and fire at the basin scale in the Sierra Nevada, California

    Science.gov (United States)

    Roche, J. W.; Goulden, M.; Bales, R. C.

    2017-12-01

    Increased forest evapotranspiration (ET) coupled with snowpack decreases in a warming climate is likely to decrease runoff and increase forest drought stress. Field experiments and modeling suggest that forest thinning can reduce ET and thus increase potential runoff relative to untreated areas. We investigated the potential magnitude and duration of ET decreases resulting from forest-thinning treatments and fire using a robust empirical relation between Landsat-derived mean-annual normalized difference vegetation index (NDVI) and annual ET measured at flux towers. Among forest treatments, the minimum observed NDVI change required to produce a significant departure from control plots with NDVI of about 0.70 was -0.07 units, corresponding to a basal-area reduction of 3.1 m2 ha-1, and equivalent to an estimated ET reduction of -102 mm yr-1. Intensive thinning in highly productive forests that approached pre-fire-exclusion densities reduced basal area by 40-50%, generating estimated ET reductions of 152-216 mm yr-1 over five years following treatment. Between 1990 and 2008, fires in the American River basin generated more than twice the ET reduction per unit area than those in the Kings River basin, corresponding to greater water and energy limitations in the latter and greater fire severity in the former. A rough extrapolation of these results to the entire American River watershed, much of which would have burned naturally during this 19-year period, could result in ET reductions that approach 10% of full natural flows for drought years and 5% averaged over all years. This work demonstrates the potential utility to estimate forest ET change at the patch scale, which in turn may allow managers to estimate thinning benefits in areas lacking detailed hydrologic measurements.

  20. Root resorption due to orthodontic treatment using self-ligating and conventional brackets : A cone-beam computed tomography study.

    Science.gov (United States)

    Aras, Isil; Unal, Idil; Huniler, Gencer; Aras, Aynur

    2018-05-01

    Purpose of the present study was to compare external root resorption (ERR) volumetrically in maxillary incisors induced by orthodontic treatment using self-ligating brackets (Damon Q, DQ) or conventional brackets (Titanium Orthos, TO) with the help of cone-beam computed tomography (CBCT). A sample of 32 subjects, with Angle Class I malocclusion and anterior crowding of 4-10 mm, was divided randomly into two groups: a DQ group, in which self-ligating DQ brackets with Damon archwires were used; and a TO group, in which conventional TO brackets with large Orthos archwires were applied. The study was conducted using CBCT scans taken before (T1), and near the end (9 months after the initiation of treatment; T2) of the orthodontic treatment. The extent of ERR was determined volumetrically using Mimics software. Changes in root volume were evaluated by repeated-measures analysis of variance as well as by paired and independent t-tests. While significant differences were found between T1 and T2 for root volume in both groups (p  0.05). Maxillary central and lateral incisors showed similar volume loss (p > 0.05). Furthermore, the TO group showed a higher prevalence of palatinal and proximal slanted RR compared with the DQ group (p bracket system over the other only considering root resorption pattern or amount. Higher incidence of slanted RR found in patients treated with the TO system warrants further research to identify possible specific causes.

  1. Stem Cell Therapy and Breast Cancer Treatment: Review of Stem Cell Research and Potential Therapeutic Impact Against Cardiotoxicities Due to Breast Cancer Treatment

    OpenAIRE

    Sharp, Thomas E.; George, Jon C.

    2014-01-01

    A new problem has emerged with the ever-increasing number of breast cancer survivors. While early screening and advances in treatment have allowed these patients to overcome their cancer, these treatments often have adverse cardiovascular side effects that can produce abnormal cardiovascular function. Chemotherapeutic and radiation therapy have both been linked to cardiotoxicity; these therapeutics can cause a loss of cardiac muscle and deterioration of vascular structure that can eventually ...

  2. The clinical significance of the early presence hyperthyroidism from into hyperthyroidism by thyroid antibody due to the radioiodine treatment

    International Nuclear Information System (INIS)

    Liang Huaju; Ma Yuqin; Xu Yaoling; Liu Junqing; Zhang Huafang

    2008-01-01

    Objective: To observe the levels of TMAb, TGAb, TRAb in the serum of patients with hyperthyroidism before the treatment of radioiodine ( 131 I) and investigate the clinical significance of the early hypothyroidism after 131 I treatment. Methods: According to the levels of thyroid auto-antibodies, 622 patients with hyperthyroidism were divided into four groups: group A 54 cases with negative TMAb, TGAb and TRAb, group B 176 cases with nagative TMAb and TGAb and positive TRAb, group C 78 caese with positive TMAb, TGAb and negative TRAb, Group D, 314 cases with positive TMAb TGAb and TRAb. The rate of early hypothyroidism were observed regularly after 1 3 1 I therapy in each group. Results: The rates of early hypothyroidism were 11.11% in group A, 13.64% in group B, 26.92% in group C and 23.57% in group D, Both the rates in group A and group B are lower than those in group C and group D (P 0.05). Conclusion: The levels of TMAb, TGAb in are serum in an important influencing factor on the rate of the early hypothyroidism after 131 I therapy for patients with hyperthyroidism, while the level of TRAb is of no importance. (authors)

  3. Phelan-McDermid syndrome due to SHANK3 mutation in an intellectually disabled adult male: successful treatment with lithium.

    Science.gov (United States)

    Egger, Jos I M; Verhoeven, Willem M A; Groenendijk-Reijenga, Renske; Kant, Sarina G

    2017-09-28

    For 30 years, Phelan and co-workers described a syndrome characterised by neonatal hypotonia, global developmental delay, strongly impaired speech, sleep disturbances and hyperreactivity to sensory stimuli. This Phelan-McDermid syndrome (PMS), also presenting with symptoms from the autism spectrum and a higher risk of developing seizure disorders, may be caused by a deletion of chromosome 22q13 or by a mutation in the SHANK3 gene. Its core psychopathological phenotype comprises symptoms from the bipolar spectrum for which generally treatment with a mood-stabilising anticonvulsant in combination with an atypical antipsychotic seems to be most effective. In addition to two elsewhere published adolescent patients, we here describe in detail the history of an adult male patient with PMS caused by a SHANK3 mutation in whom successive treatment regimens with antipsychotics and mood-stabilising anticonvulsants were all ineffective. Ultimately, addition of lithium to existing olanzapine therapy led to enduring stabilisation of mood and behaviour. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Impact of prenatal antimicrobial treatment on fetal brain damage due to autogenous fecal peritonitis in Wistar rats: A Histomorphometric Study

    Directory of Open Access Journals (Sweden)

    Neylane Gadelha

    2017-10-01

    Full Text Available Purpose: To investigate brain neuronal density in newborn rats whose mothers were subjected to fecal peritonitis and compare findings between rats born to mothers treated and not treated with antimicrobials. Methods: Peritonitis was induced with a 10% fecal suspension (4mL/kg in 2 pregnant rats. Of these, 1 received antimicrobial treatment 24 hours after peritonitis induction: moxifloxacin and dexamethasone plus 2 mL of the inner bark of the Schinus terebinthifolius raddi extract. One pregnant rat underwent no intervention and served as a control. Results: The newborn brains of rats born to mothers with fecal peritonitis were significantly smaller and of less firm consistency. Brain neuronal density was lower in the untreated group than in the control and treated groups (P<0.01. Conclusions: Untreated peritonitis caused brain damage in the offspring, which was averted by effective early antimicrobial treatment. This approach may provide an early avenue for translation of such therapy in humans. Keywords: peritonitis, brain injuries, rats

  5. Longitudinal Raman Spectroscopic Observation of Skin Biochemical Changes due to Chemotherapeutic Treatment for Breast Cancer in Small Animal Model

    Directory of Open Access Journals (Sweden)

    Myeongsu Seong

    2017-01-01

    Full Text Available The cancer field effect (CFE has been highlighted as one of indirect indications for tissue variations that are insensitive to conventional diagnostic techniques. In this research, we had a hypothesis that chemotherapy for breast cancer would affect skin biochemical compositions that would be reflected by Raman spectral changes. We used a fiber-optic probe-based Raman spectroscopy to perform preliminary animal experiments to validate the hypothesis. Firstly, we verified the probing depth of the fiber-optic probe (~800 μm using a simple intravenous fat emulsion-filled phantom having a silicon wafer at the bottom inside a cuvette. Then, we obtained Raman spectra during breast cancer treatment by chemotherapy from a small animal model in longitudinal manner. Our results showed that the treatment causes variations of biochemical compositions in the skin. For further validation, the Raman spectra will have to be collected from more populations and spectra will need to be compared with immunohistochemistry of the breast tissue.

  6. Asparaginase treatment side-effects may be due to genes with homopolymeric Asn codons (Review-Hypothesis)

    Science.gov (United States)

    BANERJI, JULIAN

    2015-01-01

    The present treatment of childhood T-cell leukemias involves the systemic administration of prokary-otic L-asparaginase (ASNase), which depletes plasma Asparagine (Asn) and inhibits protein synthesis. The mechanism of therapeutic action of ASNase is poorly understood, as are the etiologies of the side-effects incurred by treatment. Protein expression from genes bearing Asn homopolymeric coding regions (N-hCR) may be particularly susceptible to Asn level fluctuation. In mammals, N-hCR are rare, short and conserved. In humans, misfunctions of genes encoding N-hCR are associated with a cluster of disorders that mimic ASNase therapy side-effects which include impaired glycemic control, dislipidemia, pancreatitis, compromised vascular integrity, and neurological dysfunction. This paper proposes that dysregulation of Asn homeostasis, potentially even by ASNase produced by the microbiome, may contribute to several clinically important syndromes by altering expression of N-hCR bearing genes. By altering amino acid abundance and modulating ribosome translocation rates at codon repeats, the microbiomic environment may contribute to genome decoding and to shaping the proteome. We suggest that impaired translation at poly Asn codons elevates diabetes risk and severity. PMID:26178806

  7. Asparaginase treatment side-effects may be due to genes with homopolymeric Asn codons (Review-Hypothesis).

    Science.gov (United States)

    Banerji, Julian

    2015-09-01

    The present treatment of childhood T-cell leukemias involves the systemic administration of prokaryotic L-asparaginase (ASNase), which depletes plasma Asparagine (Asn) and inhibits protein synthesis. The mechanism of therapeutic action of ASNase is poorly understood, as are the etiologies of the side-effects incurred by treatment. Protein expression from genes bearing Asn homopolymeric coding regions (N-hCR) may be particularly susceptible to Asn level fluctuation. In mammals, N-hCR are rare, short and conserved. In humans, misfunctions of genes encoding N-hCR are associated with a cluster of disorders that mimic ASNase therapy side-effects which include impaired glycemic control, dislipidemia, pancreatitis, compromised vascular integrity, and neurological dysfunction. This paper proposes that dysregulation of Asn homeostasis, potentially even by ASNase produced by the microbiome, may contribute to several clinically important syndromes by altering expression of N-hCR bearing genes. By altering amino acid abundance and modulating ribosome translocation rates at codon repeats, the microbiomic environment may contribute to genome decoding and to shaping the proteome. We suggest that impaired translation at poly Asn codons elevates diabetes risk and severity.

  8. The use of a combined regimen of GnRH agonist plus a low-dose oral contraceptive improves the spontaneous pulsatile LH secretory characteristics in patients with polycycstic ovary disease after discontinuation of treatment.

    Science.gov (United States)

    Genazzani, A D; Battaglia, C; Gamba, O; Petraglia, F; Malavasi, B; Genazzani, A R

    2000-05-01

    The fertility rate in women with polycystic ovary disease (PCOD) is influenced by the type of treatment received. The present study evaluated the possible correlation between treatment and pulsatile release of gonadotropins. Spontaneous episodic secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and hormonal parameters were monitored before and after 1, 3, and 6 months after treatments suspension. Twenty-four PCOD patients were randomly divided into two groups of 12 subjects. Group A was treated with gonadotropin-releasing hormone (GnRH)-analogue plus oral contraceptive (OC). Group B was treated only with OC. Both groups were treated for 6 months and followed up for 6 months. In all subjects the therapeutic regimens reduced the androgenic milieau and the gonadotropin plasma levels. Spontaneous pulsatile secretion of LH and FSH was significantly modified in both groups, but patients who received the combined regimen showed a significantly greater reduction of LH plasma levels and a significantly greater decrease of LH pulse amplitude throughout the 6 months after treatment suspension. Ferriman-Gallway score and ovarian volumes were significantly reduced in patients who received the combined treatment than in the OC-treated patients. These data support the evidence of a higher efficacy of the combination of GnRH-a + OC than OC alone in restoring a normal and adequate spontaneous episodic gonadotropin discharge and in decreasing Ferriman-Gallway score and ovarian volumes in patients with PCOD.

  9. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism

    NARCIS (Netherlands)

    Wildschut, T.; Van Horen, F.; Hart, C.

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism).

  10. Temperature Discontinuity Caused by Relocation of Meteorological Stations in Taiwan

    Directory of Open Access Journals (Sweden)

    Chih-wen Hung

    2009-01-01

    Full Text Available With global warming upon us, it has be come increasingly important to identify the extent of this warming trend and in doing so be able to rank mean temperature changes in particular seasons and years. This requires a need for homogeneous climate data, which do not reflect individual anomalies in instruments, station locations or local environments (urbanization. Ac curate homogeneous long-term meteorological data helps show how temperature variations have truly occurred in the climate. Many possible factors contribute to artificial abrupt changes or sharp discontinuities in long time series data, such as the impact of station relocation, changes in observational schedules and instrumentation. Homogeneity adjustments of in situ climate data are very important processes for preparing observational data to be used in further analysis and research. Users require a well-documented history of stations to make appropriate homogeneity adjustments because precise historical back ground records of stations can provide researchers with knowledge of when artificial discontinuity has occurred and its causes. With out such de tailed historical data for each meteorological station, abrupt changes are difficult to interpret. Unfortunately, no homogeneity adjustments for temperature records have been con ducted previously in Tai wan, and present available sources of the history of Taiwan's meteorological stations exhibit in consistencies. In this study, information pertaining to station history, especially relocation records, is pro vided. This information is essential for anal y sis of continuous time series data for temperature and climate warming studies. Temperature data from several stations is given in this study to show how artificial discontinuity occurs due to station relocation. Al though there is no homogeneous adjusted climate data provided in this preliminary work, the summarizing of information regarding station relocations should be of assistance

  11. Improvement of attention span and reaction time with hyperbaric oxygen treatment in patients with toxic injury due to mold exposure.

    Science.gov (United States)

    Ezra, N; Dang, K; Heuser, G

    2011-01-01

    It is, by now, well established that mold toxins (mycotoxins) can cause significant adverse health effects. In this study, 15 subjects who developed an attention deficit disorder (ADD) and slowing of reaction time at the time of exposure to mold toxins were identified. Deficits in attention span and reaction time were documented not only by taking a careful history, but also by performing a Test of Variables of Attention (TOVA). The TOVA test provides an objective measure of these two variables. It was found that mold-exposed subjects show statistically significant decreases in attention span and significant increases in reaction time to stimuli compared to controls. After ten sessions of hyperbaric oxygen treatment (HBOT), a statistically significant improvement was seen in both measures. This preliminary study suggests promising outcomes in treating mold-exposed patients with hyperbaric oxygen.

  12. [Efficacy of enterocin S760 in treatment of mice with anthrax infection due to Bacillus anthracis M-71].

    Science.gov (United States)

    Svetoch, E A; Borzilov, A I; Eruslanov, B V; Korobova, O V; Kombarova, T I; Levchuk, V P; Teĭmurazov, M G; Stepanshin, Iu G; Marinin, L I; Diatlov, I A

    2011-01-01

    The therapeutic efficacy of enterocin S760, a broad spectrum antimicrobial peptide produced by Enterococcus faecium LWP760 was tested on mice infected with Bacillus anthracis M-71 to induce anthrax (second Tsenkovsky's vaccine). Intraperitoneal four-, two- or one-fold administration of the peptide in a dose of 25 mg/kg for 10 days for prophylactic (1 hour after the contamination) and therapeutic (24 hours after the contamination) purposes prevented or cured the infection in 90-100% of the mice versus the 100-percent lethality in the control (untreated animals). The antimicrobial activity of enterocin S760 against B. anthracis M-71 in vivo correlated with activity in vitro. Enterocin S760 is considered a novel promising antimicrobial for the treatment of grampositive and gramnegative infections.

  13. Successful Treatment of Septic Shock due to Spontaneous Esophageal Perforation 96 Hours after Onset by Drainage and Enteral Nutrition

    Directory of Open Access Journals (Sweden)

    Risako Yamashita

    2014-12-01

    Full Text Available Spontaneous esophageal perforation is relatively uncommon, but carries a high mortality rate if diagnosis or treatment is delayed. We report the case of a 68-year-old man with spontaneous esophageal perforation who was successfully treated over 96 h after onset by thoracic drainage and jejunostomy for enteral nutrition. He vomited after drinking alcohol, soon followed by epigastralgia. Heart failure was suspected on admission to another hospital. Spontaneous esophageal perforation was diagnosed 48 h after admission. Chest tube drainage was performed, but his general condition deteriorated and he was transferred to our hospital. Emergent surgery was performed and esophageal perforation combined with pyothorax and mediastinitis was identified on the left side of the lower esophagus. The left thoracic cavity was rinsed and thoracic drainage was performed. Feeding jejunostomy was performed for postoperative enteral nutrition. Effective drainage and sufficient nutrition management appear extremely valuable in treating spontaneous esophageal perforation.

  14. Investigations on the change of texture of plant cells due to preservative treatments by digital holographic microscopy

    Science.gov (United States)

    Vora, Priyanka; Anand, Arun

    2014-10-01

    Texture change is observed in preserved fruits and vegetables. Responsible factors for texture change during preservative treatments are cell morphology, cell wall structure, cell turger, water content and some biochemical components, and also the environmental conditions. Digital Holographic microscopy (DHM) is a quantitative phase contrast imaging technique, which provides three dimensional optical thickness profiles of transparent specimen. Using DHM the morphology of plant cells preserved by refrigeration or stored in vinegar or in sodium chloride can be obtained. This information about the spatio-temporal evolution of optical volume and thickness can be an important tool in area of food processing. Also from the three dimensional images, the texture of the cell can be retrieved and can be investigated under varying conditions.

  15. Changes in lymphocyte and macrophage subsets due to morphine and ethanol treatment during a retrovirus infection causing murine AIDS

    Energy Technology Data Exchange (ETDEWEB)

    Watson, R.R.; Prabhala, R.H.; Darban, H.R.; Yahya, M.D.; Smith, T.L.

    1988-01-01

    The number of lymphocytes of various subsets were not significantly changed by the ethanol exposure except those showing activation markers which were reduced. The percentage of peripheral blood cells showing markers for macrophage functions and their activation were significantly reduced after binge use of ethanol. Ethanol retarded suppression of cells by retroviral infection. However by 25 weeks of infection there was a 8.6% survival in the ethanol fed mice infected with retrovirus which was much less than virally infected controls. Morphine treatment also increased the percentage of cells with markers for macrophages and activated macrophages in virally infected mice, while suppressing them in uninfected mice. The second and third morphine injection series suppressed lymphocyte T-helper and T-suppressor cells, but not total T cells. However, suppression by morphine was significantly less during retroviral disease than suppression caused by the virus only. At 25 weeks of infection 44.8% of morphine treated, infected mice survived.

  16. Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch.

    Science.gov (United States)

    Lionberger, David R; Brennan, Michael J

    2010-11-10

    The objective of this article is to review published clinical data on diclofenac epolamine topical patch 1.3% (DETP) in the treatment of acute soft tissue injuries, such as strains, sprains, and contusions. Review of published literature on topical nonsteroidal anti-inflammatory drugs (NSAIDs), diclofenac, and DETP in patients with acute soft tissue injuries was included. Relevant literature was identified on MEDLINE using the search terms topical NSAIDs, diclofenac, diclofenac epolamine, acute pain, sports injury, soft tissue injury, strain, sprain, and contusion, and from citations in retrieved articles covering the years 1978-2008. Review of published, randomized clinical trials and meta-analyses shows that topical NSAIDs are significantly more effective than placebo in relieving acute pain; the pooled average relative benefit was 1.7 (95% confidence interval, 1.5-1.9). In a limited number of comparisons, topical and oral NSAIDs provided comparable pain relief, but the use of topical agents produced lower plasma drug concentrations and fewer systemic adverse events (AEs). The physical-chemical properties of diclofenac epolamine make it well suited for topical use. In patients with acute soft tissue injuries treated with DETP, clinical data report an analgesic benefit within hours of the first application, and significant pain relief relative to placebo within 3 days. Moreover, DETP displayed tolerability comparable with placebo; the most common AEs were pruritus and other application site reactions. Review of published literature suggests that DETP is generally safe and well tolerated, clinically efficacious, and a rational treatment option for patients experiencing acute pain associated with strains, sprains, and contusions, and other localized painful conditions.

  17. Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch

    Directory of Open Access Journals (Sweden)

    David R Lionberger

    2010-11-01

    Full Text Available David R Lionberger1, Michael J Brennan21Southwest Orthopedic Group, Houston, TX, USA; 2Department of Medicine, Bridgeport Hospital, Bridgeport, CT, USAAbstract: The objective of this article is to review published clinical data on diclofenac epolamine topical patch 1.3% (DETP in the treatment of acute soft tissue injuries, such as strains, sprains, and contusions. Review of published literature on topical nonsteroidal anti-inflammatory drugs (NSAIDs, diclofenac, and DETP in patients with acute soft tissue injuries was included. Relevant literature was identified on MEDLINE using the search terms topical NSAIDs, diclofenac, diclofenac epolamine, acute pain, sports injury, soft tissue injury, strain, sprain, and contusion, and from citations in retrieved articles covering the years 1978–2008. Review of published, randomized clinical trials and meta-analyses shows that topical NSAIDs are significantly more effective than placebo in relieving acute pain; the pooled average relative benefit was 1.7 (95% confidence interval, 1.5–1.9. In a limited number of comparisons, topical and oral NSAIDs provided comparable pain relief, but the use of topical agents produced lower plasma drug concentrations and fewer systemic adverse events (AEs. The physical–chemical properties of diclofenac epolamine make it well suited for topical use. In patients with acute soft tissue injuries treated with DETP, clinical data report an analgesic benefit within hours of the first application, and significant pain relief relative to placebo within 3 days. Moreover, DETP displayed tolerability comparable with placebo; the most common AEs were pruritus and other application site reactions. Review of published literature suggests that DETP is generally safe and well tolerated, clinically efficacious, and a rational treatment option for patients experiencing acute pain associated with strains, sprains, and contusions, and other localized painful conditions

  18. Discontinuity effects in dynamically loaded tilting pad journal bearings

    DEFF Research Database (Denmark)

    Thomsen, Kim; Klit, Peder; Vølund, Anders

    2011-01-01

    This paper describes two discontinuity effects that can occur when modelling radial tilting pad bearings subjected to high dynamic loads. The first effect to be treated is a pressure build-up discontinuity effect. The second effect is a contact-related discontinuity that disappears when a contact...... force is included in the theoretical model. Methods for avoiding the pressure build-up discontinuity effect are proposed....

  19. Long-term outcomes for patients with chronic lymphocytic leukemia who discontinue ibrutinib.

    Science.gov (United States)

    Jain, Preetesh; Thompson, Philip A; Keating, Michael; Estrov, Zeev; Ferrajoli, Alessandra; Jain, Nitin; Kantarjian, Hagop; Burger, Jan A; O'Brien, Susan; Wierda, William G

    2017-06-15

    Ibrutinib is a Bruton tyrosine kinase inhibitor and is approved for the treatment of patients with chronic lymphocytic leukemia (CLL) in frontline and relapsed/refractory settings. The authors previously reported poor outcomes for patients who discontinued ibrutinib; however, long-term outcomes were not reported. Data from 320 patients who received ibrutinib on clinical studies between 2010 and 2015 at The University of Texas MD Anderson Cancer Center were retrospectively analyzed. Long-term outcomes among patients with CLL after they discontinued ibrutinib were analyzed. Ninety of 320 patients (28%) who were treated on ibrutinib-based regimens discontinued ibrutinib. Of these, 80 had relapsed/refractory disease, and 10 were treatment-naive. The median time to discontinuation was 15 months (range, 1.2-54 months). After a median follow-up of 38 months after starting ibrutinib, 40 patients (44%) remained alive. Major reasons for ibrutinib discontinuation were intolerance (n = 29; 32%), miscellaneous (n = 28; 31%), progression (n = 19; 21%), and Richter transformation (RT) (n = 9; 10%). The median survival according to the reason for discontinuation was 33 months for ibrutinib intolerance, 11 months for miscellaneous causes, 16 months for progressive CLL, and 2 months for RT. Among the 19 patients who had progressive CLL, 42% responded to subsequent therapy. Ibrutinib discontinuation was observed during therapy. Patients with CLL who had disease transformation had especially poor outcomes, whereas those who developed progressive disease during ibrutinib therapy had a median survival of ibrutinib therapy is of critical importance. Cancer 2017;123:2268-2273. © 2017 American Cancer Society. © 2017 American Cancer Society.

  20. Stable and high order accurate difference methods for the elastic wave equation in discontinuous media

    KAUST Repository

    Duru, Kenneth

    2014-12-01

    © 2014 Elsevier Inc. In this paper, we develop a stable and systematic procedure for numerical treatment of elastic waves in discontinuous and layered media. We consider both planar and curved interfaces where media parameters are allowed to be discontinuous. The key feature is the highly accurate and provably stable treatment of interfaces where media discontinuities arise. We discretize in space using high order accurate finite difference schemes that satisfy the summation by parts rule. Conditions at layer interfaces are imposed weakly using penalties. By deriving lower bounds of the penalty strength and constructing discrete energy estimates we prove time stability. We present numerical experiments in two space dimensions to illustrate the usefulness of the proposed method for simulations involving typical interface phenomena in elastic materials. The numerical experiments verify high order accuracy and time stability.

  1. 27 CFR 478.127 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... business was located: Provided, however, Where State law or local ordinance requires the delivery of... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Records § 478.127 Discontinuance of business. Where a licensed business is discontinued and succeeded by a...

  2. Motion of Charged Particles near Magnetic Field Discontinuities

    International Nuclear Information System (INIS)

    Dodin, I.Y.; Fisch, N.J.

    2000-01-01

    The motion of charged particles in slowly changing magnetic fields exhibits adiabatic invariance even in the presence of abrupt magnetic discontinuities. Particles near discontinuities in magnetic fields, what we call ''boundary particles'', are constrained to remain near an arbitrarily fractured boundary even as the particle drifts along the discontinuity. A new adiabatic invariant applies to the motion of these particles

  3. Seismic wave propagation in fractured media: A discontinuous Galerkin approach

    KAUST Repository

    De Basabe, Jonás D.

    2011-01-01

    We formulate and implement a discontinuous Galekin method for elastic wave propagation that allows for discontinuities in the displacement field to simulate fractures or faults using the linear- slip model. We show numerical results using a 2D model with one linear- slip discontinuity and different frequencies. The results show a good agreement with analytic solutions. © 2011 Society of Exploration Geophysicists.

  4. Effectiveness of the Lower Eyelid Suspension Using Fascia Lata Graft for the Treatment of Lagophthalmos due to Facial Paralysis

    Directory of Open Access Journals (Sweden)

    Selam Yekta Sendul

    2015-01-01

    Full Text Available Purpose. To evaluate of functional and cosmetic effectiveness of lower eyelid sling technique with fascia lata graft in patients with lagophthalmos due to facial paralysis. Material and Method. Ten patients with a mean age of 55.1±19.77 years who underwent lower eyelid sling surgery with a fascia lata graft between September 2011 and January 2014 were included in this prospective study. Preoperatively and postoperatively patients were evaluated in terms of corneal epithelial defects, Schirmer’s test, and tear break-up time (TBUT. Cosmetically, vertical eyelid aperture, margin reflex distances 1 and 2 (MRD1 and MRD2 and scleral show were evaluated preoperatively and postoperatively. Results. One patient had facial paralysis on the right side whereas the other 9 patients had facial paralysis on the left side. Preoperatively, 3 patients were detected with corneal ulcer, whereas 7 patients were detected with persistent corneal epithelial defects localized in the lower half of the cornea. In the 3 patients with preoperative corneal ulcer, the ulcer recovered with corneal opacity, whereas in the 7 patients with punctate epitheliopathy, postoperative corneal transparency was obtained. Discussion. Lower eyelid sling technique with fascia lata graft is an effective technique for the repositioning of the lower eyelid and preventing the corneal complications.

  5. The effect of apple (Malus Domestica juice on the damage of mice liver cells due to paracetamol treatment

    Directory of Open Access Journals (Sweden)

    Anthony Hartanto

    2009-07-01

    Full Text Available The liver is an important organ for body metabolism process. Liver disease is one of serious health problems in developing countries including Indonesia. Liver damage is caused by viral infection, toxic agent exposure (medications, alcohol, hormonal disturbance, neoplasm and autoimmune diseases. The use of high dose paracetamol to reduce pain also leads to liver damage. Apple (Malus domestica juice is a natural anti oxidant agent. This laboratory experimental study was performed to discover the effect of giving apple juice on damaged cell regeneration due to the use of paracetamol. The study was performed in 21 male mice from Swiss-Webster strain that were divided into group I, II, and III. Group, I served as control while group II received 1 mg/ml paracetamol dose for 5 days and Group III received 1 mg/ml paracetamol for 5 days and 1 ml of apple juice on the 5th to 10th day. The observation of the mice liver cells was conducted using a light microscope with 400x magnification to get the number of necrotic liver cells per view field. The results of this study showed a difference in the number of necrotic liver cells between Group II and III. ANOVA statistical test ( = 0.05 concluded that apple juice significantly helps regeneration process in damaged liver cells caused by paracetamol.

  6. Treatment of periocular hyperpigmentation due to lead of kohl (surma by penicillamine: A single group non-randomized clinical trial

    Directory of Open Access Journals (Sweden)

    El Safoury Omar

    2009-01-01

    Full Text Available Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production. Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity. Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score. Results: Highly significant P values (0.000 were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040 was recorded as regard to the vertical length. Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day for its treatment.

  7. Short- and long-term changes in sugarbeet (Beta vulgaris L. gene expression due to postharvest jasmonic acid treatment - Data

    Directory of Open Access Journals (Sweden)

    Lucilene Silva de Oliveira

    2017-04-01

    Full Text Available Jasmonic acid is a natural plant hormone that induces native defense responses in plants. Sugarbeet (Beta vulgaris L. root unigenes that were differentially expressed 2 and 60 days after a postharvest jasmonic acid treatment are presented. Data include changes in unigene expression relative to water-treated controls, unigene annotations against nonredundant (Nr, Swiss-Prot, Clusters of Orthologous Groups (COG, and Kyoto Encyclopedia of Genes and Genomes (KEGG protein databases, and unigene annotations with Gene Ontology (GO terms. Putative defense unigenes are compiled and annotated against the sugarbeet genome. Differential gene expression data were generated by RNA sequencing. Interpretation of the data is available in the research article, “Jasmonic acid causes short- and long-term alterations to the transcriptome and the expression of defense genes in sugarbeet roots” (K.K. Fugate, L.S. Oliveira, J.P. Ferrareze, M.D. Bolton, E.L. Deckard, F.L. Finger, 2017 [1]. Public dissemination of this dataset will allow further analyses of the data.

  8. Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transesophageal echocardiography and intrapulmonary thrombolysis.

    Science.gov (United States)

    Krivec, B; Voga, G; Zuran, I; Skale, R; Pareznik, R; Podbregar, M; Noc, M

    1997-11-05

    To evaluate the diagnostic value of transesophageal echocardiography (TEE) as an initial diagnostic tool in shocked patients. The second objective was to study therapeutic impact of intrapulmonary thrombolysis in patients with diagnosed massive pulmonary embolism. Prospective observational study. Medical ICU in 800-bed general hospital. Twenty-four consecutive patients with unexplained shock and distended jugular veins. In 18 patients, right ventricular dilatation with global or segmental hypokinesis was documented. In addition, central pulmonary thromboemboli (12 patients), reduced contrast flow in right pulmonary artery (one patient), and right ventricular free wall akinesis (one patient) were found. No additional echocardiographic findings were apparent in four patients. According to pulmonary scintigraphy or autopsy, sensitivity of TEE for diagnosis of massive pulmonary embolism (MPE) in patients with right ventricular dilatation was 92% and specificity was 100%. In patients without right ventricular dilatation, left ventricular dysfunction (four patients) or cardiac tamponade (two patients) was confirmed. Intrapulmonary thrombolysis was evaluated in 11 of 13 patients with MPE. Two patients died prior to attempted thrombolysis. Three patients received streptokinase and eight received urokinase. Twenty-four hours after beginning of treatment, total pulmonary resistance index significantly decreased for 59% and mean pulmonary artery pressure for 31%. Cardiac index increased for 74%. Nine of 11 patients receiving thrombolysis survived to hospital discharge. Bedside TEE is a valuable tool for diagnosis of MPE. It enables immediate intrapulmonary thrombolysis, which seems to be an effective therapeutic alternative in our group of patients with obstructive shock.

  9. USING CUSTOM TRIFLANGE IMPLANT IN REVISION HIP ARTHROPLASTY IN PATIENT WITH PELVIC DISCONTINUITY (CASE REPORT

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available Revision hip arthroplasty rate is growing, and pelvic discontinuity rate ranges from 1% to 5% of acetabular component revision reasons. According to AAOS acetabular defects classification, pelvic discontinuity is fourth type defect in which cranial part of hip bone is separated from caudal part at acetabular level. Usually it occurs from bone loss secondary to osteolysis, infection, fracture or aseptic loosening. There are a lot of techniques for pelvis discontinuity treatment. Published results of bulk allografts and antiprotrusion cages have generally been poor. More preferable methods with acceptable rate of good results are cup-cage systems and custom triflange acetabular components(CTAC. CTACs are designed based on preoperative CT scans to build a custom titanium 3D-printed implant to address the patient's specific bone defect and provide secure fixation in the ilium, pubis, and ischium. We faced pelvic discontinuity, in which extensive iliac bone loss was added to caudal hip bone part medial displacement and pelvic ring deformity, in patient with multiple hip surgeries. Preoperative investigation called into question the possibility of using off-the-shelf hip implants, which could restore the biomechanics of the hip and provide reliable primary fixation at the same time. We present case report of the patient with pelvic discontinuity and massive bone loss treatment using a custom triflange component.

  10. Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite{sup Registered-Sign} treatment

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Wonmo; Kim, Siyong; Kim, Jung-in; Lee, Jae-gi; Shin, Young-Joo; Jung, Jae-Yong; Ye, Sung-Joon [Interdisciplinary Program in Radiation Applied Life Science, Seoul National University College of Medicine, Seoul 110-799, South Korea and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744 (Korea, Republic of); Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida 32224 (United States); Interdisciplinary Program in Radiation Applied Life Science, Seoul National University College of Medicine, Seoul 110-799, South Korea and Department of Radiation Oncology, Kangbuk Samsung Medical Center, Seoul 110-746 (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, South Korea and Department of Biomedical Radiation Sciences, Seoul National University, Seoul 151-742 (Korea, Republic of); Department of Radiation Oncology, Sanggye Paik Hospital, Inje University, Seoul 139-707 (Korea, Republic of); Interdisciplinary Program in Radiation Applied Life Science, Seoul National University College of Medicine, Seoul 110-799 (Korea, Republic of); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744 (Korea, Republic of); Department of Biomedical Radiation Sciences, Seoul National University, Seoul 151-742 (Korea, Republic of); Department of Radiation Oncology, Seoul National University, Seoul 110-799 (Korea, Republic of) and Advanced Institutes of Convergence Technology, Seoul National University, Suwon 443-270 (Korea, Republic of)

    2012-10-15

    Purpose: To investigate dose perturbations for pacemaker-implanted patients in partial breast irradiation using high dose rate (HDR) balloon brachytherapy. Methods: Monte Carlo (MC) simulations were performed to calculate dose distributions involving a pacemaker in Ir-192 HDR balloon brachytherapy. Dose perturbations by varying balloon-to-pacemaker distances (BPD = 50 or 100 mm) and concentrations of iodine contrast medium (2.5%, 5.0%, 7.5%, and 10.0% by volume) in the balloon were investigated for separate parts of the pacemaker (i.e., battery and substrate). Relative measurements using an ion-chamber were also performed to confirm MC results. Results: The MC and measured results in homogeneous media without a pacemaker agreed with published data within 2% from the balloon surface to 100 mm BPD. Further their dose distributions with a pacemaker were in a comparable agreement. The MC results showed that doses over the battery were increased by a factor of 3, compared to doses without a pacemaker. However, there was no significant dose perturbation in the middle of substrate but up to 70% dose increase in the substrate interface with the titanium capsule. The attenuation by iodine contrast medium lessened doses delivered to the pacemaker by up to 9%. Conclusions: Due to inhomogeneity of pacemaker and contrast medium as well as low-energy photons in Ir-192 HDR balloon brachytherapy, the actual dose received in a pacemaker is different from the homogeneous medium-based dose and the external beam-based dose. Therefore, the dose perturbations should be considered for pacemaker-implanted patients when evaluating a safe clinical distance between the balloon and pacemaker.

  11. Potential misinterpretation of treatment effects due to use of odds ratios and logistic regression in randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Mirjam J Knol

    Full Text Available BACKGROUND: In randomized controlled trials (RCTs, the odds ratio (OR can substantially overestimate the risk ratio (RR if the incidence of the outcome is over 10%. This study determined the frequency of use of ORs, the frequency of overestimation of the OR as compared with its accompanying RR in published RCTs, and we assessed how often regression models that calculate RRs were used. METHODS: We included 288 RCTs published in 2008 in five major general medical journals (Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, New England Journal of Medicine. If an OR was reported, we calculated the corresponding RR, and we calculated the percentage of overestimation by using the formula . RESULTS: Of 193 RCTs with a dichotomous primary outcome, 24 (12.4% presented a crude and/or adjusted OR for the primary outcome. In five RCTs (2.6%, the OR differed more than 100% from its accompanying RR on the log scale. Forty-one of all included RCTs (n = 288; 14.2% presented ORs for other outcomes, or for subgroup analyses. Nineteen of these RCTs (6.6% had at least one OR that deviated more than 100% from its accompanying RR on the log scale. Of 53 RCTs that adjusted for baseline variables, 15 used logistic regression. Alternative methods to estimate RRs were only used in four RCTs. CONCLUSION: ORs and logistic regression are often used in RCTs and in many articles the OR did not approximate the RR. Although the authors did not explicitly misinterpret these ORs as RRs, misinterpretation by readers can seriously affect treatment decisions and policy making.

  12. Experimental study of microstructure changes due to low cycle fatigue of a steel nanocrystallised by Surface Mechanical Attrition Treatment (SMAT)

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Z. [ICD, P2MN, LASMIS, University of Technology of Troyes, UMR 6281, CNRS, Troyes (France); Retraint, D., E-mail: delphine.retraint@utt.fr [ICD, P2MN, LASMIS, University of Technology of Troyes, UMR 6281, CNRS, Troyes (France); Baudin, T.; Helbert, A.L.; Brisset, F. [ICMMO, Univ Paris-Sud, Université Paris-Saclay, UMR CNRS 8182, 91405 Orsay Cedex (France); Chemkhi, M.; Zhou, J. [ICD, P2MN, LASMIS, University of Technology of Troyes, UMR 6281, CNRS, Troyes (France); Kanouté, P. [ICD, P2MN, LASMIS, University of Technology of Troyes, UMR 6281, CNRS, Troyes (France); ONERA, The French Aerospace Lab, 29 avenue de la Division Leclerc, 92322 Chatillon Cedex (France)

    2017-02-15

    Electron Backscatter Diffraction technique is used to characterize the microstructure of 316L steel generated by Surface Mechanical Attrition Treatment (SMAT) before and after low cycle fatigue tests. A grain size gradient is generated from the top surface to the interior of the samples after SMAT so that three main regions can be distinguished below the treated surface: (i) the ultra-fine grain area within 5 μm under the top surface with preferably oriented grains, (ii) the intermediate area where the original grains are partially transformed, and (iii) the edge periphery area where the original grains are just mechanically deformed with the presence of plastic slips. Fatigue tests show that cyclic loading does not change the grain orientation spread and does not activate any plastic slip in the ultra-fine grain top surface area induced by SMAT. On the opposite, in the plastically SMAT affected region including the intermediate area and the edge periphery area, new slip systems are activated by low cycle fatigue while the grain orientation spread is increased. These results represent a first very interesting step towards the characterization and understanding of mechanical mechanisms involved during the fatigue of a grain size gradient material. - Highlights: •LCF tests are carried out on specimens processed by SMAT. •EBSD is used to investigate microstructural changes induced by LCF. •A grain size gradient is generated by SMAT from surface to the bulk of the fatigue samples. •New slip systems are activated by LCF and GOS is increased in plastically deformed region. •However, these phenomena are not observed in the top surface ultra-fine grain area.

  13. Experimental study of microstructure changes due to low cycle fatigue of a steel nanocrystallised by Surface Mechanical Attrition Treatment (SMAT)

    International Nuclear Information System (INIS)

    Sun, Z.; Retraint, D.; Baudin, T.; Helbert, A.L.; Brisset, F.; Chemkhi, M.; Zhou, J.; Kanouté, P.

    2017-01-01

    Electron Backscatter Diffraction technique is used to characterize the microstructure of 316L steel generated by Surface Mechanical Attrition Treatment (SMAT) before and after low cycle fatigue tests. A grain size gradient is generated from the top surface to the interior of the samples after SMAT so that three main regions can be distinguished below the treated surface: (i) the ultra-fine grain area within 5 μm under the top surface with preferably oriented grains, (ii) the intermediate area where the original grains are partially transformed, and (iii) the edge periphery area where the original grains are just mechanically deformed with the presence of plastic slips. Fatigue tests show that cyclic loading does not change the grain orientation spread and does not activate any plastic slip in the ultra-fine grain top surface area induced by SMAT. On the opposite, in the plastically SMAT affected region including the intermediate area and the edge periphery area, new slip systems are activated by low cycle fatigue while the grain orientation spread is increased. These results represent a first very interesting step towards the characterization and understanding of mechanical mechanisms involved during the fatigue of a grain size gradient material. - Highlights: •LCF tests are carried out on specimens processed by SMAT. •EBSD is used to investigate microstructural changes induced by LCF. •A grain size gradient is generated by SMAT from surface to the bulk of the fatigue samples. •New slip systems are activated by LCF and GOS is increased in plastically deformed region. •However, these phenomena are not observed in the top surface ultra-fine grain area.

  14. Validation of a patient interview for assessing reasons for antipsychotic discontinuation and continuation

    Directory of Open Access Journals (Sweden)

    Matza LS

    2012-07-01

    Full Text Available Louis S Matza,1 Glenn A Phillips,2 Dennis A Revicki,1 Haya Ascher-Svanum,3 Karen G Malley,4 Andrew C Palsgrove,1 Douglas E Faries,3 Virginia Stauffer,3 Bruce J Kinon,3 A George Awad,5 Richard SE Keefe,6 Dieter Naber71Outcomes Research, United BioSource Corporation, Bethesda, MD, 2Formerly with Eli Lilly and Company, Indianapolis, IN, 3Eli Lilly and Company, Indianapolis, IN, 4Malley Research Programming, Inc, Rockville, MD, USA; 5Department of Psychiatry and Behavioral Sciences; University of Toronto, Toronto, Canada; 6Duke University Medical Center, Durham NC, USA; 7Universitaetsklinikum Hamburg-Eppendorf, Hamburg, GermanyIntroduction: The Reasons for Antipsychotic Discontinuation Interview (RAD-I was developed to assess patients’ perceptions of reasons for discontinuing or continuing an antipsychotic. The current study examined reliability and validity of domain scores representing three factors contributing to these treatment decisions: treatment benefits, adverse events, and distal reasons other than direct effects of the medication.Methods: Data were collected from patients with schizophrenia or schizoaffective disorder and their treating clinicians. For approximately 25% of patients, a second rater completed the RAD-I for assessment of inter-rater reliability.Results: All patients (n = 121; 81 discontinuation, 40 continuation reported at least one reason for discontinuation or continuation (mean = 2.8 reasons for discontinuation; 3.4 for continuation. Inter-rater reliability was supported (kappas = 0.63–1.0. Validity of the discontinuation domain scores was supported by associations with symptom measures (the Positive and Negative Syndrome Scale for Schizophrenia, the Clinical Global Impression – Schizophrenia Scale; r = 0.30 to 0.51; all P < 0.01, patients’ primary reasons for discontinuation, and adverse events. However, the continuation domain scores were not significantly associated with these other indicators

  15. Seismological evidence of the Hales discontinuity in northeast India

    Science.gov (United States)

    Anand, Aakash; Bora, Dipok K.; Borah, Kajaljyoti; Madhab Borgohain, Jayanta

    2018-04-01

    The crust and upper mantle shear wave velocity structure beneath the northeast India is estimated by joint inversion of Rayleigh wave group velocity and receiver function, calculated from teleseismic earthquakes data recorded at nine broadband seismic stations. The Assam valley and the Shillong-Mikir plateau are the two important tectonic blocks in the northeast India, which are surrounded by the Himalayan collision zone in the north, Indo-Burma subduction zone in the east and by the Bengal basin in the south. The joint inversion followed by forward modeling reveal crustal thicknesses of 30-34 km beneath the Shillong plateau, 36 km beneath the Mikir hills and 38-40 km beneath the Assam valley with an average shear wave velocity (Vs) of 3.4-3.5 km/s. The estimated low upper mantle shear wave velocity (Vsn) 4.2-4.3 km/s may be due to the rock composition or grain size or increased temperature and partial melt (<1%) in the upper mantle, or an effect of all. Also, we report for the first time, the existence of the Hales discontinuity at depths 56-74 km with Vs ∼4.4-4.6 km/s. Variable depth of the Hales discontinuity may be explained by the geotherm and/or addition of Cr3+ and Fe2+ in the spinel-garnet system.

  16. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV.

    Science.gov (United States)

    Bogart, Laura M; Wagner, Glenn J; Galvan, Frank H; Klein, David J

    2010-10-01

    African-Americans show worse HIV disease outcomes compared to Whites. Health disparities may be aggravated by discrimination, which is associated with worse health and maladaptive health behaviors. We examined longitudinal effects of discrimination on antiretroviral treatment adherence among 152 HIV-positive Black men who have sex with men. We measured adherence and discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation at baseline and monthly for 6 months. Hierarchical repeated-measures models tested longitudinal effects of each discrimination type on adherence. Over 6 months, participants took 60% of prescribed medications on average; substantial percentages experienced discrimination (HIV-serostatus, 38%; race/ethnicity, 40%; and sexual orientation, 33%). Greater discrimination due to all three characteristics was significantly bivariately associated with lower adherence (all p's discrimination was significant (p < 0.05). Efforts to improve HIV treatment adherence should consider the context of multiple stigmas, especially racism.

  17. Thyroid function in children and adolescents with Hashimoto’s thyroiditis after l-thyroxine discontinuation

    Directory of Open Access Journals (Sweden)

    Giorgio Radetti

    2017-04-01

    Full Text Available Objective: Thyroid function may recover in patients with Hashimoto’s thyroiditis (HT. Design: To investigate thyroid function and the need to resume l-thyroxine treatment after its discontinuation. Setting: Nine Italian pediatric endocrinology centers. Patients: 148 children and adolescents (25 m and 123 f with HT on treatment with l-thyroxine for at least one year. Intervention and main outcome measure: Treatment was discontinued in all patients, and serum TSH and fT4 concentrations were measured at the time of treatment discontinuation and then after 2, 6, 12 and 24 months. Therapy with l-thyroxine was re-instituted when TSH rose >10 U/L and/or fT4 was below the normal range. The patients were followed up when TSH concentrations were between 5 and 10 U/L and fT4 was in the normal range. Results: At baseline, TSH was in the normal range in 139 patients, and was between 5 and 10 U/L in 9 patients. Treatment was re-instituted after 2 months in 37 (25.5% patients, after 6 months in 13 patients (6.99%, after 12 months in 12 patients (8.6%, and after 24 months in an additional 3 patients (3.1%. At 24 months, 34 patients (34.3% still required no treatment. TSH concentration >10 U/L at the time of diagnosis was the only predictive factor for the deterioration of thyroid function after l-thyroxine discontinuation. Conclusions: This study confirms that not all children with HT need life-long therapy with l-thyroxine, and the discontinuation of treatment in patients with a TSH level <10 U/L at the time of diagnosis should be considered.

  18. Insufficient recruitment and premature discontinuation of clinical trials in Switzerland: qualitative study with trialists and other stakeholders.

    Science.gov (United States)

    Briel, Matthias; Elger, Bernice; von Elm, Erik; Satalkar, Priya

    2017-11-29

    Premature discontinuation occurs in about 25% of randomised clinical trials in Switzerland; it mainly affects investigator-initiated trials and is mostly due to problems with recruitment of patients. The aim of this study was to qualitatively investigate reasons for trial discontinuation due to poor patient recruitment and suggestions to address those reasons in the Swiss context. We conducted semi-structured interviews with trialists whose trials were discontinued because of recruitment problems, other experienced trialists, and stakeholders in clinical research in Switzerland. Interviews were audio-recorded, transcribed verbatim, and anonymised. We analysed the transcripts using deductive coding and built up themes that were continuously discussed within the research team. Of 65 invited Swiss trialists and stakeholders, 39 (60%) agreed to be interviewed and contributed to this analysis. We identified four main themes of reasons for poor recruitment: (1) Switzerland has a decentralised healthcare system with many small hospitals and few patients per hospital, many research regulations, no standardisation of medical records across hospitals, and a heterogeneous ethics assessment of study protocols. There is little collaboration of different stakeholders in clinical research and a lack of prioritisation of projects. (2) Limited human and financial resources, especially in the academic setting, compromise research questions and size of clinical trials. When funding is used up this typically triggers discontinuation of already delayed clinical trials. (3) Investigators face underdeveloped research networks and a limited collaborative attitude among clinical researchers. They typically embark on clinical studies with a great deal of optimism but insufficient preparation. (4) Swiss patients have universal health coverage and many treatment options. Negative media coverage of clinical research and a lack of accessible information for patients about ongoing clinical

  19. Triaxiality in the even-mass Hg isotopes: A discontinuity at 200Hg

    International Nuclear Information System (INIS)

    Morrison, I.; Spear, R.H.

    1981-01-01

    The mass dependence of excitation energies of the 2 + 1 , 2 + 2 , and 4 + 1 states of the even-mass Hg isotopes, and of some related B(E2) values, shows a marked discontinuity at 200 Hg. Analysis of B(E2;0 + 1 →2 + 1 ) values in terms of an extended interacting boson approximation model suggests that this discontinuity is due to a change in the proton and neutron distributions at 200 Hg. Apart from 200 Hg, the data favor γ-soft models rather than the rigid triaxial-rotor model

  20. Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

    Directory of Open Access Journals (Sweden)

    Anne Sverdrup Efjestad

    2017-02-01

    Full Text Available Background/Aims: Reduced clinical effect on cognitive decline in dementia by acetylcholinesterase inhibitors (AChEIs may be due to concurrent use of drugs with anticholinergic properties. The aim was to analyze the incidence of AChEI use and comedication with drugs with anticholinergic properties and other potential unfavorable effects. Methods: A prospective study applying drug use data from the Norwegian Prescription Database. Anticholinergic Drug Scale (ADS scores were used as a measure of overall anticholinergic burden. Results: Patients with high ADS scores were more frequently discontinuing treatment early. Coprescribing of antipsychotics was strongly associated with early discontinuation of AChEI treatment. Conclusion: Coprescribing with potentially unfavorable medications was common. A high ADS score was associated with early discontinuation of treatment.

  1. Acute Respiratory Distress due to Thymoma in a Patient Treated with TK Inhibitor: A Case Report and Review of the Current Treatment Options

    Directory of Open Access Journals (Sweden)

    P. Zarogoulidis

    2011-03-01

    Full Text Available Thymic malignancies are rare intrathoracic tumors that may be aggressive and difficult to treat in advanced stage. Surgery is the cornerstone of the management of thymomas: it is significant for the definite histopathological diagnosis and staging, and in most cases, it constitutes the first step of the treatment strategy. For patients with primary unresectable thymomas, the multimodal treatment schedule nowadays includes neoadjuvant chemotherapy, extensive surgery, adjuvant radiotherapy, and in some cases, adjuvant chemotherapy. A patient with a history of stage III COPD and an undiagnosed thoracic mass was admitted to the intensive care unit with acute respiratory distress. A radiologic evaluation by CT scan revealed a mass of 13 cm in diameter at the mediastinum. Fine needle aspiration was performed and revealed a thymoma. Due to poor performance status, the patient was not able to undergo surgery. He refused to be treated with neither chemotherapy nor radiotherapy, but due to EGFR overexpression, treatment with TK inhibitor was suggested. Fine needle aspiration biopsy is commonly used to identify metastasis to the mediastinum. However, it is less often employed as a primary diagnostic tool for tumors, particularly thymic neoplasms. The use of targeted therapies for the treatment of thymic malignancies has been described in the literature. Over the past years, significant efforts have been made to dissect the molecular pathways involved in the carcinogenesis of these tumors. Insights have been obtained following anecdotal clinical responses to targeted therapies, and large-scale genomic analyses have been conducted.

  2. Anterior segment optical coherence tomography changes with introduction and discontinuation of tamsulosin.

    Science.gov (United States)

    Al-Kharashi, Abdullah; Azimzadeh, Amir A; Leung, Jerry; Radomski, Sidney; Radomski, Lenny; Lam, Wai-Ching

    2016-01-01

    The aim of this study was to quantify changes and reversibility in pupil dilation and iris dilator muscle region thickness associated with introduction and subsequent discontinuation of tamsulosin in patients naïve to this drug with the aid of an anterior OCT system. The study was carried out on 7 patients (14 eyes) naïve to tamsulosin and with benign prostatic hypertrophy (BHP). Measurements taken by Vistante OCT were done pre- and post-dilation of the following: pupil size, iris dilator muscle region (DMR) thickness, sphincter muscle region (SMR) thickness, and anterior chamber depth. These measurement were taken at Day 0 (tamsulosin naive), Day 30 (after one month of tamsulosin, the treatment period) and day 60 (after one month of no tamsulosin, the discontinuation period). Post-dilation pupil diameter significantly increased during the discontinuation period ( P  = 0.047). Iris DMR thickness measurements post-dilation significantly decreased during treatment ( P  = 0.00044), discontinuation (0.00011), and combined periods ( P  = 0.000050). Anterior chamber depth measurements in post-dilation were significantly decreased during treatment ( P  = 0.0016), discontinuation ( P  = 0.017), and combined periods ( P  = 0.00022). Tamsulosin discontinuation effectively increases dilated pupil size, a measure that has been inversely linked to IFIS incidence pre-operatively. Decreased DMR thickness in this short term likely illustrates changes aside from atrophy, such as vascular changes. Decreased anterior chamber depths suggest aqueous humor production is decreased as well.

  3. Stem Cell Therapy and Breast Cancer Treatment: review of stem cell research and potential therapeutic impact against cardiotoxicities due to breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Thomas E. Sharp

    2014-11-01

    Full Text Available A new problem has emerged with the ever-increasing number of breast cancer survivors. While early screening and advances in treatment have allowed these patients to overcome their cancer, these treatments often have adverse cardiovascular side effects that can produce abnormal cardiovascular function. Chemotherapeutic and radiation therapy have both been linked to cardiotoxicity; these therapeutics can cause a loss of cardiac muscle and deterioration of vascular structure that can eventually lead to heart failure (HF. This cardiomyocyte toxicity can leave the breast cancer survivor with a probable diagnosis of dilated or restrictive cardiomyopathy (DCM or RCM. While current HF standard of care can alleviate symptoms, other than heart transplantation, there is no therapy that replaces cardiac myocytes that are killed during cancer therapies. There is a need to develop novel therapeutics that can either prevent or reverse the cardiac injury caused by cancer therapeutics. These new therapeutics should promote the regeneration of lost or deteriorating myocardium. Over the last several decades the therapeutic potential of cell-based therapy has been investigated for HF patients. In this review we discuss the progress of preclinical and clinical stem cell research for the diseased heart and discuss the possibility of utilizing these novel therapies to combat cardiotoxicity observed in breast cancer survivors.

  4. Singularity and dynamics on discontinuous vector fields

    CERN Document Server

    Luo, Albert CJ

    2006-01-01

    This book discussed fundamental problems in dynamics, which extensively exist in engineering, natural and social sciences. The book presented a basic theory for the interactions among many dynamical systems and for a system whose motions are constrained naturally or artificially. The methodology and techniques presented in this book are applicable to discontinuous dynamical systems in physics, engineering and control. In addition, they may provide useful tools to solve non-traditional dynamics in biology, stock market and internet network et al, which cannot be easily solved by the traditional

  5. Diffusion piecewise homogenization via flux discontinuity factors

    International Nuclear Information System (INIS)

    Sanchez, Richard; Zmijarevic, Igor

    2011-01-01

    We analyze the calculation of flux discontinuity factors (FDFs) for use with piecewise subdomain assembly homogenization. These coefficients depend on the numerical mesh used to compute the diffusion problem. When the mesh has a single degree of freedom on subdomain interfaces the solution is unique and can be computed independently per subdomain. For all other cases we have implemented an iterative calculation for the FDFs. Our numerical results show that there is no solution to this nonlinear problem but that the iterative algorithm converges towards FDFs values that reproduce subdomains reaction rates with a relatively high precision. In our test we have included both the GET and black-box FDFs. (author)

  6. Spacetime Discontinuous Galerkin FEM: Spectral Response

    International Nuclear Information System (INIS)

    Abedi, R; Omidi, O; Clarke, P L

    2014-01-01

    Materials in nature demonstrate certain spectral shapes in terms of their material properties. Since successful experimental demonstrations in 2000, metamaterials have provided a means to engineer materials with desired spectral shapes for their material properties. Computational tools are employed in two different aspects for metamaterial modeling: 1. Mircoscale unit cell analysis to derive and possibly optimize material's spectral response; 2. macroscale to analyze their interaction with conventional material. We compare two different approaches of Time-Domain (TD) and Frequency Domain (FD) methods for metamaterial applications. Finally, we discuss advantages of the TD method of Spacetime Discontinuous Galerkin finite element method (FEM) for spectral analysis of metamaterials

  7. Strengthening the Regression Discontinuity Design Using Additional Design Elements: A Within-Study Comparison

    Science.gov (United States)

    Wing, Coady; Cook, Thomas D.

    2013-01-01

    The sharp regression discontinuity design (RDD) has three key weaknesses compared to the randomized clinical trial (RCT). It has lower statistical power, it is more dependent on statistical modeling assumptions, and its treatment effect estimates are limited to the narrow subpopulation of cases immediately around the cutoff, which is rarely of…

  8. Discontinuation of angiotensin converting enzyme inhibitors (ACEIs) as a potential marker for adverse drug reactions (ADRs)

    NARCIS (Netherlands)

    Pour, Seyed Hamidreza Mahmoud; De Keyser, Catherine E.; Souverein, Patrick C.; Asselbergs, Folkert W.; Hofman, Albert; Stricker, Bruno H.; De Boer, Anthonius; Maitland-Van Der Zee, Anke-Hilse

    2014-01-01

    Background: ACEI-induced ADRs are the main reason to discontinue ACEI treatment. In prescription databases, information on ADRs is not available; therefore it is necessary to identify proxies for ADRs in such databases to study risk factors for ADRs. Objectives: To study prescription patterns for

  9. Discontinuity model for internal transport barrier formation in reversed magnetic shear plasmas

    International Nuclear Information System (INIS)

    Kishimoto, Y.; Kim, J-Y.; Horton, W.; Tajima, T.; LeBrun, M.J.

    2001-01-01

    To aid in understanding the internal transport barrier (ITB) being formed in reversed magnetic shear experiments, in addition to the well known shear flow effect, we point out an important nonlocal effect and/or finite size effect which comes from the complex behavior of the nonlocal mode over a finite radial region around the minimum q(safety factor)-surface. The nonlocal mode changes its structure depending on the sign of the magnetic shear and due to this fact, the nonlocal modes are weakly excited across the q min -surface. This leads to a discontinuity or gap which disconnects the phase relation in the global wave structure across the q min -surface. Once such a discontinuity (or gap) is formed, transport suppression occurs and therefore a transport barrier can be expected near the q min -surface. We confirm the existence of this discontinuity using a toroidal particle simulation. (author)

  10. Lyophilized allogeneic bone grafts for cystic and discontinuity defects of the jaws

    International Nuclear Information System (INIS)

    Pill Hoon Choung; Eun Seok Kim

    1999-01-01

    Allogenic bone grafts have been used after various processing in each institute was made by lyophilized allogenic bone and used for maxillofacial reconstruction. Three types of lyophilized allogenic bone grafts as powder, chip and block form were performed to reconstruct the following defects: 1) maxillectomy, 2) mandiblectomy, 3) cystectomy, 4) cleft alveolus, 5) gap in orthognathic osteotomy, 6) peri-implant defect, 7) extraction socket, and 8) facial contouring. Above defects can be classified as cystic and discontinuity defects of the maxilia and the mandible. Because discontinuity defects have more difficult problems to reconstruct considering mechanical strength of the allogenic bone. We performed allogenic bone grafts on 50 cystic defects and 12 discontinuity defects of the jaws. Among them, 3 cases were removed due to infection, and the others had no complications. In reconstruction of cystic defects, the defects were filled with allogenic chip which were made from allogenic block bone at the surgery, which later were changed to host bone. Three cases of them showed tooth eruption through the allogenic bone grafting site, changing the eruption pathway, which was interrupted by the lesion. in reconstruction of discontinuity defects, usually allogenic bone has been used as a tray, in which PMCB or demineralized bone chips were filled. But we tried to reconstruct this discontinuity defect using allogeneic bone block without inside filling of PMCB different from tray type. We will present the results of allogenic bone grafts using cranial bone, costochondral graft, and the mandible

  11. Utilization and discontinuation of contraceptive methods: the University of Calabar Teaching Hospital (UCTH experience

    Directory of Open Access Journals (Sweden)

    Njoku CO

    2014-09-01

    Full Text Available Background: Contraception has an important role to play in reducing the high rate of maternal morbidity and mortality in developing countries. Objective: The objective is to determine the prevalence rate, methods and reasons for discontinuation of contraceptive methods at UCTH, Calabar. Method: This was a retrospective study of all clients that utilised different forms of contraceptives at UCTH, Calabar from 1st January, 2009 to 31st December, 2013. Results: A total of 5,381 clients used various methods of contraception while 13,492 live births were recorded giving the prevalence rate of 39.9% of total live birth. Common methods were intrauterine contraceptive device (IUCD 1,745(32.8% and injectable contraceptives 1,268(23.8%. Most clients 1,876(35.2% were graduates while 81(1.5% had no formal education. A total of 535(10.1% clients discontinued different family planning method commonly due to desire for pregnancy and side effects. IUCD had the highest discontinuation rate. Conclusion: The study revealed low prevalence rate of contraceptive use which was more among teenagers and illiterate women. The main reasons for discontinuation of different methods were desire for pregnancy, side effects and menopause. Creating more contraceptive awareness, improvement in contraceptive counselling and female education will help to improve contraceptive utilisation rate and reduce discontinuation rate.

  12. Discontinuous precipitation in cobalt-tungsten alloys

    International Nuclear Information System (INIS)

    Zieba, P.; Cliff, G.; Lorimer, G.W.

    1997-01-01

    Discontinuous precipitation in a Co32 wt% W alloy aged in the temperature range from 875 K to 1025 K has been investigated. Philips EM 430 STEM has been used to characterize the microstructure and to measure the composition profiles across individual lamellae of ε Co and Co 3 W phases in partially transformed specimens. Two kinds of cellular precipitates have been found in the alloy. The initial transformation product, identified as primary lamellae with spacing of a few nanometers is replaced during prolonged ageing by secondary lamellae with a much larger interlamellar spacing, typically a few tens of nm. Line scans across cell boundaries of the primary lamellae revealed that, just behind the advancing cell boundary, the solute content is far from the equilibrium state. This solute excess within the cells is quickly removed at the ageing temperature. Calculations show that the diffusion process was too rapid to be identified as ordinary volume diffusion. Investigation of the kinetics showed that discontinuous precipitation is controlled by diffusion processes at the advancing cell boundary. This proposal has been confirmed by STEM analysis of tungsten profiles in the depleted ε Co lamellae

  13. Discontinuities in an axisymmetric generalized thermoelastic problem

    Directory of Open Access Journals (Sweden)

    Moncef Aouadi

    2005-06-01

    Full Text Available This paper deals with discontinuities analysis in the temperature, displacement, and stress fields of a thick plate whose lower and upper surfaces are traction-free and subjected to a given axisymmetric temperature distribution. The analysis is carried out under three thermoelastic theories. Potential functions together with Laplace and Hankel transform techniques are used to derive the solution in the transformed domain. Exact expressions for the magnitude of discontinuities are computed by using an exact method developed by Boley (1962. It is found that there exist two coupled waves, one of which is elastic and the other is thermal, both propagating with finite speeds with exponential attenuation, and a third which is called shear wave, propagating with constant speed but with no exponential attenuation. The Hankel transforms are inverted analytically. The inversion of the Laplace transforms is carried out using the inversion formula of the transform together with Fourier expansion techniques. Numerical results are presented graphically along with a comparison of the three theories of thermoelasticity.

  14. Discontinuous approximate molecular electronic wave-functions

    International Nuclear Information System (INIS)

    Stuebing, E.W.; Weare, J.H.; Parr, R.G.

    1977-01-01

    Following Kohn, Schlosser and Marcus and Weare and Parr an energy functional is defined for a molecular problem which is stationary in the neighborhood of the exact solution and permits the use of trial functions that are discontinuous. The functional differs from the functional of the standard Rayleigh--Ritz method in the replacement of the usual kinetic energy operators circumflex T(μ) with operators circumflex T'(μ) = circumflex T(μ) + circumflex I(μ) generates contributions from surfaces of nonsmooth behavior. If one uses the nabla PSI . nabla PSI way of writing the usual kinetic energy contributions, one must add surface integrals of the product of the average of nabla PSI and the change of PSI across surfaces of discontinuity. Various calculations are carried out for the hydrogen molecule-ion and the hydrogen molecule. It is shown that ab initio calculations on molecules can be carried out quite generally with a basis of atomic orbitals exactly obeying the zero-differential overlap (ZDO) condition, and a firm basis is thereby provided for theories of molecular electronic structure invoking the ZDO aoproximation. It is demonstrated that a valence bond theory employing orbitals exactly obeying ZDO can provide an adequate account of chemical bonding, and several suggestions are made regarding molecular orbital methods

  15. Diffusion piecewise homogenization via flux discontinuity ratios

    International Nuclear Information System (INIS)

    Sanchez, Richard; Dante, Giorgio; Zmijarevic, Igor

    2013-01-01

    We analyze piecewise homogenization with flux-weighted cross sections and preservation of averaged currents at the boundary of the homogenized domain. Introduction of a set of flux discontinuity ratios (FDR) that preserve reference interface currents leads to preservation of averaged region reaction rates and fluxes. We consider the class of numerical discretizations with one degree of freedom per volume and per surface and prove that when the homogenization and computing meshes are equal there is a unique solution for the FDRs which exactly preserve interface currents. For diffusion sub-meshing we introduce a Jacobian-Free Newton-Krylov method and for all cases considered obtain an 'exact' numerical solution (eight digits for the interface currents). The homogenization is completed by extending the familiar full assembly homogenization via flux discontinuity factors to the sides of regions laying on the boundary of the piecewise homogenized domain. Finally, for the familiar nodal discretization we numerically find that the FDRs obtained with no sub-mesh (nearly at no cost) can be effectively used for whole-core diffusion calculations with sub-mesh. This is not the case, however, for cell-centered finite differences. (authors)

  16. Due diligence

    International Nuclear Information System (INIS)

    Sanghera, G.S.

    1999-01-01

    The Occupational Health and Safety (OHS) Act requires that every employer shall ensure the health and safety of workers in the workplace. Issues regarding the practices at workplaces and how they should reflect the standards of due diligence were discussed. Due diligence was described as being the need for employers to identify hazards in the workplace and to take active steps to prevent workers from potentially dangerous incidents. The paper discussed various aspects of due diligence including policy, training, procedures, measurement and enforcement. The consequences of contravening the OHS Act were also described

  17. Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy

    International Nuclear Information System (INIS)

    Chen Long; Ni Caifang; Wang Zhentang; Liu Yizhi; Jin Yonghai; Zhu Xiaoli; Zou Jianwei; Xiao Xiangsheng

    2010-01-01

    Objective: To investigate the clinical feasibility and efficacy of percutaneous vertebroplasty performed with an 18G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy. Methods: During the period of 2006-2010 percutaneous vertebroplasty was performed in 10 patients with severe compression fracture of cervical vertebral body due to metastatic lesions. A total of 12 diseased vertebral bodies were detected, which distributed in the C 4 (n = 3), C 5 (n = 3), C 6 (n = 4) and C 7 (n = 2) vertebral bodies. Under DSA guidance an 18G needle was punctured into the target vertebral body and then polymethylmethacrylate bone cement was injected in. A follow-up lasting for one month was conducted. Results: The technical success of both needle puncturing and bone cement injection was achieved in all patients. The mean amount of bone cement injected in each diseased vertebra was 2.2 ml(1.5-3.2)ml. Marked pain relief was quickly obtained in al1 10 patients. No major complications occurred in this series, except for asymptomatic bone cement leaking around vertebra which appeared in 4 vertebral bodies. Conclusion: Percutaneous vertebroplasty, which is performed with an 18G needle, is a safe and effective technique for the treatment of severe compression fracture of cervical vertebral body due to malignancy. (authors)

  18. Outcome after Discontinuing Long-Term Benzimidazole Treatment in 11 Patients with Non-resectable Alveolar Echinococcosis with Negative FDG-PET/CT and Anti-EmII/3-10 Serology

    Science.gov (United States)

    Stumpe, Katrin D. M.; Grimm, Felix; Deplazes, Peter; Huber, Sabine; Bertogg, Kaja; Fischer, Dorothee R.; Müllhaupt, Beat

    2015-01-01

    Background/Aims Benzimidazoles are efficacious for treating non-resectable alveolar echinococcosis (AE), but their long-term parasitocidal (curative) effect is disputed. In this study, we prospectively analyzed the potential parasitocidal effect of benzimidazoles and whether normalization of FDG-PET/CT scans and anti-Emll/3-10-antibody levels could act as reliable "in vivo" parameters of AE-inactivation permitting to abrogate chemotherapy with a low risk for AE-recurrence. Method This prospective study included 34 patients with non-resectable AE subdivided into group A (n = 11), followed-up after diagnosis and begin of chemotherapy at months 6, 12 and 24, and group B (n = 23) with a medium duration of chemotherapy of 10 (range 2–25) years. All patients were assessed by FDG-PET/CT examinations and anti-EmII/3-10 serology. Chemotherapy was abrogated in patients with normalization of FDG-PET/CT and serum anti-EmII/3-10 levels. These patients were closely followed-up for AE recurrence. Endpoint (parasitocidal efficacy) was defined by the absence of AE-recurrence >24 months after stopping treatment. Results Normalization of FDG-PET/CT scan and anti-EmII/3-10 levels occurred in 11 of 34 patients (32%). After abrogation of chemotherapy in these 11 patients, there was no evidence of AE-recurrence within a median of 70.5 (range 16–82) months. However, the patients’ immunocompetence appears pivotal for the described long-term parasitocidal effect of benzimidazoles. Conclusions The combination of negative FDG-PET/CT-scans and anti-EmII/3-10 antibody levels seem to be reliable parameters for assessing in vivo AE-larval inactivity after long-term benzimidazole chemotherapy. Trial Registration clinicaltrials.gov: NCT00658294 PMID:26389799

  19. Rock discontinuity surface roughness variation with scale

    Science.gov (United States)

    Bitenc, Maja; Kieffer, D. Scott; Khoshelham, Kourosh

    2017-04-01

    ABSTRACT: Rock discontinuity surface roughness refers to local departures of the discontinuity surface from planarity and is an important factor influencing the shear resistance. In practice, the Joint Roughness Coefficient (JRC) roughness parameter is commonly relied upon and input to a shear strength criterion such as developed by Barton and Choubey [1977]. The estimation of roughness by JRC is hindered firstly by the subjective nature of visually comparing the joint profile to the ten standard profiles. Secondly, when correlating the standard JRC values and other objective measures of roughness, the roughness idealization is limited to a 2D profile of 10 cm length. With the advance of measuring technologies that provide accurate and high resolution 3D data of surface topography on different scales, new 3D roughness parameters have been developed. A desirable parameter is one that describes rock surface geometry as well as the direction and scale dependency of roughness. In this research a 3D roughness parameter developed by Grasselli [2001] and adapted by Tatone and Grasselli [2009] is adopted. It characterizes surface topography as the cumulative distribution of local apparent inclination of asperities with respect to the shear strength (analysis) direction. Thus, the 3D roughness parameter describes the roughness amplitude and anisotropy (direction dependency), but does not capture the scale properties. In different studies the roughness scale-dependency has been attributed to data resolution or size of the surface joint (see a summary of researches in [Tatone and Grasselli, 2012]). Clearly, the lower resolution results in lower roughness. On the other hand, have the investigations of surface size effect produced conflicting results. While some studies have shown a decrease in roughness with increasing discontinuity size (negative scale effect), others have shown the existence of positive scale effects, or both positive and negative scale effects. We

  20. Gynecomastia due to hormone therapy for advanced prostate cancer: a report of ten surgically treated cases and a review of treatment options.

    Science.gov (United States)

    Prezioso, Domenico; Piccirillo, Giuseppe; Galasso, Raffaele; Altieri, Vincenzo; Mirone, Vincenzo; Lotti, Tullio

    2004-01-01

    Gynecomastia is an abnormal increase in the volume of the male breast that is generally considered to be due to an increased estrogen/androgen ratio. Pathological causes of gynecomastia include organic diseases and therapy, such as the administration of estrogens and antiandrogens, which alter the ratio of circulating hormones. Hormone therapy for prostate cancer is generally well tolerated but often accompanied by the occurrence of gynecomastia and breast pain or tenderness. The increased use of antiandrogens as monotherapy is leading to an increase in the number of patients affected by gynecomastia. Treatments are available to alleviate or prevent the development of gynecomastia, including medical treatment with antiestrogens and aromatase inhibitors. Alternatively, mastectomy with excision of the gland, liposuction or an association of the two techniques have proved to be effective. Radiation therapy may provide effective relief from the breast pain associated with gynecomastia. In this paper we show the good results of mastectomy performed with a lower semicircular periareolar incision in men suffering from gynecomastia due to antiandrogen therapy for inoperable prostate cancer. In addition, we present a review of the various techniques used for the treatment of gynecomastia. During the period from September 1998 to May 2001, 10 patients receiving hormone treatment for metastatic or inoperable prostatic cancer were selected for the study if they had breast pain and bilateral gynecomastia. Five of these patients had been offered prophylactic radiotherapy before treatment but refused, while the remaining five patients had refused radiotherapy after hormone treatment. These patients were therefore given the option of surgical treatment. Before surgery all patients underwent clinical and ultrasound examination of the breast. All surgical samples were examined histopathologically. During follow-up clinical examinations were carried out one week, one month, six

  1. Brand-name drug, generic drug, orphan drug. Pharmacological therapy with biosimilar drugs – provision of due diligence in the treatment process

    Science.gov (United States)

    Zajdel, Justyna

    2013-01-01

    Due diligence in the process of provision of healthcare services refers, among other elements, to the application of pharmacological therapy at a time which offers the greatest chance for a successful outcome of treatment, i.e. for achieving the optimum expected effect understood as an improvement in the patient's health, reduction of health risks or elimination of the disease. However, due diligence may also refer to actions aimed at ensuring that neither the patient nor the healthcare payer is required to incur unreasonable costs in the process of treatment. The validity of that statement stems not only from normative acts but also from ethical standards laid down in the Medical Code of Ethics (Article 57 section 2). It often happens that the provision of optimal treatment calls for deviations from the formal provisions included in Summary Product Characteristics (SPCs), and the application of drugs that are bioequivalent to reference drugs, which translates into a significant reduction of costs. The present study addresses the problem of acceptability of a specific form of drug substitution consisting in the replacement of a reference drug with a generic drug. Also explored are legal aspects associated with the possibility of therapy based on “off-label use”. The study reviews normative acts existing in the Polish and EU legislation. It also provides a clear definition of orphan drug, which has made it possible to make a distinction and investigate mutual relations between the concepts of brand-name (reference) drug, orphan drug and generic drug. PMID:24592133

  2. Brand-name drug, generic drug, orphan drug. Pharmacological therapy with biosimilar drugs - provision of due diligence in the treatment process.

    Science.gov (United States)

    Zajdel, Justyna; Zajdel, Radosław

    2013-01-01

    Due diligence in the process of provision of healthcare services refers, among other elements, to the application of pharmacological therapy at a time which offers the greatest chance for a successful outcome of treatment, i.e. for achieving the optimum expected effect understood as an improvement in the patient's health, reduction of health risks or elimination of the disease. However, due diligence may also refer to actions aimed at ensuring that neither the patient nor the healthcare payer is required to incur unreasonable costs in the process of treatment. The validity of that statement stems not only from normative acts but also from ethical standards laid down in the Medical Code of Ethics (Article 57 section 2). It often happens that the provision of optimal treatment calls for deviations from the formal provisions included in Summary Product Characteristics (SPCs), and the application of drugs that are bioequivalent to reference drugs, which translates into a significant reduction of costs. The present study addresses the problem of acceptability of a specific form of drug substitution consisting in the replacement of a reference drug with a generic drug. Also explored are legal aspects associated with the possibility of therapy based on "off-label use". The study reviews normative acts existing in the Polish and EU legislation. It also provides a clear definition of orphan drug, which has made it possible to make a distinction and investigate mutual relations between the concepts of brand-name (reference) drug, orphan drug and generic drug.

  3. Efficacy and safety of vedolizumab as a treatment option for moderate to severe refractory ulcerative colitis in two patients after liver transplant due to primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Raúl Vicente Olmedo-Martín

    Full Text Available Vedolizumab is a humanized IgG1 monoclonal antibody that selectively blocks the lymphocyte integrin α4β7 and prevents its interaction with endothelial adhesion molecules and subsequent transmigration to the gastrointestinal tract. The drug was approved in 2014 for the induction and maintenance treatment of ulcerative colitis and moderate to severe Crohn's disease that is refractory or intolerant to conventional treatment with corticoids and immunosuppressants and/or anti-TNFα drugs. However, inflammatory bowel disease has a variable behavior following liver transplant. One third of patients with ulcerative colitis associated with primary sclerosing cholangitis are expected to deteriorate despite receiving immunosuppression to prevent rejection. There is limited experience with anti-TNFα agents in patients with inflammatory bowel disease in the setting of liver transplantation and the studies to date involve a limited number of cases. The efficacy and safety data of vedolizumab in this situation are unreliable and very preliminary. We present two cases with the aim to present the efficacy and safety of vedolizumab after one year of treatment in two patients who underwent a transplant due to primary sclerosing cholangitis. One case had de novo post-transplant ulcerative colitis refractory to two anti-TNFα drugs (golimumab and infliximab. The other patient had a colostomy due to fulminant colitis and developed severe ulcerative proctitis refractory to infliximab after reconstruction with an ileorectal anastomosis.

  4. Acetylcholinesterase inhibitor treatment alleviated cognitive impairment caused by delayed encephalopathy due to carbon monoxide poisoning: Two case reports and a review of the literature.

    Science.gov (United States)

    Yanagiha, Kumi; Ishii, Kazuhiro; Tamaoka, Akira

    2017-02-01

    Delayed encephalopathy due to carbon monoxide (CO) poisoning can even occur in patients with mild symptoms of acute CO poisoning. Some cases taking conventional hyperbaric oxygen (HBO) therapy or steroid-pulse therapy may be insufficient, and AchEI may be effective. We report two cases of delayed encephalopathy after acute CO poisoning involving two women aged 69 (Case 1) and 60 years (Case 2) whose cognitive function improved with acetylcholinesterase inhibitor (AchEI) treatment. Delayed encephalopathy occurred 25 and 35 days after acute CO poisoning in Case 1 and Case 2, respectively. Both patients demonstrated cognitive impairment, apathy, and hypokinesia on admission. Although hyperbaric oxygen therapy did not yield any significant improvements, cognitive dysfunction improved substantially. This was evidenced by an improved Mini-Mental State Examination score ffom 9 to 28 points in Case 1 and an improved Hasegawa's dementia rating scale score from 4 to 25 points in Case 2 after administration of an AchEI. In Case 1, we administered galantamine hydrobromide, which was related with improved white matter lesions initially detected on brain magnetic resonance imaging. However, in Case 2 white matter lesions persisted despite AchEI treatment. AchEI treatment may result in improved cognitive and frontal lobe function by increasing low acetylcholine concentrations in the hippocampus and frontal lobe caused by decreased nicotinic acetylcholine receptor levels in delayed encephalopathy after CO poisoning. Physicians should consider AchEIs for patients demonstrating delayed encephalopathy due to CO poisoning.

  5. Oral Effects and Early Implant Survival Results After Imatinib Discontinuation Therapy for Chronic Myelogenous Leukemia: A Case Report.

    Science.gov (United States)

    Dixon, Douglas R; Yassin, Alaa

    2017-08-01

    Little is known regarding the success, failure, or complication rates of advanced implant procedures in patients after discontinuation therapy of long-term medications for the treatment of chronic myelogenous leukemia (CML). This case report presents initial results of a case involving implant placement in the mandible and maxilla as well as reduction of palatal oral pigmentation in a patient discontinuing long-term tyrosine kinase inhibitor (TKI) therapy for CML. A 57-year-old male was referred to the Department of Periodontics, University of Washington, Seattle, Washington, for an assessment of edentulous areas (tooth sites #3 and #14) and failing tooth #19. Previous medical treatment included oral administration (>10 years) of TKI for the treatment of CML. Systemic complications arising from long-term TKI therapy were treated with discontinuation of this medication. Concurrently, after multispecialty dental and medical consultation, extraction of tooth #19 with immediate implant placement and bilateral sinus augmentation with simultaneous implant placement were successfully performed during three separate surgical appointments. Additionally, marked reduction of oral palatal pigmentation was observed during the surgical and restorative phases after TKI discontinuation. Patients with a history of long-term TKIs for CML are at risk for developing complications that result in discontinuation of therapy. Long-term benefits of therapy may allow these patients to enjoy remission with an extended and improved quality of life. Patients undergoing discontinuation therapy may seek dental care. Therefore, dental providers need to understand these systemic interactions and, with multispecialty consultation, may help effectively treat these individuals.

  6. Effect of TSUMURA Saiboku-to as an agent for healing damage in treatment of radiomucositis due to irradiation of the head and neck area and mediastinum

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Yoshihiro (Tatebayashi Kosei Hospital, Gunma (Japan)); Mitsuhashi, Norio; Takahashi, Iku (and others)

    1992-12-01

    A joint multicenter study was conducted on the utility of TSUMURA Saiboku-to as an agent for healing radiation damage in treatment of radiomucositis due to irradiation of the head and neck area and mediastinum, with the following results. In a comparison of each clinical symptom, efficacy in the TSUMURA Saiboku-to group was not clear, but an overall evaluation of the individual cases showed a significantly increased number of subjects with evaluations of effective or better in the administration group. No serious side effects were observed. (author).

  7. Study of in vitro toxicity and ex vivo and in vivo efficiency of calixarene galenic forms developed for the treatment of cutaneous contamination due to uranium compounds

    International Nuclear Information System (INIS)

    Grives, Sophie

    2015-01-01

    In case of radiological skin contamination by uranium compounds, the only treatments currently available consist in rinsing the contaminated skin area with water and detergent, or with a calcium salt of diethylene triamine pentaacetic acid (Ca-DTPA) solution. However, these procedures are not specific and no efficient treatment for cutaneous contamination due to uranium exists. In the absence of such treatments, uranium diffusion through the skin is fast, inducing an internal exposure after its distribution inside the body through the bloodstream. One part of the bioavailable uranium is up-taken in target organs which are the kidneys and the skeleton, where its toxic effects occur. Therefore a topical formulation consisting of an oil-in-water nano-emulsion incorporating a tricarboxylic calixarene molecule, as a specific chelating agent for uranium, was previously developed. The work achieved in this thesis aimed at evaluating the ex vivo and in vivo decontamination efficiency of this new emergency treatment on intact and superficially wounded skin. For this purpose, skin excoriation model was used. Reproducible models of superficial wounds consisting of micro-cuts and micro-punctures were also developed in order to evaluate the efficiency of the nano-emulsion on physical wounds such as incisions. These studies showed that the calixarene nano-emulsion could be an efficient decontaminating treatment, less aggressive than using the current treatment: soaped water. Its potential cutaneous toxicity was evaluated on in vitro reconstructed human epidermis using three different toxicity tests (MTT, LDH and IL-1-α). These studies demonstrated that the calixarene nano-emulsion did not induce skin toxicity even after 24 h of exposure time. (author)

  8. Discontinuous Schedule of Bevacizumab in Colorectal Cancer Induces Accelerated Tumor Growth and Phenotypic Changes

    Directory of Open Access Journals (Sweden)

    Selma Becherirat

    2018-04-01

    Full Text Available Antiangiogenics administration in colorectal cancer patients seemed promising therapeutic approach. Inspite of early encouraging results, it however gave only modest clinical benefits. When AAG was administered with discontinuous schedule, the disease showed acceleration in certain cases. Though resistance to AAG has been extensively studied, it is not documented for discontinuous schedules. To simulate clinical situations, we subjected a patient-derived CRC subcutaneous xenograft in mice to three different protocols: 1 AAG (bevacizumab treatment for 30 days (group A (group B was the control, 2 bevacizumab treatment for 50 days (group C and bevacizumab for 30 days and 20 without treatment (group D, and 3 bevacizumab treatment for 70 days (group E and 70 days treatment with a drug-break period between day 30 and 50 (group F. The tumor growth was monitored, and at sacrifice, the vascularity of tumors was measured and the proangiogenic factors quantified. Tumor phenotype was studied by quantifying cancer stem cells. Interrupting bevacizumab during treatment accelerated tumor growth and revascularization. A significant increase of proangiogenic factors was observed when therapy was stopped. On withdrawal of bevacizumab, as also after the drug-break period, the plasmatic VEGF increased significantly. Similarly, a notable increase of CSCs after the withdrawal and drug-break period of bevacizumab was observed (P<.01. The present study indicates that bevacizumab treatment needs to be maintained because discontinuous schedules tend to trigger tumor regrowth, and increase tumor resistance and CSC heterogeneity.

  9. Retrospective Study to Compare Selective Decongestive Devascularization and Gastrosplenic Shunt versus Splenectomy with Pericardial Devascularization for the Treatment of Patients with Esophagogastric Varices Due to Cirrhotic Portal Hypertension.

    Science.gov (United States)

    Bao, Haili; He, Qikuan; Dai, Ninggao; Ye, Ruifan; Zhang, Qiyu

    2017-06-08

    BACKGROUND For patients with esophagogastric varices secondary to portal hypertension due to liver cirrhosis, portosystemic shunts and devascularization have become the most commonly used treatment methods. We have developed a novel surgical approach for the treatment of patients with cirrhotic portal hypertension, selective decongestive devascularization, and shunt of the gastrosplenic region (SDDS-GSR). This aim of this study was to compare the efficacy and safety of SDDS-GSR with splenectomy with pericardial devascularization (SPD). MATERIAL AND METHODS A retrospective study was undertaken between 2006 and 2013 and included 110 patients with cirrhotic portal hypertension, 34 of whom underwent SDDS-GSR; 76 patients underwent SPD. Kaplan-Meier analysis was used to evaluate clinical outcomes, mortality, the incidence of re-bleeding, encephalopathy, and portal venous system thrombosis (PVST). RESULTS Postoperatively portal venous pressure decreased by 20% in both groups. The long-term incidence of re-bleeding and PVST was significantly lower in the SDDS-GSR group compared with the SPD group (P=0.018 and P=0.039, respectively). CONCLUSIONS This preliminary retrospective study has shown that SDDS-GSR was an effective treatment for patients with esophagogastric varices secondary to portal hypertension that may be used as a first-line treatment to prevent variceal bleeding and lower the incidence of PVST.

  10. Estimates of Nitrogen, Phosphorus, Biochemical Oxygen Demand, and Fecal Coliforms Entering the Environment Due to Inadequate Sanitation Treatment Technologies in 108 Low and Middle Income Countries.

    Science.gov (United States)

    Fuhrmeister, Erica R; Schwab, Kellogg J; Julian, Timothy R

    2015-10-06

    Understanding the excretion and treatment of human waste (feces and urine) in low and middle income countries (LMICs) is necessary to design appropriate waste management strategies. However, excretion and treatment are often difficult to quantify due to decentralization of excreta management. We address this gap by developing a mechanistic, stochastic model to characterize phosphorus, nitrogen, biochemical oxygen demand (BOD), and fecal coliform pollution from human excreta for 108 LMICs. The model estimates excretion and treatment given three scenarios: (1) use of existing sanitation systems, (2) use of World Health Organization-defined "improved sanitation", and (3) use of best available technologies. Our model estimates that more than 10(9) kg/yr each of phosphorus, nitrogen and BOD are produced. Of this, 22(19-27)%, 11(7-15)%, 17(10-23)%, and 35 (23-47)% (mean and 95% range) BOD, nitrogen, phosphorus, and fecal coliforms, respectively, are removed by existing sanitation systems. Our model estimates that upgrading to "improved sanitation" increases mean removal slightly to between 17 and 53%. Under the best available technology scenario, only approximately 60-80% of pollutants are treated. To reduce impact of nutrient and microbial pollution on human and environmental health, improvements in both access to adequate sanitation and sanitation treatment efficiency are needed.

  11. Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic Hepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms

    Directory of Open Access Journals (Sweden)

    Nikhil P. Jaik

    2008-01-01

    Full Text Available Extrahepatic hepatic ductal injuries (EHDIs due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT, abdominal ultrasonography (AUS, nuclear imaging (HIDA scan, and cholangiography. Traditional options in management of EHDI include primary ductal repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage. Simple drainage and biliary decompression is often the most appropriate treatment in unstable patients. More recently, endoscopic retrograde cholangiopancreatography (ERCP allowed for diagnosis and potential treatment of these injuries via stenting and/or papillotomy. Our review of 53 cases of EHDI reported in the English-language literature has focused on the evolving role of ERCP in diagnosis and treatment of these injuries. Diagnostic and treatment algorithms incorporating ERCP have been designed to help systematize and simplify the management of EHDI. An illustrative case is reported of blunt traumatic injury involving both the extrahepatic portion of the left hepatic duct and its confluence with the right hepatic duct. This injury was successfully diagnosed and treated using ERCP.

  12. Factors predicting successful discontinuation of continuous renal replacement therapy.

    Science.gov (United States)

    Katayama, S; Uchino, S; Uji, M; Ohnuma, T; Namba, Y; Kawarazaki, H; Toki, N; Takeda, K; Yasuda, H; Izawa, J; Tokuhira, N; Nagata, I

    2016-07-01

    This multicentre, retrospective observational study was conducted from January 2010 to December 2010 to determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating factors predictive of successful discontinuation in patients with acute kidney injury. Analysis was performed for patients after CRRT was discontinued because of renal function recovery. Patients were divided into two groups according to the success or failure of CRRT discontinuation. In multivariate logistic regression analysis, urine output at discontinuation, creatinine level and CRRT duration were found to be significant variables (area under the receiver operating characteristic curve for urine output, 0.814). In conclusion, we found that higher urine output, lower creatinine and shorter CRRT duration were significant factors to predict successful discontinuation of CRRT.

  13. Universal quantum computation by discontinuous quantum walk

    International Nuclear Information System (INIS)

    Underwood, Michael S.; Feder, David L.

    2010-01-01

    Quantum walks are the quantum-mechanical analog of random walks, in which a quantum ''walker'' evolves between initial and final states by traversing the edges of a graph, either in discrete steps from node to node or via continuous evolution under the Hamiltonian furnished by the adjacency matrix of the graph. We present a hybrid scheme for universal quantum computation in which a quantum walker takes discrete steps of continuous evolution. This ''discontinuous'' quantum walk employs perfect quantum-state transfer between two nodes of specific subgraphs chosen to implement a universal gate set, thereby ensuring unitary evolution without requiring the introduction of an ancillary coin space. The run time is linear in the number of simulated qubits and gates. The scheme allows multiple runs of the algorithm to be executed almost simultaneously by starting walkers one time step apart.

  14. Discontinuity minimization for omnidirectional video projections

    Science.gov (United States)

    Alshina, Elena; Zakharchenko, Vladyslav

    2017-09-01

    Advances in display technologies both for head mounted devices and television panels demand resolution increase beyond 4K for source signal in virtual reality video streaming applications. This poses a problem of content delivery trough a bandwidth limited distribution networks. Considering a fact that source signal covers entire surrounding space investigation reviled that compression efficiency may fluctuate 40% in average depending on origin selection at the conversion stage from 3D space to 2D projection. Based on these knowledge the origin selection algorithm for video compression applications has been proposed. Using discontinuity entropy minimization function projection origin rotation may be defined to provide optimal compression results. Outcome of this research may be applied across various video compression solutions for omnidirectional content.

  15. Discontinuity and complexity in nonlinear physical systems

    CERN Document Server

    Baleanu, Dumitru; Luo, Albert

    2014-01-01

    This unique book explores recent developments in experimental research in this broad field, organized in four distinct sections. Part I introduces the reader to the fractional dynamics and Lie group analysis for nonlinear partial differential equations. Part II covers chaos and complexity in nonlinear Hamiltonian systems, important to understand the resonance interactions in nonlinear dynamical systems, such as Tsunami waves and wildfire propagations; as well as Lev flights in chaotic trajectories, dynamical system synchronization and DNA information complexity analysis. Part III examines chaos and periodic motions in discontinuous dynamical systems, extensively present in a range of systems, including piecewise linear systems, vibro-impact systems and drilling systems in engineering. And in Part IV, engineering and financial nonlinearity are discussed. The mechanism of shock wave with saddle-node bifurcation and rotating disk stability will be presented, and the financial nonlinear models will be discussed....

  16. Robust Discontinuity Preserving Optical Flow Methods

    Directory of Open Access Journals (Sweden)

    Nelson Monzón

    2016-11-01

    Full Text Available In this work, we present an implementation of discontinuity-preserving strategies in TV-L1 optical flow methods. These are based on exponential functions that mitigate the regularization at image edges, which usually provide precise flow boundaries. Nevertheless, if the smoothing is not well controlled, it may produce instabilities in the computed motion fields. We present an algorithm that allows three regularization strategies: the first one uses an exponential function together with a TV process; the second one combines this strategy with a small constant that ensures a minimum isotropic smoothing; the third one is a fully automatic approach that adapts the diffusion depending on the histogram of the image gradients. The last two alternatives are aimed at reducing the effect of instabilities. In the experiments, we observe that the pure exponential function is highly unstable while the other strategies preserve accurate motion contours for a large range of parameters.

  17. RURAL TOURISM IN ROMANIA - EVOLUTIONS AND DISCONTINUITIES

    Directory of Open Access Journals (Sweden)

    Ionica SOARE

    2011-12-01

    Full Text Available This paper analyzes the evolution of rural tourism since the early '70s, the time of onset, and indicates the discontinuity recorded especially after 1989 until the brink of the preparation for Romania's joining the European Union and the present state, one far behind the countries with extremely high degree of urbanization and industrialization, probably as a result of a lack of strategy for this form of tourism in which the beneficiary is the Ministry of Tourism, as the health tourism and ecotourism have recently had. The location of many villages in areas of outstanding natural landscapes, the richness and variety of cultural heritage that endows them, are issues related to an increased tourism potential that can be capitalized and those unique tourism products that can not be seen, admired and offered by other countries.

  18. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism

    OpenAIRE

    Wildschut, T.; Van Horen, F.; Hart, C.

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism). Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent). A prisoner’s dil...

  19. Preparation and Mechanical Properties of Aligned Discontinuous Carbon Fiber Composites

    OpenAIRE

    DENG Hua; GAO Junpeng; BAO Jianwen

    2018-01-01

    Aligned discontinuous carbon fiber composites were fabricated from aligned discontinuous carbon fiber prepreg, which was prepared from continuous carbon fiber prepreg via mechanical high-frequency cutting. The internal quality and mechanical properties were characterized and compared with continuous carbon fiber composites. The results show that the internal quality of the aligned discontinuous carbon fiber composites is fine and the mechanical properties have high retention rate after the fi...

  20. Schroedinger propagation of initial discontinuities leads to divergence of moments

    International Nuclear Information System (INIS)

    Marchewka, A.; Schuss, Z.

    2009-01-01

    We show that the large phase expansion of the Schroedinger propagation of an initially discontinuous wave function leads to the divergence of average energy, momentum, and displacement, rendering them unphysical states. If initially discontinuous wave functions are considered to be approximations to continuous ones, the determinant of the spreading rate of these averages is the maximal gradient of the initial wave function. Therefore a dilemma arises between the inclusion of discontinuous wave functions in quantum mechanics and the requirement of finite moments.

  1. Schroedinger propagation of initial discontinuities leads to divergence of moments

    Energy Technology Data Exchange (ETDEWEB)

    Marchewka, A., E-mail: avi.marchewka@gmail.co [Ruppin Academic Center, Emek-Hefer 40250 (Israel); Schuss, Z., E-mail: schuss@post.tau.ac.i [Department of Mathematics, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv (Israel)

    2009-09-21

    We show that the large phase expansion of the Schroedinger propagation of an initially discontinuous wave function leads to the divergence of average energy, momentum, and displacement, rendering them unphysical states. If initially discontinuous wave functions are considered to be approximations to continuous ones, the determinant of the spreading rate of these averages is the maximal gradient of the initial wave function. Therefore a dilemma arises between the inclusion of discontinuous wave functions in quantum mechanics and the requirement of finite moments.

  2. Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

    OpenAIRE

    Steven F. Koch; Jeffrey S. Racine

    2013-01-01

    We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relat...

  3. Discontinuation of orthokeratology on eyeball elongation (DOEE).

    Science.gov (United States)

    Cho, P; Cheung, S W

    2017-04-01

    To evaluate and compare changes in axial elongation, over a 14-month period, in subjects who discontinued and then resumed ortho-k lens wear with those who continued to wear their lenses or spectacles following a 2-year myopia control study. This single masked, prospective study recruited subjects who had just completed a 2-year myopia control study. Ortho-k subjects were classified as Group OKc, in which subjects continued ortho-k lens wear for the duration of the study; or Group OKd in which subjects discontinued lens wear for seven months and wore single-vision spectacles (Phase I) and then resumed ortho-k lens wear for another seven months (Phase II). Spectacle-wearing control subjects from the initial myopia control study continued wearing spectacles as control subjects. Axial lengths were measured at scheduled visits using the IOLMaster. Thirteen, 16, and 15 Control, OKc, and OKd subjects, aged 8-14 years, respectively completed the study. Significant increase in axial elongation was found in OKd subjects only in Phase I but not in Phase II. On resuming lens wear, in Phase II, the rate of axial elongation was no longer significantly different from those of the Control or OKc subjects. Stopping ortho-k lens wear at or before the age of 14 years led to a more rapid increase in axial length; comparable to those wearing spectacles during the initial 2-year myopia control study, but greater than the Control and OKc group in this study. Axial elongation slowed again with resumed lens wear after six months. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  4. Correction of distortions in a discontinuous image

    International Nuclear Information System (INIS)

    Geagan, M.J.; Chase, B.B.; Muehllehner, G.

    1994-01-01

    Large area position-sensitive NaI detectors have been successfully applied to positron emission tomography (PET). Typical PET studies involve detector singles rates in excess of 500 kcps, which can lead to pile-up and image degradation as a function of countrate. Better high countrate performance can be achieved with a local centroid algorithm, in which the position of each event is calculated from a small group of photomultipliers (PMTs) immediately surrounding the PMT with the highest signal (the peak PMT). The local centroid contains most of the light from the scintillation. If a local centroid of only seven PMTs is used, the position resolution becomes quite stable at high countrates, however, discontinuities appear in the detector flood image as events cluster around each PMT. We therefore developed a method for distortion correction of a discontinuous flood image. For each PMT on the detector, a peak PMT domain is defined. The peak PMT domain is the area on the detector where that PMT could have the highest signal. The peak PMT domains overlap slightly, so that all combinations of peak PMT and position are represented. A collimated source is moved through a regular grid of points - a template - over each peak PMT region. A short collection is performed at each point, and the real and measured position data are recorded. For each point in the spatial range of a given PMT, distortion correction offsets are computed by interpolating between the data points which correspond to that PMT. This new method has been implemented and evaluated. System resolution has been measured at low and high countrates. The high countrate resolution is better with the new method, with no degradation in low countrate resolution. The axial sensitivity profile is also more stable at high countrates, compared to the previously developed method. 3-D brain phantom images show a clear improvement in image quality at high countrates. ((orig.))

  5. Abrupt opium discontinuation has no significant triggering effect on acute myocardial infarction.

    Science.gov (United States)

    Masoomi, Mohammad; Zare, Jahangir; Nasri, Hamidreza; Mirzazadeh, Ali; Sheikhvatan, Mehrdad

    2011-04-01

    A deleterious effect of withdrawal symptoms due to abrupt discontinuation of opium on the cardiovascular system is one of the recent interesting topics in the cardiovascular field. The current study hypothesized that the withdrawal syndrome due to discontinuing opium might be an important trigger for the appearance of acute myocardial infarction. Eighty-one opium-addicted individuals who were candidates for cardiovascular clinical evaluation and consecutively hospitalized in the coronary care unit (CCU) ward of Shafa Hospital in Kerman between January and July 2009 were included in the study and categorized in the case group, including patients experiencing withdrawal symptoms within 6-12 h after the reduced or discontinued use of opium according to the Diagnostic and Statistical Manual of Mental Disorders-revised IV version (DSM-IV-R) criteria for opium dependence and withdrawal, and the control group, without opium withdrawal symptoms. The appearance of acute myocardial infarction was compared between the two groups using multivariable regression models. Acute myocardial infarction occurred in 50.0% of those with withdrawal symptoms and in 45.1% of patients without evidence of opium withdrawal (P = 0.669). Multivariable analysis showed that opium withdrawal symptoms were not a trigger for acute myocardial infarction adjusting for demographic characteristics, marital status, education level and common coronary artery disease risk profiles [odds ratio (OR) = 0.920, 95% confidence interval (CI) = 0.350-2.419, P = 0.866]. Also, daily dose of opium before reducing or discontinuing use did not predict the appearance of myocardial infarction in the presence of confounder variables (OR = 0.975, 95% CI = 0.832-1.143, P = 0.755). Withdrawal syndrome due to abrupt discontinuation of opium does not have a triggering role for appearance of acute myocardial infarction.

  6. Anaphylactic Reactions After Discontinuation of Hymenoptera Venom Immunotherapy: A Clonal Mast Cell Disorder Should Be Suspected.

    Science.gov (United States)

    Bonadonna, Patrizia; Zanotti, Roberta; Pagani, Mauro; Bonifacio, Massimiliano; Scaffidi, Luigi; Olivieri, Elisa; Franchini, Maurizio; Reccardini, Federico; Costantino, Maria Teresa; Roncallo, Chiara; Mauro, Marina; Boni, Elisa; Rizzini, Fabio Lodi; Bilò, Maria Beatrice; Marcarelli, Anna Rosaria; Passalacqua, Giovanni

    2017-12-16

    Up to 75% of patients with severe anaphylactic reactions after Hymenoptera sting are at risk of further severe reactions if re-stung. Venom immunotherapy (VIT) is highly effective in protecting individuals with ascertained Hymenoptera venom allergy (HVA) and previous severe reactions. After a 3- to 5-year VIT course, most patients remain protected after VIT discontinuation. Otherwise, a lifelong treatment should be considered in high-risk patients (eg, in mastocytosis). Several case reports evidenced that patients with mastocytosis and HVA, although protected during VIT, can re-experience severe and sometimes fatal reactions after VIT discontinuation. To evaluate whether patients who lost protection after VIT discontinuation may suffer from clonal mast cell disorders. The survey describes the characteristics of patients who received a full course of VIT for previous severe reactions and who experienced another severe reaction at re-sting after VIT discontinuation. Those with a Red Española de Mastocitosis score of 2 or more or a serum basal tryptase level of more than 25 ng/mL underwent a hematological workup (bone marrow biopsy, KIT mutation, expression of aberrant CD25) and/or skin biopsy. Nineteen patients (mean age, 56.3 years; 89.5% males) were evaluated. All of them had received at least 4 years of VIT and were protected. After VIT discontinuation they were re-stung and developed, in all but 1 case, severe anaphylactic reactions (12 with loss of consciousness, in the absence of urticaria/angioedema). Eighteen patients (94.7%) had a clonal mast cell disorder, 8 of them with normal tryptase. Looking at this selected population, we suggest that mastocytosis should be considered in patients developing severe reactions at re-sting after VIT discontinuation and, as a speculation, patients with mastocytosis and HVA should be VIT-treated lifelong. Copyright © 2017. Published by Elsevier Inc.

  7. Comparative analysis of the development of collateral vessels in macular edema due to branch retinal vein occlusion following grid laser or ranibizumab treatment

    Directory of Open Access Journals (Sweden)

    Kokolaki AE

    2015-09-01

    Full Text Available Afroditi Eleni Kokolaki, Ilias Georgalas, Chryssanthi Koutsandrea, Athanasios Kotsolis, Maria Niskopoulou, Ioannis LadasDepartment of Ophthalmology, University of Athens, Athens, Greece Purpose: To evaluate the differences in the development of collateral vessels in patients with macular edema due to branch retinal vein occlusion (BRVO after treatment with either grid laser or ranibizumab (RNB.Methods: Comparative study including patients with macular edema due to acute BRVO and best-corrected visual acuity (BCVA between 20/40 and 20/200. The sample was divided into two groups according to the treatment applied: laser group, including eyes treated with Argon laser when retinal hemorrhages were sufficiently absorbed to perform the treatment, and RNB group,  including patients treated initially with one monthly intravitreal injection for a period of 3 months of RNB and more injections according to need thereafter.. Before treatment patients in both groups, received a complete ophthalmic examination, including BCVA, fundus examination, optical coherence tomography, fundus color photography, and fundus fluorescein angiography (FA. This same protocol of examination was repeated in every visit after treatment, except FA that was only repeated every 3 months. The detection of the collateral vessels was done by two experienced examiners based on the analysis of the early phase of the FA. If there was a discrepancy in their judgment, the criterion of a third examiner evaluating the FA was considered.Results: Mean baseline BCVA was 0.86±0.26 and 0.82±0.25 (logMAR [logarithm of the minimum angle of resolution] in the RNB and laser groups, respectively (P=0.83. At the end of the follow-up, mean BCVA was 0.38±0.18 and 0.64±0.33 (logMAR in the RNB and laser groups, respectively. The difference in the final BCVA between both groups was statistically significant (P=0.002. Collaterals developed in both groups; 66.67% of patients (14 out of 21

  8. Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis.

    Science.gov (United States)

    Abásolo, Lydia; Rosales, Zulema; Díaz-Valle, David; Gómez-Gómez, Alejandro; Peña-Blanco, Rayma C; Prieto-García, Ángela; Benítez-Del-Castillo, José Manuel; Pato, Esperanza; García-Feijoo, Julián; Fernández-Gutiérrez, Benjamín; Rodriguez-Rodriguez, Luis

    2016-09-01

    To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. Longitudinal retrospective cohort study. We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Uncertainty Quantification given Discontinuous Climate Model Response and a Limited Number of Model Runs

    Science.gov (United States)

    Sargsyan, K.; Safta, C.; Debusschere, B.; Najm, H.

    2010-12-01

    Uncertainty quantification in complex climate models is challenged by the sparsity of available climate model predictions due to the high computational cost of model runs. Another feature that prevents classical uncertainty analysis from being readily applicable is bifurcative behavior in climate model response with respect to certain input parameters. A typical example is the Atlantic Meridional Overturning Circulation. The predicted maximum overturning stream function exhibits discontinuity across a curve in the space of two uncertain parameters, namely climate sensitivity and CO2 forcing. We outline a methodology for uncertainty quantification given discontinuous model response and a limited number of model runs. Our approach is two-fold. First we detect the discontinuity with Bayesian inference, thus obtaining a probabilistic representation of the discontinuity curve shape and location for arbitrarily distributed input parameter values. Then, we construct spectral representations of uncertainty, using Polynomial Chaos (PC) expansions on either side of the discontinuity curve, leading to an averaged-PC representation of the forward model that allows efficient uncertainty quantification. The approach is enabled by a Rosenblatt transformation that maps each side of the discontinuity to regular domains where desirable orthogonality properties for the spectral bases hold. We obtain PC modes by either orthogonal projection or Bayesian inference, and argue for a hybrid approach that targets a balance between the accuracy provided by the orthogonal projection and the flexibility provided by the Bayesian inference - where the latter allows obtaining reasonable expansions without extra forward model runs. The model output, and its associated uncertainty at specific design points, are then computed by taking an ensemble average over PC expansions corresponding to possible realizations of the discontinuity curve. The methodology is tested on synthetic examples of

  10. Cost-effectiveness of ranibizumab versus aflibercept in the treatment of visual impairment due to diabetic macular edema: a UK healthcare perspective

    Directory of Open Access Journals (Sweden)

    Régnier SA

    2015-05-01

    Full Text Available Stephane A Régnier,1 William Malcolm,2 Jennifer Haig,3 Weiguang Xue41Novartis Pharma AG, Basel, Switzerland; 2Novartis Pharmaceuticals UK Ltd, Frimley Business Park, UK; 3Optum, Burlington, ON, Canada; 4Optum, Uxbridge, UKBackground: Ranibizumab and aflibercept are alternative anti-vascular endothelial growth factor agents approved for the treatment of visual impairment (VI due to diabetic macular edema (DME.Objective: To estimate, from a UK healthcare perspective, the cost-effectiveness of ranibizumab 0.5 mg pro re nata (PRN and ranibizumab 0.5 mg treat and extend (T&E compared with aflibercept 2 mg every 8 weeks after five initial monthly doses (2q8 in the treatment of VI due to DME.Methods: A Markov model previously reviewed by the National Institute for Health and Care Excellence was used to simulate the long-term outcomes and costs of treating DME. Health states were defined by increments of ten letters in best-corrected visual acuity (BCVA, with a 3-month cycle length. Patients could gain (or lose a maximum of two health states between cycles. A 3-year treatment time frame and a lifetime horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Patient baseline characteristics and the efficacy of ranibizumab PRN were derived using data from the RESTORE study. The relative efficacies of ranibizumab PRN, ranibizumab T&E, and aflibercept were assessed with a network meta-analysis. Different utilities were assigned based on BCVA and whether the treated eye was the better- or the worse-seeing eye. Sensitivity analyses tested the robustness of the model.Results: Lifetime costs per patient of treating DME were £20,019 for ranibizumab PRN, £22,930 for ranibizumab T&E, and £25,859 for aflibercept 2q8. Ranibizumab was dominant over aflibercept, with an incremental gain of 0.05 quality-adjusted life-years (QALYs and cost savings of £5,841 (PRN and £2,930 (T&E compared with aflibercept. Ranibizumab PRN and

  11. 39 CFR 241.3 - Discontinuance of post offices.

    Science.gov (United States)

    2010-07-01

    ... CLASSIFICATION, AND DISCONTINUANCE § 241.3 Discontinuance of post offices. (a) Introduction—(1) Coverage. This... justify in sufficient detail to Postal Service management and affected customers the proposed service... inspection during normal business hours at each post office where the Final Determination is posted for 30...

  12. Discontinuous Galerkin finite element methods for hyperbolic differential equations

    NARCIS (Netherlands)

    van der Vegt, Jacobus J.W.; van der Ven, H.; Boelens, O.J.; Boelens, O.J.; Toro, E.F.

    2002-01-01

    In this paper a suryey is given of the important steps in the development of discontinuous Galerkin finite element methods for hyperbolic partial differential equations. Special attention is paid to the application of the discontinuous Galerkin method to the solution of the Euler equations of gas

  13. Discontinuities in Early Development of the Understanding of Physical Causality

    Science.gov (United States)

    Aschersleben, Gisa; Henning, Anne; Daum, Moritz M.

    2013-01-01

    Research on early physical reasoning has shown surprising discontinuities in developmental trajectories. Infants possess some skills that seem to disappear and then re-emerge in childhood. It has been suggested that prediction skills required in search tasks might cause these discontinuities (Keen, 2003). We tested 3.5- to 5-year-olds'…

  14. Airline loyalty (programs) across borders : A geographic discontinuity approach

    NARCIS (Netherlands)

    de Jong, Gerben; Behrens, Christiaan; van Ommeren, Jos

    2018-01-01

    We analyze brand loyalty advantages of national airlines in their domestic countries using geocoded data from a major international frequent flier program. We employ a geographic discontinuity design that estimates discontinuities in program activity at the national borders of the program's

  15. The interventional treatment for recurrent jaundice after palliative bilio-intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma

    International Nuclear Information System (INIS)

    Han Xinwei; Li Yongdong; Li Tianxiao; Ma Bo; Xing Gusheng; Wu Gang

    2002-01-01

    Objective: To explore the interventional methods to treat recurrent jaundice after palliative bilio-intestinal anastomosis in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: Ten patients with recurrent jaundice after bilio-intestinal anastomosis were retrospectively evaluated. Nine of ten underwent PTCD with metallic stent placement, one underwent the inner-outer draining catheter procedure. The patients were evaluated with comparison in regard to preoperative conditions, TBIL, ALT, GTP and AKP values. Results: Stent placement was successful only once in all 10 cases with successful rate of 100%. TBIL, ALT, GTP and AKP values were significantly lower 7 days postoperative than that preoperation. Subsidence of jaundice was satisfactory for 100% in all patients after the treatment. Conclusions: Percutaneous placement of biliary metallic stents is a safety, simple, low complication method for managing recurrent jaundice after palliative bilio-intestinal anastomosis for the terminal stage of malignant obstructive jaundice

  16. The Seizure of Shares Due to Shareholder’s Personal Debt: a Historical Study of the Evolution of the Legal Treatment and Case Law Towards The Institute

    Directory of Open Access Journals (Sweden)

    Alexandre Ferreira de Assumpção Alves

    2016-12-01

    Full Text Available Historical analysis of the legal treatment of the seizure of shares due to shareholder’s personal debt and the impacts of such measure on the affectio societatis. In order to do so, with the usage of the deductive method of research, hereby it will be presenting two different views on the issue: a first one based solemnly on the rules and principles the are commonly accepted and a second based on logical arguments. Afterwards, the two premises are going to be confronted in order achieve the best answers. Moreover, with the usage of bibliographical and documental research, this work intends to demonstrate how the seizure of shares has evolved from an impossibility, under the terms of the article 292 of the Commercial Code, to a reality, whereas the seizure is now possible even on those cases where the article of association lacks the regulation on the issue.

  17. On the stability of rotational discontinuities and intermediate shocks

    International Nuclear Information System (INIS)

    Lee, L.C.; Huang, L.; Chao, J.K.

    1989-01-01

    The stability of rotational discontinuities and intermediate shocks is studied based on a hybrid simulation code. The simulation results show that rotational discontinuities are stable and intermediate shocks are not stationary. Intermediate shocks tend to evolve to rotational discontinuities and waves. The authors employ several different initial profiles for the magnetic field in the transition region and find that the final structure of the discontinuities or shocks is not sensitive to the initial magnetic field profile. The present results are different from those obtained from the resistive MHD simulations. Furthermore, their study indicates that the kinetic effect of particles plays an important role in the structure and stability of rotational discontinuities and intermediate shocks

  18. The myth of DSM's invention of new categories of disorder: Houts's diagnostic discontinuity thesis disconfirmed.

    Science.gov (United States)

    Wakefield, J C

    2001-05-01

    Houts (2001) argues that increases in DSM diagnostic categories are due to the invention of new disorders that are discontinuous with old conceptions of disorder and would not have been previously diagnosed. He maintains that DSM category increases are not comparable in nature to ICD category increases, which are mainly refinements of recognized disorders. I survey categories of disorder introduced after DSM-II and assess whether they are discontinuous with old concepts and categories of disorder. Candidate categories are identified from: Houts and Follette (1998), Mentalism, mechanisms, and medical analogues: Reply to Wakefield. Journal of Consulting and Clinical Psychology; Kutchins and Kirk (1997) Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: Free Press; and my own list. The result is that virtually none of the candidate categories are invented, discontinuous categories. In almost every case, the newly labeled conditions were considered disorders at the time of DSM-II and would have been diagnosed under DSM-II categories. I also reexamine DSM-IV sleep disorder categories, which Houts claims are discontinuous with past diagnostic conceptions. The result is that all DSM-IV sleep disorders were recognized as disorders at the time of DSM-II, and most were recognized as mental disorders. I conclude that DSM category increases are comparable in nature to ICD category increases, and that the invention-of-disorder account cannot explain the vast majority of such increases.

  19. A study of upper mantle discontinuities beneath the Korean Peninsula using teleseismic receiver functions

    Science.gov (United States)

    Lee, S.; Park, Y.; Kim, K.; Rhie, J.

    2010-12-01

    The study on the topography of the upper mantle discontinuities helps us to understand the complex interactions between the subducting slabs and upper mantle discontinuities. To investigate the depth variation of the upper mantle discontinuities beneath the Korean Peninsula and surrounding regions, we applied the common conversion point stacking of the P-to-s receiver functions. The broadband seismic networks in South Korea and Japan were used to produce the high-resolution receiver function images of the region. The 410- and 660-km discontinuities (hereafter referred to as the 410 and the 660) are clearly imaged and their depth variations show interesting features, especially for the 660. In this region, the subducting Pacific slab bends to flatten over the 660 and several tomographic images indicate that the stagnant slab is extending to the west under China. If the depth of the 660 is affected by the temperature, the broad depression of the 660 is expected and several SS precursor studies support this idea. However, our observation shows that the 660 is locally depressed and its pattern is spatially changing. While the depressed 660 due to the Pacific slab is clearly imaged at lower latitudes (depressed 660 to the north. It indicates that the effect of the Pacific slab on the depth variation of the 660 is changing significantly in our study area.

  20. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study].

    Science.gov (United States)

    Milewicz, A; Gejdel, E; Sworen, H; Sienkiewicz, K; Jedrzejak, J; Teucher, T; Schmitz, H

    1993-07-01

    The efficacy of a Vitex agnus castus preparation (Strotan capsules) was investigated in a randomized double blind study vs. placebo. This clinical study involved 52 women with luteal phase defects due to latent hyperprolactinaemia. The daily dose was one capsule (20 mg) Vitex agnus castus preparation and placebo, respectively. Aim of the study was to prove whether the elevated pituitary prolactin reserve can be reduced and deficits in luteal phase length and luteal phase progesterone synthesis be normalized. Blood for hormonal analysis was taken at days 5-8 and day 20 of the menstrual cycle before and after three month of therapy. Latent hyperprolactinaemia was analysed by monitoring the prolactin release 15 and 30 min after i.v. injection of 200 micrograms TRH. 37 complete case reports (placebo: n = 20, verum: n = 17) after 3 month of therapy were statistically evaluated. The prolactin release was reduced after 3 months, shortened luteal phases were normalised and deficits in the luteal progesterone synthesis were eliminated. These changes were significant and occurred only in the verum group. All other hormonal parameters did not change with the exception of 17 beta-estradiol which rouse up in the luteal phase in patients receiving verum. Side effects were not seen, two women treated with the Vitex agnus castus preparation got pregnant. The tested preparation is thought to be an efficient medication in the treatment of luteal phase defects due to latent hyperprolactinaemia.

  1. Variational functionals which admit discontinuous trial functions

    International Nuclear Information System (INIS)

    Nelson, P. Jr.

    1975-01-01

    It is argued that variational synthesis with discontinuous trial functions requires variational principles applicable to equations involving operators acting between distinct Hilbert spaces. A description is given of a Roussopoulos-type variational principle generalized to cover this situation. This principle is suggested as the basis for a unified approach to the derivation of variational functionals. In addition to esthetics, this approach has the advantage that the mathematical details increase the understanding of the derived functional, particularly the sense in which a synthesized solution should be regarded as an approximation to the true solution. By way of illustration, the generalized Roussopoulos principle is applied to derive a class of first-order diffusion functionals which admit trial functions containing approximations at an interface. These ''asymptotic'' interface quantities are independent of the limiting approximations from either side and permit use of different trial spectra at and on either side of an interface. The class of functionals derived contains as special cases both the Lagrange multiplier method of Buslik and two functionals of Lambropoulos and Luco. Some numerical results for a simple two-group model confirm that the ''multipliers'' can closely approximate the appropriate quantity in the region near an interface. (U.S.)

  2. Thermal classification of lithospheric discontinuities beneath USArray

    Science.gov (United States)

    Hansen, Steven M.; Dueker, Ken; Schmandt, Brandon

    2015-12-01

    Broadband seismic data from the United States were processed into Ps and Sp receiver function image volumes for the purpose of constraining negative velocity gradients (NVG) at depths between the Moho and 200 km. Moho depth picks from the two independent datasets are in good agreement, however, large discrepancies in NVG picks occur and are attributed to free-surface multiples which obscure deep NVG arrivals in the Ps data. From the Sp data, shallow NVG are found west of the Rockies and in the central US while deep and sporadic NVG are observed beneath the Great Plains and northern Rockies. To aid the interpretation of the observed NVG arrivals, the mantle thermal field is estimated by mapping surface wave tomography velocities to temperature assuming an anelastic olivine model. The distribution of temperature versus NVG depth is bi-modal and displays two distinct thermal populations that are interpreted to represent both the lithosphere-asthenosphere boundary (LAB) and mid-lithosphere discontinuities (MLD). LAB arrivals occur in the western US at 60-85 km and 1200-1400 °C depth suggesting that they manifest partial melt near the base of the thermal plate. MLD arrivals primarily occur at 70-110 km depth and 700-900 °C and we hypothesize that these arrivals are caused by a low-velocity metasomatic layer containing phlogopite resulting from magma crystallization products that accumulate within long-lived thick lithosphere.

  3. Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study.

    Science.gov (United States)

    Wright, N C; Foster, P J; Mudano, A S; Melnick, J A; Lewiecki, M E; Shergy, W J; Curtis, J R; Cutter, G R; Danila, M I; Kilgore, M L; Lewis, E C; Morgan, S L; Redden, D T; Warriner, A H; Saag, K G

    2017-08-01

    The Effectiveness of Discontinuing Bisphosphonates (EDGE) study is a planned pragmatic clinical trial to guide "drug holiday" clinical decision making. This pilot study assessed work flow and feasibility of such a study. While participant recruitment and treatment adherence were suboptimal, administrative procedures were generally feasible and minimally disrupted clinic flow. The comparative effectiveness of continuing or discontinuing long-term alendronate (ALN) on fractures is unknown. A large pragmatic ALN discontinuation study has potential to answer this question. We conducted a 6-month pilot study of the planned the EDGE study among current long-term ALN users (women aged ≥65 with ≥3 years of ALN use) to determine study work flow and feasibility including evaluating the administrative aspects of trial conduct (e.g., time to contract, institutional review board (IRB) approval), assessing rates of site and participant recruitment, and evaluating post-randomization outcomes, including adherence, bisphosphonate-associated adverse events, and participant and site satisfaction. We assessed outcomes 1 and 6 months after randomization. Nine sites participated, including seven community-based medical practices and two academic medical centers. On average (SD), contract execution took 3.4 (2.3) months and IRB approval took 13.9 (4.1) days. Sites recruited 27 participants (13 to continue ALN and 14 to discontinue ALN). Over follow-up, 22% of participants did not adhere to their randomization assignment: 30.8% in the continuation arm and 14.3% in the discontinuation arm. No fractures or adverse events were reported. Sites reported no issues regarding work flow, and participants were highly satisfied with the study. Administrative procedures of the EDGE study were generally feasible, with minimal disruption to clinic flow. In this convenience sample, participant recruitment was suboptimal across most practice sites. Accounting for low treatment arm adherence, a

  4. The effect of manufacturing conditions on discontinuity population and fatigue fracture behavior in carbon/epoxy composites

    Science.gov (United States)

    Hakim, Issa; Laquai, Rene; Walter, David; Mueller, Bernd; Graja, Paul; Meyendorf, Norbert; Donaldson, Steven

    2017-02-01

    Carbon fiber composites have been increasingly used in aerospace, military, sports, automotive and other fields due to their excellent properties, including high specific strength, high specific modulus, corrosion resistance, fatigue resistance, and low thermal expansion coefficient. Interlaminar fracture is a serious failure mode leading to a loss in composite stiffness and strength. Discontinuities formed during manufacturing process degrade the fatigue life and interlaminar fracture resistance of the composite. In his study, three approaches were implemented and their results were correlated to quantify discontinuities effecting static and fatigue interlaminar fracture behavior of carbon fiber composites. Samples were fabricated by hand layup vacuum bagging manufacturing process under three different vacuum levels, indicated High (-686 mmHg), Moderate (-330 mmHg) and Poor (0 mmHg). Discontinuity content was quantified through-thickness by destructive and nondestructive techniques. Eight different NDE methods were conducted including imaging NDE methods: X-Ray laminography, ultrasonic, high frequency eddy current, pulse thermography, pulse phase thermography and lock-in-thermography, and averaging NDE techniques: X-Ray refraction and thermal conductivity measurements. Samples were subsequently destructively serial sectioned through-thickness into several layers. Both static and fatigue interlaminar fracture behavior under Mode I were conducted. The results of several imaging NDE methods revealed the trend in percentages of discontinuity. However, the results of averaging NDE methods showed a clear correlation since they gave specific values of discontinuity through-thickness. Serial sectioning exposed the composite's internal structure and provided a very clear idea about the type, shape, size, distribution and location of most discontinuities included. The results of mechanical testing showed that discontinuities lead to a decrease in Mode I static interlaminar

  5. Disturbance of SH-type waves due to moving stress discontinuity in ...

    Indian Academy of Sciences (India)

    Introduction. The two main ... isolated points, while materials such as sedimentary rocks and concrete are regarded as a solid skeleton traversed by ... technique. Sengupta & Nath (2001) have investigated the surface waves in fibre-reinforced.

  6. Financial Burden Faced by Families due to Out-of-pocket Expenses during the Treatment of their Cancer Children: An Indian Perspective.

    Science.gov (United States)

    Sneha, Latha M; Sai, Jeyanth; Ashwini, S; Ramaswamy, Sunitha; Rajan, Mahalakshmi; Scott, Julius X

    2017-01-01

    Life-saving cancer therapy is costly and may result in financial burden for these families. Financial costs for treating childhood cancer care are traditionally assessed based on the amount spent for diagnostic tests, hospitalization, and chemotherapy. The financial costs for travel, accommodation, out-of-pocket expenses for food, phone bills, and loss of income due to reduction or termination of parental employment are hidden nonmedical expenses that are rarely accounted for. Studies on the financial implications of pediatric cancer treatment are based on the Western model of healthcare with good government/state insurance coverage and hence literature on lifestyle implications for families in developing nations with limited resources is still scarce. The aim of this study is to find out the details of out-of-pocket expenses incurred by the families during their treatment of cancer children and its implications on their quality of life. Settings and Design: This study was conducted in a tertiary care center for pediatric malignancies for over 1-year period. About seventy families whose children were diagnosed with acute leukemia and undergoing treatment at our center were asked to fill a questionnaire detailing their out-of-pocket expenses. Nonmedical expenses accounts for about 46% of their monthly household income of parents from rural areas and 22% of their household income from urban areas. On an average, a family from rural area spends four times the normal amount spent on home for their daily food expenditure. Thirty-eight percent of families have borrowed money from money lenders with an average interest rate of about 12.5% which pushes them to a state of debt for the next few years. Out-of-pocket expenses contribute a significant proportion to the financial burden of the families with childhood malignancies and these invisible expenses should be recognized and provide adequate support to lessen the burden of this economic impact.

  7. Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments

    Directory of Open Access Journals (Sweden)

    Shirakata Y

    2016-02-01

    Full Text Available Yukari Shirakata,1 Kouki Fukuda,1 Tomoyoshi Fujita,1 Yuki Nakano,1 Hiroyuki Nomoto,2 Hidetaka Yamaji,3 Fumio Shiraga,4 Akitaka Tsujikawa1 1Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, 2Nomoto Eye Clinic, Himeji, 3Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, 4Department of Ophthalmology, Okayama University, Okayama, Japan Purpose: To evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME due to branch retinal vein occlusion (BRVO after intravitreal injections of antivascular endothelial growth factor (anti-VEGF agents. Methods: Twenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling. Results: After the surgery, ME was significantly reduced at 1 month (P=0.031 and the reduction increased with time (P=0.007 at the final visit. With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA. At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048. The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (-0.10±0.32 in logarithm of the minimum angle of resolution [logMAR], eyes with epiretinal membrane showed greater visual improvement (-0.38±0.12 in logMAR, P=0.012. Conclusion: For recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a

  8. The Effects Of Adding Complementary Treatment And Comparison To Ordinary Physical Therapy In Women With Low Back Pain Due To Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Talebian S

    2005-06-01

    Full Text Available Background: Low back pain (LBP is a one of the most common symptoms of vertebral column diseases. Spinal muscles have a outstanding role in maintaining vertebral column function in daily life. But proper function and motion of hip and knee joints also has an important role in performing smooth, fine and nonstressed movements of lumbar spin. Where as accurate and fine motions of hip and knee joints in cooperate with lumbar spin can improve translation and summation of forces and increase performance of movements. The aim of this research is to indicate the amount of interventions of lower limb joints on lumbar spin function in patients with LBP, and attention to physical treatment (PT of them. Materials and Methods: Fifty females with LBP due to osteoarthritis ( OA of lumbar spin participated in this study and divided in two groups randomly with similar number of cases: a ordinary treatment or control group and b complementary treatment group. Patients in control group treated by routine PT approach ( superficial heat, ultrasound, TENS, forward flexion and back extension exercises and patients in complementary or test group received routine treatment similar to control group and also strength and stretching exercises of hip and knee joint muscles ( latisimous dorsi, gluteous maximus, iliopsoas, quadriceps and hamstring bilaterally. Range of motion (ROM of lumbar, hip and keen joints by valid goniametere and pain of lumbar in motions at all of axis by visual analog scale measured before, after five and ten sessions of treatments in both groups. Results: In control group with non parametric tests there was not significant difference of MMT of muscles and ROMs of hip and knee joints. Lumbar pain in motion after ten sessions of PT in this group reduced significantly ( P< 0.05 . Increase of lumbar motion in all of axis after PT was significant at this patients ( P< 0.05 . In second group that received complementary treatments; ROM of joints, lumbar

  9. Metabolic syndrome and drug discontinuation in schizophrenia: a randomized trial comparing aripiprazole olanzapine and haloperidol.

    Science.gov (United States)

    Parabiaghi, A; Tettamanti, M; D'Avanzo, B; Barbato, A

    2016-01-01

    To determine whether the prescription of aripiprazole, compared with olanzapine and haloperidol, was associated with a lower frequency of metabolic syndrome (MS) and treatment discontinuation at 1 year. Patients were randomly assigned to be treated open-label and according to usual clinical practice with either aripiprazole, olanzapine, or haloperidol and followed up for 1 year. Three hundred out-patients with persistent schizophrenia were recruited in 35 mental health services. The intention-to-treat (ITT) analysis found no significant differences in the rate of MS between aripiprazole (37%), olanzapine (47%), and haloperidol (42%). Treatment discontinuation for any cause was higher for aripiprazole (52%) than for olanzapine (33%; OR, 0.41; P = 0.004), or haloperidol (37%; OR, 0.51; P = 0.030). No significant difference was found between olanzapine and haloperidol. Time to discontinuation for any cause was longer for olanzapine than for aripiprazole (HR, 0.55; P haloperidol and aripiprazole, or between olanzapine and haloperidol. The prescription of aripiprazole did not significantly reduce the rates of MS, but its treatment retention was worse. Aripiprazole cannot be considered the safest and most effective drug for maintenance treatment of schizophrenia in routine care, although it may have a place in antipsychotic therapy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Durable Clinical Benefit in Metastatic Renal Cell Carcinoma Patients Who Discontinue PD-1/PD-L1 Therapy for Immune-Related Adverse Events.

    Science.gov (United States)

    Martini, Dylan J; Hamieh, Lana; McKay, Rana R; Harshman, Lauren C; Brandao, Raphael; Norton, Craig K; Steinharter, John A; Krajewski, Katherine M; Gao, Xin; Schutz, Fabio A; McGregor, Bradley; Bossé, Dominick; Lalani, Aly-Khan A; De Velasco, Guillermo; Michaelson, M Dror; McDermott, David F; Choueiri, Toni K

    2018-04-01

    The current standard of care for treatment of metastatic renal cell carcinoma (mRCC) patients is PD-1/PD-L1 inhibitors until progression or toxicity. Here, we characterize the clinical outcomes for 19 mRCC patients who experienced an initial clinical response (any degree of tumor shrinkage), but after immune-related adverse events (irAE) discontinued all systemic therapy. Clinical baseline characteristics, outcomes, and survival data were collected. The primary endpoint was time to progression from the date of treatment cessation (TTP). Most patients had clear cell histology and received anti-PD-1/PD-L1 therapy as second-line or later treatment. Median time on PD-1/PD-L1 therapy was 5.5 months (range, 0.7-46.5) and median TTP was 18.4 months (95% CI, 4.7-54.3) per Kaplan-Meier estimation. The irAEs included arthropathies, ophthalmopathies, myositis, pneumonitis, and diarrhea. We demonstrate that 68.4% of patients ( n = 13) experienced durable clinical benefit off treatment (TTP of at least 6 months), with 36% ( n = 7) of patients remaining off subsequent treatment for over a year after their last dose of anti-PD-1/PD-L1. Three patients with tumor growth found in a follow-up visit, underwent subsequent surgical intervention, and remain off systemic treatment. Nine patients (47.4%) have ongoing irAEs. Our results show that patients who benefitted clinically from anti-PD-1/PD-L1 therapy can experience sustained beneficial responses, not needing further therapies after the initial discontinuation of treatment due to irAEs. Investigation of biomarkers indicating sustained benefit to checkpoint blockers are needed. Cancer Immunol Res; 6(4); 402-8. ©2018 AACR . ©2018 American Association for Cancer Research.

  11. Discontinuous bifurcation and coexistence of attractors in a piecewise linear map with a gap

    International Nuclear Information System (INIS)

    Qu Shixian; Lu Yongzhi; Zhang Lin; He Daren

    2008-01-01

    Coexistence of attractors with striking characteristics is observed in this work, where a stable period-5 attractor coexists successively with chaotic band-11, period-6, chaotic band-12 and band-6 attractors. They are induced by different mechanisms due to the interaction between the discontinuity and the non-invertibility. A characteristic boundary collision bifurcation, is observed. The critical conditions are obtained both analytically and numerically. (general)

  12. Validation of a questionnaire to monitor symptoms in HIV-infected patients during hepatitis C treatment.

    Science.gov (United States)

    Cachay, Edward R; Ballard, Craig; Colwell, Bradford; Torriani, Francesca; Hicks, Charles; Mathews, Wm Christopher

    2017-09-20

    Clinicians are incorporating patient-reported outcomes in the management of HIV-infected persons co-infected with hepatitis C virus (HCV), but there are no validated inventories to monitor symptoms of patients during HCV therapy. Five-year retrospective cohort analysis of persons living with HIV (PLWH) treated for HCV. The HCV symptom-inventory (HCV-SI) was administered before, during, and after HCV treatment. Discriminant validity was assessed, separately, in mixed model linear regression of HCV-SI T-scores on treatment regimens (pegylated-interferon and ribavirin; pegylated-interferon, ribavirin, and telaprevir; and interferon-free antivirals); and side effect-related premature treatment discontinuation (SE-DC). From the 103 patients who completed the HCV-SI, 7% were female, 26% non-white, 32% cirrhotics and 91% had undetectable HIV viral loads. Most had genotype 1 (83%) and were HCV treatment-naïve (78%). We treated 19% of patients with pegylated-interferon and ribavirin, 22% with pegylated-interferon, ribavirin, and telaprevir and 59% received interferon-free antivirals. Overall, 77% achieved a sustained virologic response, and 6% discontinued HCV treatment due to side effects. In the treatment discrimination model, compared to the no treatment period, HCV-SI scores were significantly (p < 0.01) lower for interferon-free antivirals and higher for interferon-containing regimens. In the SE-DC model, the total HCV-SI, somatic and neuropsychiatric scores significantly predicted those patients who prematurely discontinued HCV treatment (P < 0.05). The HCV-SI effectively differentiated among treatment regimens known to vary by side effect profiles and between patients with and without treatment discontinuation due to side effects. The HCV-SI may have value as a patient-reported outcome instrument predicting the risk of HCV treatment discontinuation.

  13. Adaptive Finite Element Methods for Elliptic Problems with Discontinuous Coefficients

    KAUST Repository

    Bonito, Andrea; DeVore, Ronald A.; Nochetto, Ricardo H.

    2013-01-01

    Elliptic PDEs with discontinuous diffusion coefficients occur in application domains such as diffusions through porous media, electromagnetic field propagation on heterogeneous media, and diffusion processes on rough surfaces. The standard approach to numerically treating such problems using finite element methods is to assume that the discontinuities lie on the boundaries of the cells in the initial triangulation. However, this does not match applications where discontinuities occur on curves, surfaces, or manifolds, and could even be unknown beforehand. One of the obstacles to treating such discontinuity problems is that the usual perturbation theory for elliptic PDEs assumes bounds for the distortion of the coefficients in the L∞ norm and this in turn requires that the discontinuities are matched exactly when the coefficients are approximated. We present a new approach based on distortion of the coefficients in an Lq norm with q < ∞ which therefore does not require the exact matching of the discontinuities. We then use this new distortion theory to formulate new adaptive finite element methods (AFEMs) for such discontinuity problems. We show that such AFEMs are optimal in the sense of distortion versus number of computations, and report insightful numerical results supporting our analysis. © 2013 Societ y for Industrial and Applied Mathematics.

  14. Evaluation of distant results after lamivudine discontinuation in children with chronic hepatitis B.

    Directory of Open Access Journals (Sweden)

    Lech Chyczewski

    2010-08-01

    Full Text Available The aim of this study was to estimate distant results after discontinuation of long term lamivudine treatment in children with chronic hepatitis B. Furthermore, the emergence of HBV polymerase gene variants in YMDD motif during therapy was examined. Additionally, the most commonly occurring type of mutation in the polymerase YMDD region were investigated. The study involved 27 HBeAg positive children with chronic hepatitis B. Children included to lamivudine therapy were previously treated without effects with interferon alpha.

  15. Bronchial artery embolization for the treatment of hemoptysis due to pulmonary tuberculosis: its clinical effect with an analysis of the causes of recurrence

    International Nuclear Information System (INIS)

    Zhang Shoumin; Li Jingying; Wang Guoxing

    2012-01-01

    Objective: To investigate clinical effect of bronchial artery embolization (BAE) in treating massive hemoptysis due to pulmonary tuberculosis and to analyze the causes of recurrence in order to improve the therapeutic results. Methods: A total of 39 cases of patients with recurrent massive hemoptysis due to pulmonary tuberculosis, who were encountered during the period from Oct. 2007 to Sep. 2010, were enrolled in this study. The lesions included infiltrative pulmonary tuberculosis (n= 28) and chronic fibrocavitary pulmonary tuberculosis (n= 11). BAE with polyvinyl alcohol (PVA) particles only was performed in 14 cases (group A), while BAE with both PVA particles and coils was carried out in 25 cases (group B). All the patients were followed up for 12 - 48 months. The results were compared between the two groups. Results: Immediate hemostasis was obtained in 36 cases (92.3%), the clinical result was excellent in 3 cases. The complete cure or excellent result with single embolization procedure was achieved in 30 cases (76.9%). Recurrence was seen in 9 cases (23.1%). The difference in the recurrence rate between group A (42.9%) and group B (12.0%) was statistically significant (P < 0.05). The relapsing rate of patients with chronic fibrocavitary pulmonary tuberculosis was significantly higher than that of patients with infiltrative pulmonary tuberculosis (45.5% vs. 14.3%, P < 0.05). Conclusion: BAE has an instant effect of hemostasis and satisfactory clinical result. Nowadays BAE has already become the treatment of first choice for hemoptysis caused by pulmonary tuberculosis. The dual embolization technique with the combination use of PVA particles and coils can effectively reduce the recurrence of' pulmonary tuberculosis hemoptysis. (authors)

  16. Zinc as an adjunct treatment for reducing case fatality due to clinical severe infection in young infants: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Wadhwa, Nitya; Basnet, Sudha; Natchu, Uma Chandra Mouli; Shrestha, Laxman P; Bhatnagar, Shinjini; Sommerfelt, Halvor; Strand, Tor A; Ramji, Siddarth; Aggarwal, K C; Chellani, Harish; Govil, Anuradha; Jajoo, Mamta; Mathur, N B; Bhatt, Meenakshi; Mohta, Anup; Ansari, Imran; Basnet, Srijana; Chapagain, Ram H; Shah, Ganesh P; Shrestha, Binod M

    2017-07-10

    An estimated 2.7 of the 5.9 million deaths in children under 5 years of age occur in the neonatal period. Severe infections contribute to almost a quarter of these deaths. Mortality due to severe infections in developing country settings is substantial despite antibiotic therapy. Effective interventions that can be added to standard therapy for severe infections are required to reduce case fatality. This is a double-blind randomized placebo-controlled parallel group superiority trial to investigate the effect of zinc administered orally as an adjunct to standard therapy to infants aged 3 days up to 2 months (59 days) hospitalized with clinical severe infection, that will be undertaken in seven hospitals in Delhi, India and Kathmandu, Nepal. In a 1:1 ratio, we will randomly assign young infants to receive 10 mg of elemental zinc or placebo orally in addition to the standard therapy for a total of 14 days. The primary outcomes hospital case fatality, which is death due to any cause and at any time after enrolment while hospitalized for the illness episode, and extended case fatality, which encompasses the period until 12 weeks after enrolment. A previous study showed a beneficial effect of zinc in reducing the risk of treatment failure, as well as a non-significant effect on case fatality. This study was not powered to detect an effect on case fatality, which this current study is. If the results are consistent with this earlier trial, we would have provided strong evidence for recommending zinc as an adjunct to standard therapy for clinical severe infection in young infants. Universal Trial Number: U1111-1187-6479, Clinical Trials Registry - India: CTRI/2017/02/007966 : Registered on February 27, 2017.

  17. Discontinuity of maximum entropy inference and quantum phase transitions

    International Nuclear Information System (INIS)

    Chen, Jianxin; Ji, Zhengfeng; Yu, Nengkun; Zeng, Bei; Li, Chi-Kwong; Poon, Yiu-Tung; Shen, Yi; Zhou, Duanlu

    2015-01-01

    In this paper, we discuss the connection between two genuinely quantum phenomena—the discontinuity of quantum maximum entropy inference and quantum phase transitions at zero temperature. It is shown that the discontinuity of the maximum entropy inference of local observable measurements signals the non-local type of transitions, where local density matrices of the ground state change smoothly at the transition point. We then propose to use the quantum conditional mutual information of the ground state as an indicator to detect the discontinuity and the non-local type of quantum phase transitions in the thermodynamic limit. (paper)

  18. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism.

    Science.gov (United States)

    Wildschut, Tim; van Horen, Femke; Hart, Claire

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism). Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent). A prisoner's dilemma game experiment supported this prediction. Specifically, intergroup (compared to interindividual) interaction activated an injunctive ingroup-favoring norm, and accountability enhanced the influence of this norm on competitive behavior.

  19. Accountability Accentuates Interindividual—Intergroup Discontinuity by Enforcing Parochialism

    Directory of Open Access Journals (Sweden)

    Tim eWildschut

    2015-11-01

    Full Text Available Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism. Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent. A prisoner’s dilemma game experiment supported this prediction. Specifically, intergroup (compared to interindividual interaction activated an injunctive ingroup-favoring norm, and accountability enhanced the influence of this norm on competitive behavior.

  20. Actor Bonds in Situations of Discontinuous Business Activities

    DEFF Research Database (Denmark)

    Skaates, Maria Anne

    2000-01-01

    Demand in many industrial buying situations, e.g. project purchases or procurement related to virtual organizations, is discontinuous. In situations of discontinuity, networks are often more of an ad hos informational and social nature, as strong activity and resource links are not present....... Furthermore the governance structure of markets characterized by discontinuous business activities is either that of the "socially constructed market" (Skaates, 2000) or that of the (socially constructed) network (Håkansson and Johanson, 1993). Additionally relationships and actor bonds vary substantially...

  1. A Simple Stochastic Differential Equation with Discontinuous Drift

    DEFF Research Database (Denmark)

    Simonsen, Maria; Leth, John-Josef; Schiøler, Henrik

    2013-01-01

    In this paper we study solutions to stochastic differential equations (SDEs) with discontinuous drift. We apply two approaches: The Euler-Maruyama method and the Fokker-Planck equation and show that a candidate density function based on the Euler-Maruyama method approximates a candidate density...... function based on the stationary Fokker-Planck equation. Furthermore, we introduce a smooth function which approximates the discontinuous drift and apply the Euler-Maruyama method and the Fokker-Planck equation with this input. The point of departure for this work is a particular SDE with discontinuous...

  2. Stacking by electroinjection with discontinuous buffers in capillary zone electrophoresis.

    Science.gov (United States)

    Shihabi, Zak K

    2002-08-01

    The work presented here demonstrates that electroinjection can be performed using discontinuous buffers, which can result in better stacking than that obtained by hydrodynamic injection. The sample can be concentrated at the tip of the capillary leaving practically the whole capillary for sample separation. This results in several advantages, such as better sample concentration, higher plate number and shorter time of stacking. However, sample introduction by electromigration is suited for samples free or low in salt content. Samples, which are high in salt content, are better introduced by the hydrodynamic injection for stacking by the discontinuous buffers. Different simple methods to introduce the discontinuity in the buffer for electroinjection are discussed.

  3. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials.

    Science.gov (United States)

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. No failure risk rate per development phase is available for ATMPs. The discontinuation rate may prove helpful when assessing the

  4. Dynamic response of underground openings in discontinuous rock

    International Nuclear Information System (INIS)

    Asmis, H.W.

    1984-02-01

    This report examines the behaviour of underground openings in discontinuous rock in response to seismic waves associated with either earthquakes or rock bursts. A literature search revealed that well-constructed underground structures, such as would be expected for nuclear fuel waste disposal vaults, underground pumped-storage or nuclear plants, have an extremely high resistance to damage from seismic motion. To complement these qualitative results, it was necessary to examine the basic mechanisms of the entire progression of seismic motion, from wave generation and propagation, to wave interaction with the underground opening. From these investigations, it was found that unless a seismic event occurs very close to the installation, the stresses generated will be low with respect to the excavation stresses, because high stress waves are rapidly attenuated in travelling through rock. As well, an earthquake may generate extremely high accelerations, but is limited in the maximum amount of stress that it can create. The question, however, of the actual specific nature of underground seismic motions still remains essentially unanswered, although it is expected that there is a reduction in peak motions with depth due to the effect of the free surface of the earth

  5. Roughness-dependent tribology effects on discontinuous shear thickening.

    Science.gov (United States)

    Hsu, Chiao-Peng; Ramakrishna, Shivaprakash N; Zanini, Michele; Spencer, Nicholas D; Isa, Lucio

    2018-05-15

    Surface roughness affects many properties of colloids, from depletion and capillary interactions to their dispersibility and use as emulsion stabilizers. It also impacts particle-particle frictional contacts, which have recently emerged as being responsible for the discontinuous shear thickening (DST) of dense suspensions. Tribological properties of these contacts have been rarely experimentally accessed, especially for nonspherical particles. Here, we systematically tackle the effect of nanoscale surface roughness by producing a library of all-silica, raspberry-like colloids and linking their rheology to their tribology. Rougher surfaces lead to a significant anticipation of DST onset, in terms of both shear rate and solid loading. Strikingly, they also eliminate continuous thickening. DST is here due to the interlocking of asperities, which we have identified as "stick-slip" frictional contacts by measuring the sliding of the same particles via lateral force microscopy (LFM). Direct measurements of particle-particle friction therefore highlight the value of an engineering-tribology approach to tuning the thickening of suspensions. Copyright © 2018 the Author(s). Published by PNAS.

  6. Magnetohydrodynamic flow in ducts with discontinuous electrical insulation

    International Nuclear Information System (INIS)

    Mistrangelo, C.; Bühler, L.

    2015-01-01

    Highlights: • Liquid metal MHD flows in ducts with flow channel inserts. • Study of the influence of local interruption of electrical insulation. • 3D numerical simulations. - Abstract: In liquid metal blankets the interaction of the moving breeder with the intense magnetic field that confines the fusion plasma results in significant modifications of the velocity distribution and increased pressure drop compared to hydrodynamic flows. Those changes are due to the occurrence of electromagnetic forces that slow down the core flow and which are balanced by large driving pressure heads. The resulting magnetohydrodynamic (MHD) pressure losses are proportional to the electric current density induced in the fluid and they can be reduced by electrically decoupling the wall from the liquid metal. For applications to dual coolant blankets it is foreseen to loosely insert electrically insulating liners into the ducts. In long channels the insulation could consist of a number of shorter inserts, which implies a possible local interruption of the insulation. Three dimensional numerical simulations have been performed to investigate MHD flows in electrically well-conducting channels with internal discontinuous insulating inserts. The local jump in the electric conductivity of the duct wall results in induced 3D electric currents and related electromagnetic forces yielding additional pressure losses and increased velocity in boundary layers parallel to the magnetic field.

  7. Discontinuation of continuous renal replacement therapy: A post hoc analysis of a prospective multicenter observational study

    NARCIS (Netherlands)

    Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Oudemans-van Straaten, Heleen; Ronco, Claudio; Kellum, John A.

    2009-01-01

    Objectives: To describe current practice for the discontinuation of continuous renal replacement therapy in a multinational setting and to identify variables associated with successful discontinuation. The approach to discontinue continuous renal replacement therapy may affect patient outcomes.

  8. Obturator Neuromodulation with Laparoscopic Placement of an Obturator Lead for the Treatment of Intractable Opioid Dependent Chronic Pelvic Pain due to Obturator Neuralgia.

    Science.gov (United States)

    Marvel, Richard P

    2018-05-12

    Chronic pelvic pain(CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries causing persistent neuropathic pain. This is a case of a young woman with severe opioid dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed a multitude of treatments including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis and spinal cord stimulation without significant benefit. She underwent a trial of peripheral neuromodulation of the obturator nerve with laparoscopic placement of a quadripolar lead. During the 6-day trial she had almost complete relief of her pain; therefore, she underwent permanent implantation of an intermittent pulse generator. Over the next 6 months she was completely weaned completely off her chronic opioids. At 23 months post implantation, she had essentially no pain and is no longer on any analgesic, antidepressant or membrane stabilizing medications. Peripheral Neuromodulation has the potential to alleviate pain and significantly improve quality of life in women with longstanding neuropathic chronic pelvic pain who have failed multimodal conservative therapy. Copyright © 2018. Published by Elsevier Inc.

  9. Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.

    Science.gov (United States)

    Sundström, Johan; Hedberg, Jakob; Thuresson, Marcus; Aarskog, Pernilla; Johannesen, Kasper Munk; Oldgren, Jonas

    2017-09-26

    There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events. We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk. During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time. In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal. © 2017 American Heart Association, Inc.

  10. Automated extraction and analysis of rock discontinuity characteristics from 3D point clouds

    Science.gov (United States)

    Bianchetti, Matteo; Villa, Alberto; Agliardi, Federico; Crosta, Giovanni B.

    2016-04-01

    A reliable characterization of fractured rock masses requires an exhaustive geometrical description of discontinuities, including orientation, spacing, and size. These are required to describe discontinuum rock mass structure, perform Discrete Fracture Network and DEM modelling, or provide input for rock mass classification or equivalent continuum estimate of rock mass properties. Although several advanced methodologies have been developed in the last decades, a complete characterization of discontinuity geometry in practice is still challenging, due to scale-dependent variability of fracture patterns and difficult accessibility to large outcrops. Recent advances in remote survey techniques, such as terrestrial laser scanning and digital photogrammetry, allow a fast and accurate acquisition of dense 3D point clouds, which promoted the development of several semi-automatic approaches to extract discontinuity features. Nevertheless, these often need user supervision on algorithm parameters which can be difficult to assess. To overcome this problem, we developed an original Matlab tool, allowing fast, fully automatic extraction and analysis of discontinuity features with no requirements on point cloud accuracy, density and homogeneity. The tool consists of a set of algorithms which: (i) process raw 3D point clouds, (ii) automatically characterize discontinuity sets, (iii) identify individual discontinuity surfaces, and (iv) analyse their spacing and persistence. The tool operates in either a supervised or unsupervised mode, starting from an automatic preliminary exploration data analysis. The identification and geometrical characterization of discontinuity features is divided in steps. First, coplanar surfaces are identified in the whole point cloud using K-Nearest Neighbor and Principal Component Analysis algorithms optimized on point cloud accuracy and specified typical facet size. Then, discontinuity set orientation is calculated using Kernel Density Estimation and

  11. Discontinuation of denosumab and associated fracture incidence

    DEFF Research Database (Denmark)

    Brown, Jacques P; Roux, Christian; Törring, Ove

    2012-01-01

    associated with transient increases in bone remodeling and declines in bone mineral density (BMD), the effect on fracture risk during treatment cessation is not as well characterized. To understand the fracture incidence between treatment groups after cessation of investigational product, we evaluated...

  12. Some modifications to the process of discontinuous deformation analysis

    Directory of Open Access Journals (Sweden)

    Yong Yu

    2015-02-01

    Full Text Available This paper presents a modified method of discontinuous deformation analysis (DDA. In the presented method, open-close iteration may not be needed, small penetration is permitted among blocks, and springs are added between contacting block pairs only when a penetration takes place. The three contact patterns (i.e. sliding, locking and opening in original DDA method are not involved, and the recognition of these contact patterns and treatment of transformation among patterns are not required either, significantly saving the computing time. In a convex to concave contact, there are two candidate entrance edges which may cause uncertainty. In this case, we propose the angle bisector criterion to determine the entrance edge. The spring stiffness is much larger than Young's modulus in the original DDA, however we find that the correct results can still be obtained when it is much smaller than Young's modulus. Finally, the penetrations by using penalty method and augmented Lagrangian method are compared. Penetration of the latter is 1/4 of the former. The range of spring stiffness for the latter is wider than the former, being 0.01–1 of the former. Both methods can lead to correct contact forces.

  13. On the Issue of Labor Relations Discontinuance by Staff Reduction

    Directory of Open Access Journals (Sweden)

    Sheveleva A. A.

    2012-11-01

    Full Text Available This article is devoted to consideration of issues related to the procedure of labor law contract termination by staff reduction. The author, analyzing the judicial practice, gives practical recommendations on the procedure of employment relationships discontinuance

  14. On cell entropy inequality for discontinuous Galerkin methods

    Science.gov (United States)

    Jiang, Guangshan; Shu, Chi-Wang

    1993-01-01

    We prove a cell entropy inequality for a class of high order discontinuous Galerkin finite element methods approximating conservation laws, which implies convergence for the one dimensional scalar convex case.

  15. 14 CFR 170.25 - LORAN-C discontinuance criteria.

    Science.gov (United States)

    2010-01-01

    ... nonprecision approach may be subject to discontinuance when the present value of the continued maintenance costs (PVCM) of the LORAN-C approach exceed the present value of its remaining life-cycle benefits (PVB...

  16. On the relativistic transport equation for a multiple discontinuity wave

    International Nuclear Information System (INIS)

    Giambo, Sebastiano

    1980-01-01

    The theory of singular hypersurfaces is combined with the ray theory to study propagation of weak discontinuities of solutions of quasi-linear hyperbolic system in the context of special relativity. The case of a multiple wave is considered [fr

  17. Rotational discontinuities and the structure of the magnetopause

    International Nuclear Information System (INIS)

    Swift, D.W.; Lee, L.C.

    1983-01-01

    Symmetric and asymmetric rotational discontinuities are studied by means of a one-dimensional computer simulation and by single-particle trajectory calculations. The numerical simulations show the symmetric rotation to be stable for both ion and electron senses of rotation with a thickness of the order of a few ion gyroradii when the rotation angle of the tangential field is 180 0 or less. Larger rotation angles tend to be unstable. In an expansive discontinuity, when the magnetic field on the downstream side of the discontinuity is larger, an expanding transition layer separating the high-field from a low-field region develops on the downstream side, and a symmetric rotational discontinuity forms at the upstream edge. The implication of these results for magnetopause structure and energy flow through the magnetopause is described

  18. Discontinuous conduction mode analysis of phase-modulated series ...

    Indian Academy of Sciences (India)

    modulated dc–dc series resonant converter (SRC) operating in discontinuous conduction mode (DCM). The conventional fundamental harmonic approximation technique is extended for a non-ideal series resonant tank to clarify the limitations of ...

  19. Relativistic transport equation for a discontinuity wave of multiplicity one

    Energy Technology Data Exchange (ETDEWEB)

    Giambo, S; Palumbo, A [Istituto di Matematica, Universita degli Studi, Messina (Italy)

    1980-04-14

    In the framework of the theory of the singular hypersurfaces, the transport equation for the amplitude of a discontinuity wave, corresponding to a simple characteristic of a quasi-linear hyperbolic system, is established in the context of special relativity.

  20. Relativistic transport equation for a multiple discontinuity wave

    Energy Technology Data Exchange (ETDEWEB)

    Giambo, S [Istituto di Matematica, Universita degli Studi, Messina (Italy)

    1980-09-29

    The theory of singular hypersurfaces is combined with the ray theory to study propagation of weak discontinuities of solutions of a quasi-linear hyperbolic system in the context of special relativity. The case of a multiple wave is considered.

  1. Modelling discontinuous well log signal to identify lithological ...

    Indian Academy of Sciences (India)

    1Indian School of Mines (ISM), Dhanbad 826 004, India. ... new wavelet transform-based algorithm to model the abrupt discontinuous changes from well log data by taking care of ...... the 11th ACM International Conference on Multimedia,.

  2. Father's Labour Migration and Children's School Discontinuation in Rural Mozambique.

    Science.gov (United States)

    Yabiku, Scott T; Agadjanian, Victor

    2017-08-01

    We examine how the discontinuation of schooling among left-behind children is related to multiple dimensions of male labor migration: the accumulation of migration experience, the timing of these migration experiences in the child's life course, and the economic success of the migration. Our setting is rural southern Mozambique, an impoverished area with massive male labor out-migration. Results show that fathers' economically successful labor migration is more beneficial for children's schooling than unsuccessful migration or non-migration. There are large differences, however, by gender: compared to sons of non-migrants, sons of migrant fathers (regardless of migration success) have lower rates of school discontinuation, while daughters of migrant fathers have rates of school discontinuation no different than daughters of non-migrants. Furthermore, accumulated labor migration across the child's life course is beneficial for boys' schooling, but not girls'. Remittances sent in the past year reduce the rate of discontinuation for sons, but not daughters.

  3. Reasons for discontinuation of implanon among users in Buffalo City ...

    African Journals Online (AJOL)

    Reasons for discontinuation of implanon among users in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study. Khungelwa Patricia Mrwebi, Daniel Ter Goon, Eyitayo Omolara Owolabi, Oladele Vincent Adeniyi, Eunice Seekoe, Anthony Idowu Ajayi ...

  4. Determining the Locations and Discontinuities in the Derivatives of Functions

    International Nuclear Information System (INIS)

    Archibald, Richard K.; Gelb, Anne; Yoon, Jungho

    2007-01-01

    We introduce a method for detecting discontinuities in piecewise smooth functions and in their derivatives. The method is constructed from a local stencil of grid point values and is based on a polynomial annihilation technique. By varying the order of the method and the arrangement of the corresponding stencils, the jump discontinuities of a function and its derivatives can be identified with high order accuracy. The method is efficient and robust and can be applied to non-uniform distributions in one dimension

  5. Reactive oxygen species production and discontinuous gas exchange in insects

    OpenAIRE

    Boardman, Leigh; Terblanche, John S.; Hetz, Stefan K.; Marais, Elrike; Chown, Steven L.

    2011-01-01

    While biochemical mechanisms are typically used by animals to reduce oxidative damage, insects are suspected to employ a higher organizational level, discontinuous gas exchange mechanism to do so. Using a combination of real-time, flow-through respirometry and live-cell fluorescence microscopy, we show that spiracular control associated with the discontinuous gas exchange cycle (DGC) in Samia cynthia pupae is related to reactive oxygen species (ROS). Hyperoxia fails to increase mean ROS produ...

  6. A note on iterated function systems with discontinuous probabilities

    International Nuclear Information System (INIS)

    Jaroszewska, Joanna

    2013-01-01

    Highlights: ► Certain iterated function system with discontinuous probabilities is discussed. ► Existence of an invariant measure via the Schauder–Tychonov theorem is established. ► Asymptotic stability of the system under examination is proved. -- Abstract: We consider an example of an iterated function system with discontinuous probabilities. We prove that it posses an invariant probability measure. We also prove that it is asymptotically stable provided probabilities are positive

  7. A simple model of discontinuous firm’s growth

    OpenAIRE

    D'Elia, Enrico

    2011-01-01

    Typically, firms change their size through a row of discrete leaps over time. Sunk costs, regulatory, financial and organizational constraints, talent distribution and other factors may explain this fact. However, firms tend to grow or fall discontinuously even if those inertial factors were removed. For instance, a very essential model of discontinuous growth can be based on a couple of assumptions concerning only technology and entrepreneurs’ strategy, that is: (a) in the short run, the...

  8. Discrete modeling of multiple discontinuities in rock mass using XFEM

    OpenAIRE

    Das, Kamal C.; Ausas, Roberto Federico; Carol, Ignacio; Rodrigues, Eduardo; Sandeep, Sandra; Vargas, P. E.; Gonzalez, Nubia Aurora; Segura, Josep María; Lakshmikantha, Ramasesha Mookanahallipatna; Mello,, U.

    2017-01-01

    Modeling of discontinuities (fractures and fault surfaces) is of major importance to assess the geomechanical behavior of oil and gas reservoirs, especially for tight and unconventional reservoirs. Numerical analysis of discrete discontinuities traditionally has been studied using interface element concepts, however more recently there are attempts to use extended finite element method (XFEM). The development of an XFEM tool for geo-mechanical fractures/faults modeling has significant industr...

  9. A Gas-kinetic Discontinuous Galerkin Method for Viscous Flow Equations

    International Nuclear Information System (INIS)

    Liu, Hongwei; Xu, Kun

    2007-01-01

    This paper presents a Runge-Kutta discontinuous Galerkin (RKDG) method for viscous flow computation. The construction of the RKDG method is based on a gas-kinetic formulation, which not only couples the convective and dissipative terms together, but also includes both discontinuous and continuous representation in the flux evaluation at the cell interface through a simple hybrid gas distribution function. Due to the intrinsic connection between the gaskinetic BGK model and the Navier-Stokes equations, the Navier-Stokes flux is automatically obtained by the present method. Numerical examples for both one dimensional (10) and two dimensional(20) compressible viscous flows are presented to demonstrate the accuracy and shock capturing capability of the current RKDG method

  10. Detection and Correction of Step Discontinuities in Kepler Flux Time Series

    Science.gov (United States)

    Kolodziejczak, J. J.; Morris, R. L.

    2011-01-01

    PDC 8.0 includes an implementation of a new algorithm to detect and correct step discontinuities appearing in roughly one of every 20 stellar light curves during a given quarter. The majority of such discontinuities are believed to result from high-energy particles (either cosmic or solar in origin) striking the photometer and causing permanent local changes (typically -0.5%) in quantum efficiency, though a partial exponential recovery is often observed [1]. Since these features, dubbed sudden pixel sensitivity dropouts (SPSDs), are uncorrelated across targets they cannot be properly accounted for by the current detrending algorithm. PDC detrending is based on the assumption that features in flux time series are due either to intrinsic stellar phenomena or to systematic errors and that systematics will exhibit measurable correlations across targets. SPSD events violate these assumptions and their successful removal not only rectifies the flux values of affected targets, but demonstrably improves the overall performance of PDC detrending [1].

  11. Convergence of Discontinuous Galerkin Methods for Incompressible Two-Phase Flow in Heterogeneous Media

    KAUST Repository

    Kou, Jisheng; Sun, Shuyu

    2013-01-01

    A class of discontinuous Galerkin methods with interior penalties is presented for incompressible two-phase flow in heterogeneous porous media with capillary pressures. The semidiscrete approximate schemes for fully coupled system of two-phase flow are formulated. In highly heterogeneous permeable media, the saturation is discontinuous due to different capillary pressures, and therefore, the proposed methods incorporate the capillary pressures in the pressure equation instead of saturation equation. By introducing a coupling approach for stability and error estimates instead of the conventional separate analysis for pressure and saturation, the stability of the schemes in space and time and a priori hp error estimates are presented in the L2(H 1) for pressure and in the L∞(L2) and L2(H1) for saturation. Two time discretization schemes are introduced for effectively computing the discrete solutions. © 2013 Societ y for Industrial and Applied Mathematics.

  12. Response of vascular pigment epithelium detachment due to age-related macular degeneration to monthly treatment with ranibizumab: the prospective, multicentre RECOVER study.

    Science.gov (United States)

    Clemens, Christoph R; Wolf, Armin; Alten, Florian; Milojcic, Carolin; Heiduschka, Peter; Eter, Nicole

    2017-11-01

    μm ± 185.6). In group A, 10 patients developed a RPE tear (25%) after a mean of 3.6 injections. No tear was documented in group B. Lesion height, ratio of CNV size to PED size and presence of hyperreflective lines differed significantly between patients with and without RPE tear development. Serous vascular PED lesions showed an improvement regarding BCVA and morphologic characteristics unless an RPE tear occurred. In fPED lesions, a functional and morphological stabilization was observed. Monthly ranibizumab injections are an effective treatment regarding the resorption of subretinal fluid in vPED due to AMD. Patients should be screened for the presence of morphologic risk factors for RPE tear development before and during treatment. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. Class of reconstructed discontinuous Galerkin methods in computational fluid dynamics

    International Nuclear Information System (INIS)

    Luo, Hong; Xia, Yidong; Nourgaliev, Robert

    2011-01-01

    A class of reconstructed discontinuous Galerkin (DG) methods is presented to solve compressible flow problems on arbitrary grids. The idea is to combine the efficiency of the reconstruction methods in finite volume methods and the accuracy of the DG methods to obtain a better numerical algorithm in computational fluid dynamics. The beauty of the resulting reconstructed discontinuous Galerkin (RDG) methods is that they provide a unified formulation for both finite volume and DG methods, and contain both classical finite volume and standard DG methods as two special cases of the RDG methods, and thus allow for a direct efficiency comparison. Both Green-Gauss and least-squares reconstruction methods and a least-squares recovery method are presented to obtain a quadratic polynomial representation of the underlying linear discontinuous Galerkin solution on each cell via a so-called in-cell reconstruction process. The devised in-cell reconstruction is aimed to augment the accuracy of the discontinuous Galerkin method by increasing the order of the underlying polynomial solution. These three reconstructed discontinuous Galerkin methods are used to compute a variety of compressible flow problems on arbitrary meshes to assess their accuracy. The numerical experiments demonstrate that all three reconstructed discontinuous Galerkin methods can significantly improve the accuracy of the underlying second-order DG method, although the least-squares reconstructed DG method provides the best performance in terms of both accuracy, efficiency, and robustness. (author)

  14. Minimizers with discontinuous velocities for the electromagnetic variational method

    International Nuclear Information System (INIS)

    De Luca, Jayme

    2010-01-01

    The electromagnetic two-body problem has neutral differential delay equations of motion that, for generic boundary data, can have solutions with discontinuous derivatives. If one wants to use these neutral differential delay equations with arbitrary boundary data, solutions with discontinuous derivatives must be expected and allowed. Surprisingly, Wheeler-Feynman electrodynamics has a boundary value variational method for which minimizer trajectories with discontinuous derivatives are also expected, as we show here. The variational method defines continuous trajectories with piecewise defined velocities and accelerations, and electromagnetic fields defined by the Euler-Lagrange equations on trajectory points. Here we use the piecewise defined minimizers with the Lienard-Wierchert formulas to define generalized electromagnetic fields almost everywhere (but on sets of points of zero measure where the advanced/retarded velocities and/or accelerations are discontinuous). Along with this generalization we formulate the generalized absorber hypothesis that the far fields vanish asymptotically almost everywhere and show that localized orbits with far fields vanishing almost everywhere must have discontinuous velocities on sewing chains of breaking points. We give the general solution for localized orbits with vanishing far fields by solving a (linear) neutral differential delay equation for these far fields. We discuss the physics of orbits with discontinuous derivatives stressing the differences to the variational methods of classical mechanics and the existence of a spinorial four-current associated with the generalized variational electrodynamics.

  15. Research progress on criteria for discontinuation of EGFR inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Zhuang HQ

    2012-10-01

    Full Text Available Hong-qing Zhuang, Zhi-yong Yuan, Jun Wang, Ping Wang, Lu-jun Zhao, Bai-lin ZhangDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin, People's Republic of ChinaAbstract: The clinical success of the epidermal growth factor receptor (EGFR tyrosine kinase inhibitors (TKI as therapeutic agents has prompted great interest in their further development and clinical testing for a wide variety of malignancies. However, most studies have focused on the efficacy of TKI, and few studies have been done on the criteria for their discontinuation. The current standard for drug discontinuation is “until progression”, based on change in tumor size. However, tumor size is not related to the gene expression which determines the efficacy of TKI in the final analysis, and it is also difficult to make a thorough and correct prediction based on tumor size when the TKI is discontinued. Nevertheless, clinical evaluation of the criteria for TKI discontinuation is still in its early days. Some promising findings have started to emerge. With the improving knowledge of EGFR and its inhibitors, it is expected that the criteria for discontinuation of EGFR inhibitor therapy will become clearer.Keywords: epidermal growth factor receptor, drug discontinuation, acquired drug-resistance

  16. Oocyte cryopreservation for fertility preservation in postpubertal female children at risk for premature ovarian failure due to accelerated follicle loss in Turner syndrome or cancer treatments.

    Science.gov (United States)

    Oktay, K; Bedoschi, G

    2014-12-01

    To preliminarily study the feasibility of oocyte cryopreservation in postpubertal girls aged between 13 and 15 years who were at risk for premature ovarian failure due to the accelerated follicle loss associated with Turner syndrome or cancer treatments. Retrospective cohort and review of literature. Academic fertility preservation unit. Three girls diagnosed with Turner syndrome, 1 girl diagnosed with germ-cell tumor. and 1 girl diagnosed with lymphoblastic leukemia. Assessment of ovarian reserve, ovarian stimulation, oocyte retrieval, in vitro maturation, and mature oocyte cryopreservation. Response to ovarian stimulation, number of mature oocytes cryopreserved and complications, if any. Mean anti-müllerian hormone, baseline follical stimulating hormone, estradiol, and antral follicle counts were 1.30 ± 0.39, 6.08 ± 2.63, 41.39 ± 24.68, 8.0 ± 3.2; respectively. In Turner girls the ovarian reserve assessment indicated already diminished ovarian reserve. Ovarian stimulation and oocyte cryopreservation was successfully performed in all female children referred for fertility preservation. A range of 4-11 mature oocytes (mean 8.1 ± 3.4) was cryopreserved without any complications. All girls tolerated the procedure well. Oocyte cryopreservation is a feasible technique in selected female children at risk for premature ovarian failure. Further studies would be beneficial to test the success of oocyte cryopreservation in young girls. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Rosiglitazone treatment of patients with extreme insulin resistance and diabetes mellitus due to insulin receptor mutations has no effects on glucose and lipid metabolism

    DEFF Research Database (Denmark)

    Vestergaard, H; Lund, S; Pedersen, O

    2001-01-01

    Rosiglitazone, a thiazolidinedione (TZD), increases insulin sensitivity by reducing levels of plasma NEFA, triglycerides (TG), glucose and serum insulin. Rosiglitazone treatment decreases insulin resistance in type 2 diabetic patients, but no data exist concerning rosiglitazone treatment...

  18. Multistability of neural networks with discontinuous non-monotonic piecewise linear activation functions and time-varying delays.

    Science.gov (United States)

    Nie, Xiaobing; Zheng, Wei Xing

    2015-05-01

    This paper is concerned with the problem of coexistence and dynamical behaviors of multiple equilibrium points for neural networks with discontinuous non-monotonic piecewise linear activation functions and time-varying delays. The fixed point theorem and other analytical tools are used to develop certain sufficient conditions that ensure that the n-dimensional discontinuous neural networks with time-varying delays can have at least 5(n) equilibrium points, 3(n) of which are locally stable and the others are unstable. The importance of the derived results is that it reveals that the discontinuous neural networks can have greater storage capacity than the continuous ones. Moreover, different from the existing results on multistability of neural networks with discontinuous activation functions, the 3(n) locally stable equilibrium points obtained in this paper are located in not only saturated regions, but also unsaturated regions, due to the non-monotonic structure of discontinuous activation functions. A numerical simulation study is conducted to illustrate and support the derived theoretical results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Epstein-Barr virus DNA monitoring in serum and whole blood in pediatric liver transplant recipients who do or do not discontinue immunosuppressive therapy.

    Science.gov (United States)

    Kullberg-Lindh, C; Saalman, R; Olausson, M; Herlenius, G; Lindh, M

    2017-08-01

    The rate of PTLD can be reduced by weaned IS guided by monitoring of EBV DNA. In this single-center retrospective case series study, we analyzed how reduction in IS influenced EBV DNA levels in whole blood and serum in 30 children during the first year after liver transplantation, and how these levels were related to symptoms putatively due to EBV. Primary and reactivated EBV infection was seen in 18 (60%) and eight patients (27%), respectively. Thirteen patients (42%) developed chronic high load the first year post-transplant. IS was successfully discontinued in six patients the first year post-transplant and in another two patients within 3 years. EBV DNA levels were reduced, but persisted long term in all the eight patients who had IS completely withdrawn. There was no case of PTLD. In summary, EBV DNAemia and chronic high load were very common after pediatric liver transplantation. Liver graft tolerance facilitates radical reduction in IS treatment, which may prevent PTLD, but EBV DNAemia may persist long term after discontinued IS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Continuing weight-loss effect after topiramate discontinuation in obese persons with schizophrenia: a pilot open-label study.

    Science.gov (United States)

    Liang, C-S; Yang, F-W; Huang, S-Y; Ho, P-S

    2014-07-01

    Few studies have investigated the likelihood of weight maintenance in obese persons with schizophrenia after their initial successful weight loss. This pilot open-label study examined the efficacy of topiramate in weight loss and the trajectory of weight changes after topiramate discontinuation. This study enrolled 10 obese persons with schizophrenia. A 4-month treatment phase was started, followed by a 12-month discontinuation phase. Body weight was measured as the primary outcome every month. Secondary outcomes included leptin levels, fasting glucose, lipid profiles, and insulin resistance index. After the 4-month addition of topiramate, participants lost 1.79 kg of their body weight (95% CI=-3.03 to -0.56, p=0.005). The maximum weight reduction was 4.32 kg, occurring when topiramate had been discontinued for 12 months (95% CI=-6.41 to -2.24, p<0.001). The continuing weight-loss effect after topiramate discontinuation might have resulted from topiramate's potential to improve leptin functioning. These findings demonstrate that topiramate's weight-loss effect could not only persist during its administration, but also continue to improve after its discontinuation. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Toward Continuous GPS Carrier-Phase Time Transfer: Eliminating the Time Discontinuity at an Anomaly.

    Science.gov (United States)

    Yao, Jian; Levine, Judah; Weiss, Marc

    2015-01-01

    The wide application of Global Positioning System (GPS) carrier-phase (CP) time transfer is limited by the problem of boundary discontinuity (BD). The discontinuity has two categories. One is "day boundary discontinuity," which has been studied extensively and can be solved by multiple methods [1-8]. The other category of discontinuity, called "anomaly boundary discontinuity (anomaly-BD)," comes from a GPS data anomaly. The anomaly can be a data gap (i.e., missing data), a GPS measurement error (i.e., bad data), or a cycle slip. Initial study of the anomaly-BD shows that we can fix the discontinuity if the anomaly lasts no more than 20 min, using the polynomial curve-fitting strategy to repair the anomaly [9]. However, sometimes, the data anomaly lasts longer than 20 min. Thus, a better curve-fitting strategy is in need. Besides, a cycle slip, as another type of data anomaly, can occur and lead to an anomaly-BD. To solve these problems, this paper proposes a new strategy, i.e., the satellite-clock-aided curve fitting strategy with the function of cycle slip detection. Basically, this new strategy applies the satellite clock correction to the GPS data. After that, we do the polynomial curve fitting for the code and phase data, as before. Our study shows that the phase-data residual is only ~3 mm for all GPS satellites. The new strategy also detects and finds the number of cycle slips by searching the minimum curve-fitting residual. Extensive examples show that this new strategy enables us to repair up to a 40-min GPS data anomaly, regardless of whether the anomaly is due to a data gap, a cycle slip, or a combination of the two. We also find that interference of the GPS signal, known as "jamming", can possibly lead to a time-transfer error, and that this new strategy can compensate for jamming outages. Thus, the new strategy can eliminate the impact of jamming on time transfer. As a whole, we greatly improve the robustness of the GPS CP time transfer.

  2. Adaptive mixed-hybrid and penalty discontinuous Galerkin method for two-phase flow in heterogeneous media

    KAUST Repository

    Hou, Jiangyong

    2016-02-05

    In this paper, we present a hybrid method, which consists of a mixed-hybrid finite element method and a penalty discontinuous Galerkin method, for the approximation of a fractional flow formulation of a two-phase flow problem in heterogeneous media with discontinuous capillary pressure. The fractional flow formulation is comprised of a wetting phase pressure equation and a wetting phase saturation equation which are coupled through a total velocity and the saturation affected coefficients. For the wetting phase pressure equation, the continuous mixed-hybrid finite element method space can be utilized due to a fundamental property that the wetting phase pressure is continuous. While it can reduce the computational cost by using less degrees of freedom and avoiding the post-processing of velocity reconstruction, this method can also keep several good properties of the discontinuous Galerkin method, which are important to the fractional flow formulation, such as the local mass balance, continuous normal flux and capability of handling the discontinuous capillary pressure. For the wetting phase saturation equation, the penalty discontinuous Galerkin method is utilized due to its capability of handling the discontinuous jump of the wetting phase saturation. Furthermore, an adaptive algorithm for the hybrid method together with the centroidal Voronoi Delaunay triangulation technique is proposed. Five numerical examples are presented to illustrate the features of proposed numerical method, such as the optimal convergence order, the accurate and efficient velocity approximation, and the applicability to the simulation of water flooding in oil field and the oil-trapping or barrier effect phenomena.

  3. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term.

    Science.gov (United States)

    Abolghasemian, M; Tangsaraporn, S; Drexler, M; Barbuto, R; Backstein, D; Safir, O; Kuzyk, P; Gross, A

    2014-02-01

    The use of ilioischial cage reconstruction for pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer, Warsaw, Indiana) cup-cage technique in our institution, due to the unsatisfactory outcome of using a cage alone in this situation. We report the outcome of 26 pelvic discontinuities in 24 patients (20 women and four men, mean age 65 years (44 to 84)) treated by the cup-cage technique at a mean follow-up of 82 months (12 to 113) and compared them with a series of 19 pelvic discontinuities in 19 patients (18 women and one man, mean age 70 years (42 to 86)) treated with a cage at a mean follow-up of 69 months (1 to 170). The clinical and radiological outcomes as well as the survivorship of the groups were compared. In all, four of the cup-cage group (15%) and 13 (68%) of the cage group failed due to septic or aseptic loosening. The seven-year survivorship was 87.2% (95% confidence interval (CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84) for the cage-alone group (p = 0.009). There were four major complications in the cup-cage group and nine in the cage group. Radiological union of the discontinuity was found in all successful cases in the cup-cage group and three of the successful cage cases. Three hips in the cup-cage group developed early radiological migration of the components, which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating pelvic discontinuity in mid-term follow-up and is preferred to ilioischial cage reconstruction. If the continuity of the bone graft at the discontinuity site is not disrupted, early migration of the components does not necessarily result in failure.

  4. Adaptive mixed-hybrid and penalty discontinuous Galerkin method for two-phase flow in heterogeneous media

    KAUST Repository

    Hou, Jiangyong; Chen, Jie; Sun, Shuyu; Chen, Zhangxin

    2016-01-01

    In this paper, we present a hybrid method, which consists of a mixed-hybrid finite element method and a penalty discontinuous Galerkin method, for the approximation of a fractional flow formulation of a two-phase flow problem in heterogeneous media with discontinuous capillary pressure. The fractional flow formulation is comprised of a wetting phase pressure equation and a wetting phase saturation equation which are coupled through a total velocity and the saturation affected coefficients. For the wetting phase pressure equation, the continuous mixed-hybrid finite element method space can be utilized due to a fundamental property that the wetting phase pressure is continuous. While it can reduce the computational cost by using less degrees of freedom and avoiding the post-processing of velocity reconstruction, this method can also keep several good properties of the discontinuous Galerkin method, which are important to the fractional flow formulation, such as the local mass balance, continuous normal flux and capability of handling the discontinuous capillary pressure. For the wetting phase saturation equation, the penalty discontinuous Galerkin method is utilized due to its capability of handling the discontinuous jump of the wetting phase saturation. Furthermore, an adaptive algorithm for the hybrid method together with the centroidal Voronoi Delaunay triangulation technique is proposed. Five numerical examples are presented to illustrate the features of proposed numerical method, such as the optimal convergence order, the accurate and efficient velocity approximation, and the applicability to the simulation of water flooding in oil field and the oil-trapping or barrier effect phenomena.

  5. Augmented effect of early antibiotic treatment in mice with experimental lung infections due to sequentially adapted mucoid strains of Pseudomonas aeruginosa

    DEFF Research Database (Denmark)

    van Gennip, M; Moser, Claus; Christensen, Louise D

    2009-01-01

    : A significant reduction in the number of bacteria was observed when initiating treatment 1 h post-infection compared with initiating treatment after 24 h, although the latest isolate avoided complete clearance. Early antibiotic treatment directed at the mucoid phenotype in mice also reduced the inflammation and......Background: Effects of treatment with tobramycin initiated 1 or 24 h post-infection were investigated in a new version of a pulmonary infection model in mice. The model reflects the differentiated behaviour of Pseudomonas aeruginosa mucoid strains isolated from the lungs of one chronically infected......, histopathology, and measurement of granulocyte colony-stimulating factor (G-CSF) and macrophage inflammatory protein 2 (MIP-2). Results: There was a significant reduction of bacteria when comparing treatment initiated 1 h post-infection with treatment initiated after 24 h for isolates 1997 and 2003. Treatment...

  6. Socio-Economic Differentials in Contraceptive Discontinuation in India

    Directory of Open Access Journals (Sweden)

    Kiran Agrahari

    2016-05-01

    Full Text Available Fertility divergence amid declining in use of modern contraception in many states of India needs urgent research and programmatic attention. Although utilization of antenatal, natal, and post-natal care has shown spectacular increase in post National Rural Health Mission (NRHM period, the contraceptive use had shown a declining trend. Using the calendar data from the National Family Health Survey–3, this article examines the reasons of contraceptive discontinuation among spacing method users by socio-economic groups in India. Bivariate and multivariate analyses and life table discontinuation rates are used in the analyses. Results suggest that about half of the pill users, two fifths of the condom users, one third of traditional method users, and one fifth of IUD users discontinue a method in first 12 months of use. However, the discontinuation of all three modern spacing methods declines in subsequent period (within 12-36 months. The probability of method failure was highest among traditional method users and higher among poor and less educated that may lead to unwanted/mistimed birth. Although discontinuation of condom declines with economic status, it does not show any large variation for pill users. The contraceptive discontinuation was significantly associated with duration of use, age, parity, contraceptive method, religion, and contraceptive intention. Based on these findings, it is suggested that follow-up services to modern spacing method users, increasing counseling for spacing method users, motivating the traditional method user to use modern spacing method, and improving the overall quality of family planning services can reduce the discontinuation of spacing method.

  7. Convergence Improvement of Response Matrix Method with Large Discontinuity Factors

    International Nuclear Information System (INIS)

    Yamamoto, Akio

    2003-01-01

    In the response matrix method, a numerical divergence problem has been reported when extremely small or large discontinuity factors are utilized in the calculations. In this paper, an alternative response matrix formulation to solve the divergence problem is discussed, and properties of iteration matrixes are investigated through eigenvalue analyses. In the conventional response matrix formulation, partial currents between adjacent nodes are assumed to be discontinuous, and outgoing partial currents are converted into incoming partial currents by the discontinuity factor matrix. Namely, the partial currents of the homogeneous system (i.e., homogeneous partial currents) are treated in the conventional response matrix formulation. In this approach, the spectral radius of an iteration matrix for the partial currents may exceed unity when an extremely small or large discontinuity factor is used. Contrary to this, an alternative response matrix formulation using heterogeneous partial currents is discussed in this paper. In the latter approach, partial currents are assumed to be continuous between adjacent nodes, and discontinuity factors are directly considered in the coefficients of a response matrix. From the eigenvalue analysis of the iteration matrix for the one-group, one-dimensional problem, the spectral radius for the heterogeneous partial current formulation does not exceed unity even if an extremely small or large discontinuity factor is used in the calculation; numerical stability of the alternative formulation is superior to the conventional one. The numerical stability of the heterogeneous partial current formulation is also confirmed by the two-dimensional light water reactor core analysis. Since the heterogeneous partial current formulation does not require any approximation, the converged solution exactly reproduces the reference solution when the discontinuity factors are directly derived from the reference calculation

  8. Modeling Storm Surges Using Discontinuous Galerkin Methods

    Science.gov (United States)

    2016-06-01

    layer non-reflecting boundary condition (NRBC) on the right wall of the model. A NRBC is when an artificial boundary , B, is created, which truncates the... applications ,” Journal of Computational Physics, 2004. [30] P. L. Butzer and R. Weis, “On the lax equivalence theorem equipped with orders,” Journal of...closer to the shoreline. In our simulation, we also learned of the effects spurious waves can have on the results. Due to boundary conditions, a

  9. Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device.

    Science.gov (United States)

    Hameed, Waqas; Azmat, Syed Khurram; Ali, Moazzam; Hussain, Wajahat; Mustafa, Ghulam; Ishaque, Muhammad; Ali, Safdar; Ahmed, Aftab; Temmerman, Marleen

    2015-01-01

    Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

  10. Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device

    Directory of Open Access Journals (Sweden)

    Waqas Hameed

    2015-01-01

    Full Text Available Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9 randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0 the chances of method switching. Compared with women who received free IUCD service (via voucher scheme, the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

  11. Discontinuity of mode transition and hysteresis in hydrogen inductively coupled plasma via a fluid model

    International Nuclear Information System (INIS)

    Xu Hui-Jing; Shu-Xia Zhao; Gao Fei; Zhang Yu-Ru; Li Xue-Chun; Wang You-Nian

    2015-01-01

    A new type of two-dimensional self-consistent fluid model that couples an equivalent circuit module is used to investigate the mode transition characteristics and hysteresis in hydrogen inductively coupled plasmas at different pressures, by varying the series capacitance of the matching box. The variations of the electron density, temperature, and the circuit electrical properties are presented. As cycling the matching capacitance, at high pressure both the discontinuity and hysteresis appear for the plasma parameters and the transferred impedances of both the inductive and capacitive discharge components, while at low pressure only the discontinuity is seen. The simulations predict that the sheath plays a determinative role on the presence of discontinuity and hysteresis at high pressure, by influencing the inductive coupling efficiency of applied power. Moreover, the values of the plasma transferred impedances at different pressures are compared, and the larger plasma inductance at low pressure due to less collision frequency, as analyzed, is the reason why the hysteresis is not seen at low pressure, even with a wider sheath. Besides, the behaviors of the coil voltage and current parameters during the mode transitions are investigated. They both increase (decrease) at the E to H (H to E) mode transition, indicating an improved (worsened) inductive power coupling efficiency. (paper)

  12. Discontinuous ventilator weaning of patients with acute SCI.

    Science.gov (United States)

    Füssenich, Wout; Hirschfeld Araujo, Sven; Kowald, Birgitt; Hosman, Allard; Auerswald, Marc; Thietje, Roland

    2018-05-01

    Retrospective, single centre cohort study. To determine factors associated with ventilator weaning success and failure in patients with acute spinal cord injury (SCI); determine length of time and attempts required to wean from the ventilator successfully and determine the incidence of pneumonia. BG Klinikum Hamburg, Level 1 trauma centre, SCI Department, Germany. From 2010 until 2017, 165 consecutive patients with cervical SCI, initially dependent on a ventilator, were included and weaned discontinuously via tracheal cannula. Data related to anthropometric details, neurological injury, respiratory outcomes, and weaning parameters were prospectively recorded in a database and retrospectively analysed. Seventy-nine percent of all patients were successfully weaned from ventilation. Average duration of the complete weaning process was 37 days. Ninety-one percent of the successfully weaned patients completed this on first attempt. Age (>56 years), level of injury (C4 and/or above), vital capacity (25 kg/m 2 ), and chronic obstructive pulmonary disease (COPD) significantly decreased the chance of successful weaning. These factors also correlated with a higher number of weaning attempts. High level of injury, older age, and reduced vital capacity also increased the duration of the weaning process. Patients with low vital capacity and concurrent therapy with Baclofen and Dantrolene showed higher rates of pneumonia. We conclude that mentioned factors are associated with weaning outcome and useful for clinical recommendations and patient counselling. These data further support the complexity of ventilator weaning in the SCI population due to associated complications, therefore we recommend conducting weaning of patients with SCI on intensive or intermediate care units (ICU/IMCU) in specialised centres.

  13. Solutions of the Wheeler-Feynman equations with discontinuous velocities.

    Science.gov (United States)

    de Souza, Daniel Câmara; De Luca, Jayme

    2015-01-01

    We generalize Wheeler-Feynman electrodynamics with a variational boundary value problem for continuous boundary segments that might include velocity discontinuity points. Critical-point orbits must satisfy the Euler-Lagrange equations of the action functional at most points, which are neutral differential delay equations (the Wheeler-Feynman equations of motion). At velocity discontinuity points, critical-point orbits must satisfy the Weierstrass-Erdmann continuity conditions for the partial momenta and the partial energies. We study a special setup having the shortest time-separation between the (infinite-dimensional) boundary segments, for which case the critical-point orbit can be found using a two-point boundary problem for an ordinary differential equation. For this simplest setup, we prove that orbits can have discontinuous velocities. We construct a numerical method to solve the Wheeler-Feynman equations together with the Weierstrass-Erdmann conditions and calculate some numerical orbits with discontinuous velocities. We also prove that the variational boundary value problem has a unique solution depending continuously on boundary data, if the continuous boundary segments have velocity discontinuities along a reduced local space.

  14. 21 CFR 1301.52 - Termination of registration; transfer of registration; distribution upon discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... discontinues business or professional practice. Any registrant who ceases legal existence or discontinues... registration; distribution upon discontinuance of business. 1301.52 Section 1301.52 Food and Drugs DRUG... of registration; transfer of registration; distribution upon discontinuance of business. (a) Except...

  15. Discontinuous Galerkin Dynamical Core in HOMME

    Energy Technology Data Exchange (ETDEWEB)

    Nair, R. D. [Univ. of Colorado, Boulder, CO (United States); Tufo, Henry [Univ. of Colorado, Boulder, CO (United States)

    2012-08-14

    Atmospheric numerical modeling has been going through radical changes over the past decade. One major reason for this trend is due to the recent paradigm change in scientific computing , triggered by the arrival of petascale computing resources with core counts in the tens of thousands to hundreds of thousands range. Modern atmospheric modelers must adapt grid systems and numerical algorithms to facilitate an unprecedented levels of scalability on these modern highly parallel computer architectures. The numerical algorithms which can address these challenges should have the local properties such as high on-processor floating-point operation count to bytes moved and minimum parallel communication overhead.

  16. The role of conductivity discontinuities in design of cardiac defibrillation

    Science.gov (United States)

    Lim, Hyunkyung; Cun, Wenjing; Wang, Yue; Gray, Richard A.; Glimm, James

    2018-01-01

    Fibrillation is an erratic electrical state of the heart, of rapid twitching rather than organized contractions. Ventricular fibrillation is fatal if not treated promptly. The standard treatment, defibrillation, is a strong electrical shock to reinitialize the electrical dynamics and allow a normal heart beat. Both the normal and the fibrillatory electrical dynamics of the heart are organized into moving wave fronts of changing electrical signals, especially in the transmembrane voltage, which is the potential difference between the cardiac cellular interior and the intracellular region of the heart. In a normal heart beat, the wave front motion is from bottom to top and is accompanied by the release of Ca ions to induce contractions and pump the blood. In a fibrillatory state, these wave fronts are organized into rotating scroll waves, with a centerline known as a filament. Treatment requires altering the electrical state of the heart through an externally applied electrical shock, in a manner that precludes the existence of the filaments and scroll waves. Detailed mechanisms for the success of this treatment are partially understood, and involve local shock-induced changes in the transmembrane potential, known as virtual electrode alterations. These transmembrane alterations are located at boundaries of the cardiac tissue, including blood vessels and the heart chamber wall, where discontinuities in electrical conductivity occur. The primary focus of this paper is the defibrillation shock and the subsequent electrical phenomena it induces. Six partially overlapping causal factors for defibrillation success are identified from the literature. We present evidence in favor of five of these and against one of them. A major conclusion is that a dynamically growing wave front starting at the heart surface appears to play a primary role during defibrillation by critically reducing the volume available to sustain the dynamic motion of scroll waves; in contrast, virtual

  17. Resistance to discontinuing breast cancer screening in older women: A qualitative study.

    Science.gov (United States)

    Housten, Ashley J; Pappadis, Monique R; Krishnan, Shilpa; Weller, Susan C; Giordano, Sharon H; Bevers, Therese B; Volk, Robert J; Hoover, Diana S

    2018-06-01

    Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. We used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. Women ≥70 years of age who reported having a screening mammogram in the past 3 years and/or reported that they intended to continue screening in the future were recruited for in-depth interviews. Participants who intended to continue screening were asked to describe how the following hypothetical scenarios would impact a decision to discontinue screening: health concerns or limited life expectancy, a physician's recommendation to discontinue, reluctance to undergo treatment, and recommendations from experts or governmental panels to stop screening. Semi-structured, face-to-face interviews were audio-recorded. Data coding and analysis followed inductive and deductive approaches. Regardless of the scenario, participants (n = 29) expressed a strong intention to continue screening. Based on the hypothetical physician recommendations, intentions to continue screening appeared to remain strong. They did not envision a change in their health status that would lead them to discontinue screening and were skeptical of expert/government recommendations. There were no differences observed according to age, race/ethnicity, or education. Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels. Copyright © 2018 John Wiley & Sons, Ltd.

  18. Modeling shallow water flows using the discontinuous Galerkin method

    CERN Document Server

    Khan, Abdul A

    2014-01-01

    Replacing the Traditional Physical Model Approach Computational models offer promise in improving the modeling of shallow water flows. As new techniques are considered, the process continues to change and evolve. Modeling Shallow Water Flows Using the Discontinuous Galerkin Method examines a technique that focuses on hyperbolic conservation laws and includes one-dimensional and two-dimensional shallow water flows and pollutant transports. Combines the Advantages of Finite Volume and Finite Element Methods This book explores the discontinuous Galerkin (DG) method, also known as the discontinuous finite element method, in depth. It introduces the DG method and its application to shallow water flows, as well as background information for implementing and applying this method for natural rivers. It considers dam-break problems, shock wave problems, and flows in different regimes (subcritical, supercritical, and transcritical). Readily Adaptable to the Real World While the DG method has been widely used in the fie...

  19. The structure of rotational discontinuities. [in solar wind

    Science.gov (United States)

    Neugebauer, M.

    1989-01-01

    This study examines the structures of a set of rotational discontinuities detected in the solar wind by the ISEE-3 spacecraft. It is found that the complexity of the structure increases as the angle theta between the propagation vector k and the magnetic field decreases. For rotational discontinuities that propagate at a large angle to the field with an ion (left-hand) sense of rotation, the magnetic hodograms tend to be flattened, in agreement with prior numerical simulations. When theta is large, angular 'overshoots' are often observed at one or both ends of the discontinuity. When the propagation is nearly parallel to the field (when theta is small), many different types of structure are seen, ranging from straight lines, to S-shaped curves, to complex, disorganized shapes.

  20. Occupy the Financial Niche – Saturation and Crisis (discontinuous decisions

    Directory of Open Access Journals (Sweden)

    Ionut PURICA

    2014-09-01

    Full Text Available The model presented is proposing an approach that could verify the nonlinear behaviour during a crisis, such that to quantify and predict potential discontinuous behaviour. In this case, the crisis behaviour associated with financial funds reallocation among various credit instruments, described as memes with the sense of Dawkins, is shown to be of discontinuous nature stemming from a logistic penetration in the financial behaviour niche. Actually the logistic penetration is typical in creating cyclic behaviour of economic structures as shown by Marchetti and others from IIASA. A Fokker-Planck equation description results in a stationary solution having a bifurcation like solution with evolution trajectories on a ‘cusp’ type catastrophe that may describe discontinuous decision behaviour