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Sample records for findings spare diagnostic

  1. Multifocal osteolysis following limb-sparing procedures: imaging findings and a review of the literature

    Kaste, S.C.; Rao, B.N.; Lynch, M.H.; Parham, D.M.; Meyer, W.H.

    1996-01-01

    Limb-sparing procedures utilizing endoprostheses improve both the quality of life and functional level of patients treated for primary bone sarcomas. Herein, we present the imaging findings of an uncommon cause of prosthetic failure, i. e., foreign body reaction, manifested by progressive multifocal osteolysis along the prosthetic femoral shaft. (orig.). With 3 figs

  2. Clinic-radiology findings at limp-sparing surgery of alveolar sarcoma

    Tzekov, A.; Penchev, V.; Niagolova, S.; Kovachev, V.

    2007-01-01

    Soft-tissue sarcomas are a rare and heterogeneous group of tumors. Alveolar soft part sarcoma is a rare sarcoma of an unclear cause. It is representing 0.2-1 percent of soft tissue sarcomas. Unique biologic behaviors of soft-tissue sarcomas features include formation of a reactive zone, intra-compartmental growth, and, rarely, the presence of skip metastases. Although the soft-tissue sarcomas have a unique morphology, biological behavior, and prognosis, they share biological characteristics and are treated in a similar fashion. The concept of limb-sparing surgery, or limb salvage, has gradually evolved over the past 25 years. Prior to this the basic principles of surgical oncology for the extremities consisted solely of determining the correct level at which to perform an amputation. The three stages of a limb-sparing procedure are as follows: tumor resection skeletal reconstruction and soft-tissue coverage and muscle transfers to restore function. Imaging diagnostic is a key step in the limp-sparing surgery of a soft tissue sarcomas at relation of: preoperatively - the diagnosis of lesion, the decision for biopsy, about location of the lesion and what is the safest anatomic route to that location, possibly lung and bone metastases; postoperative - checking the position of the prosthesis, inflammatory, mechanic and oncology complications. (authors)

  3. Aluminum toxicity in dialysis patients: Radiographic findings and establishment of biopsy-sparing criteria

    Kriegshauser, J.S.; Swee, R.G.; McCarthy, J.T.; Hauser, M.F.

    1986-01-01

    Aluminum toxicity in dialysis patients currently requires bone biopsy for diagnosis. The authors retrospectively reviewed the findings in 63 dialysis patients who had undergone bone biopsies. In 30 patients biopsies were negative for aluminum toxicity and in 33 patients biopsies were positive. In 17 of the 30 biopsy-negative patients, absence of aluminum toxicity could be predicted by a high parathyroid hormone (iPTH) level (>200 μEq/ml) and fewer than three fractures, or by the presence of osteosclerosis on radiographs. No biopsy-positive patients met these criteria (P < .001). In 16 of 33 biopsy-positive patients aluminum toxicity could be predicted by a low iPTH level (<500 μEq/ml) and more than three fractures. No biopsy-negative patient met these criteria (P < .001). Thus, based on the criteria we have identified, 52.4% of the patients could have been spared biopsy

  4. The next organizational challenge: finding and addressing diagnostic error.

    Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

    2014-03-01

    Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

  5. Amelogenesis imperfecta: review of diagnostic findings and treatment concepts.

    Sabandal, Martin M I; Schäfer, Edgar

    2016-09-01

    Mineralization defects like amelogenesis imperfecta are often of hereditary origin. This article reviews the diagnostic findings and summarizes the suggested treatment approaches. Currently, there are no defined therapy recommendations available for patients suffering from amelogenesis imperfecta. The mentioned therapies are more or less equal but no comprehensive therapy recommendation is evident. When treating patients suffering from amelogenesis imperfecta, a comprehensive therapy of almost every dental discipline has to be considered. The earlier the diagnosis of amelogenesis imperfecta is confirmed, the better the outcome is. Optimal treatment approaches consist of early diagnosis and treatment approach and frequent dental recall appointments to prevent progressive occlusal wear or early destruction by caries. Full-mouth prosthetic treatment seems to be the best treatment option.

  6. Stratified computed tomography findings improve diagnostic accuracy for appendicitis

    Park, Geon; Lee, Sang Chul; Choi, Byung-Jo; Kim, Say-June

    2014-01-01

    AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings. METHODS: We retrospectively reviewed the database of 224 patients who had been operated on for the suspicion of appendicitis, but whose CT findings were negative or equivocal for appendicitis. The patient population was divided into two groups: a pathologically proven appendicitis group (n = 177) and a non-appendicitis group (n = 47). The CT images of these patients were re-evaluated according to the characteristic CT features as described in the literature. The re-evaluations and baseline characteristics of the two groups were compared. RESULTS: The two groups showed significant differences with respect to appendiceal diameter, and the presence of periappendiceal fat stranding and intraluminal air in the appendix. A larger proportion of patients in the appendicitis group showed distended appendices larger than 6.0 mm (66.3% vs 37.0%; P appendicitis group. Furthermore, the presence of two or more of these factors increased the odds ratio to 6.8 times higher than baseline (95%CI: 3.013-15.454; P appendicitis with equivocal CT findings. PMID:25320531

  7. Delayed Diagnoses: Nonspecific Findings and Diagnostic Challenges in Eating Disorders

    Dan Schwarz

    2009-01-01

    Full Text Available Objective. Eating disorders commonly present with nonspecific findings, masquerading as other, more common etiologies of malnutrition and wasting. In low-prevalence populations, these ambiguities can complicate clinicians’ diagnostic reasoning, resulting in delayed or missed diagnoses. Method. We report the atypical case of a 51-year-old male with a five-year history of unexplained weight loss despite extensive past medical evaluation. Previous documentation of profound lymphopenia and bone marrow atrophy had not been linked to a known association with eating disorders. Results. Evaluation for medical etiologies of wasting was negative. Following psychiatric evaluation, the patient was diagnosed with an eating disorder, not otherwise specified, and admitted to a specialized nutritional rehabilitation program. Conclusion. The nonspecific clinical history, physical exam, and laboratory abnormalities of eating disorders can make these diagnoses challenging and delay appropriate treatment. Clinicians should consider eating disorders in patients with malnutrition, severe lymphopenias, and gelatinous marrow transformation early in their workup, so as to avoid potentially negative outcomes.

  8. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

    McCarthy, C.L.; Wilson, D.J.; Coltman, T.P.

    2008-01-01

    The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

  9. Normal lymphographic findings and diagnostic errors in the retroperitoneal space

    Klein, U.; Heinze, H.G.

    1980-01-01

    Diagnostic erros in the lymphograms of 194 normal patients are shown to be due to topographical variations of the lymph system, influx and distribution of contrast media in the lymph ducts and nodes, and degenerative changes caused by old age. (orig.) [de

  10. Antithyroperoxidase Antibodies in Encephalopathy : Diagnostic Marker or Incidental Finding?

    Dontje, B.; Van Santen, H. M.; Niermeijer, J. M.; Schonenberg-Meinema, D.; Van Trotsenburg, A. S P

    2016-01-01

    Patients with acute encephalopathy who are thoroughly examined for an underlying diagnosis and in whom infectious, metabolic, and malignant causes are excluded can form a true diagnostic dilemma. If antithyroperoxidase antibodies (anti-TPO abs) are present, the diagnosis steroid responsive

  11. Finding NMO: The Evolving Diagnostic Criteria of Neuromyelitis Optica

    Bennett, Jeffrey L.

    2016-01-01

    Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder of the central nervous system (CNS) with predilection for the optic nerves and spinal cord. Since its emergence in the medical literature in the late 1800’s, the diagnostic criteria for NMO has slowly evolved from the simultaneous presentation of neurologic and ophthalmic signs to a relapsing or monophasic CNS disorder defined by clinical, neuroimaging, and laboratory criteria. Due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 (AQP4) in the vast majority of affected individuals, the clinical spectrum of NMO has greatly expanded necessitating the development of new international criteria for the diagnosis of NMO spectrum disorder (NMOSD). The routine application of new diagnostic criteria for NMOSD in clinical practice will be critical for future refinement and correlation with therapeutic outcomes. PMID:27529327

  12. Laparoscopic diagnostic findings in atypical intestinal malrotation in ...

    We present our experience with laparoscopic management of atypical presentations of intestinal malrotation in children, describing laparoscopic findings in these ... Thirty-six patients (90%) were found to have definite laparoscopic findings in the form of markedly dilated stomach and first part of duodenum, ectopic site of ...

  13. Hepatic hemangiomas with peritumoral sparing of fatty infiltration in hepatic steatosis: findings on contrast-enhanced MR imaging and on sonography

    Kim, Min Jeong; Kim, Kyoung Won; Won, Hyung Jin

    2006-01-01

    We wanted to determine the frequency of peritumoral sparing of fatty infiltration (PTSF) around hepatic hemangioma in hepatic steatosis and to evaluate the finding of these tumors on dynamic contrast-enhanced MR imaging and on sonography. This study included 76 hemangiomas in 67 patients suffering with hepatic steatosis. A diagnosis of hemangioma was based on the histologic findings, hemangioma SPECT or a compatible enhancement pattern on the dynamic contrast-enhanced MR study. For chemical shifting, PTSF was defined when there wasn't any decrease in signal intensity of the liver parenchyma on the opposed-phase images as compared with the in-phase images, and this intensity appeared as a hyperintense area around the tumor. We evaluated the frequency of PTSF and we analyzed if the presence of PTSF was related to the tumor size, the rapidity of enhancement or an associated arterioportal shunt. Among those, sonographic images were available in 55 hemangiomas. We also evaluated the sonographic appearances of hemangiomas with PTSF. Of the 76 hemangiomas, PTSF was noted on the MR chemical-shift images in 57 hemangiomas (75%). There was no significant relationship between tumor size and the presence of PTSF (ρ = .578). However, this finding was more frequently found in high-flow hemangiomas than in the slow-flow ones (ρ = .0038) and it was also related to the presence of associated arterioportal shunt (ρ = .0158). Sonographically, hemangiomas with PTSF were commonly surrounded by a peritumoral low-echoic area (28/41, 68%); these tumors more frequently showed a thin high-echoic rim on sonography than did the tumors without this finding (ρ = .0055). PTSF is commonly seen in hemangiomas in hepatic steatosis patients. Hepatic hemangiomas with PTSF tend to show rapid enhancement on dynamic MR imaging and this is accompanied by arterioportal shunt. They tend to be seen as an iso-or low-echoic mass with a thin high-echoic rim on sonography, and the mass is commonly

  14. Hepatic hemangiomas with peritumoral sparing of fatty infiltration in hepatic steatosis: findings on contrast-enhanced MR imaging and on sonography

    Kim, Min Jeong; Kim, Kyoung Won; Won, Hyung Jin [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)] (and others)

    2006-12-15

    We wanted to determine the frequency of peritumoral sparing of fatty infiltration (PTSF) around hepatic hemangioma in hepatic steatosis and to evaluate the finding of these tumors on dynamic contrast-enhanced MR imaging and on sonography. This study included 76 hemangiomas in 67 patients suffering with hepatic steatosis. A diagnosis of hemangioma was based on the histologic findings, hemangioma SPECT or a compatible enhancement pattern on the dynamic contrast-enhanced MR study. For chemical shifting, PTSF was defined when there wasn't any decrease in signal intensity of the liver parenchyma on the opposed-phase images as compared with the in-phase images, and this intensity appeared as a hyperintense area around the tumor. We evaluated the frequency of PTSF and we analyzed if the presence of PTSF was related to the tumor size, the rapidity of enhancement or an associated arterioportal shunt. Among those, sonographic images were available in 55 hemangiomas. We also evaluated the sonographic appearances of hemangiomas with PTSF. Of the 76 hemangiomas, PTSF was noted on the MR chemical-shift images in 57 hemangiomas (75%). There was no significant relationship between tumor size and the presence of PTSF ({rho} = .578). However, this finding was more frequently found in high-flow hemangiomas than in the slow-flow ones ({rho} = .0038) and it was also related to the presence of associated arterioportal shunt ({rho} = .0158). Sonographically, hemangiomas with PTSF were commonly surrounded by a peritumoral low-echoic area (28/41, 68%); these tumors more frequently showed a thin high-echoic rim on sonography than did the tumors without this finding ({rho} = .0055). PTSF is commonly seen in hemangiomas in hepatic steatosis patients. Hepatic hemangiomas with PTSF tend to show rapid enhancement on dynamic MR imaging and this is accompanied by arterioportal shunt. They tend to be seen as an iso-or low-echoic mass with a thin high-echoic rim on sonography, and the mass is

  15. Retroperitoneal schwannoma: diagnostic imaging findings in 5 patients

    Baltazar, Alberto; Santamarina, Mario; Scalise, Gabriela; Ponce de Leon, Valeria; Bello, Lorena

    2003-01-01

    Purpose: To evaluate the different imaging findings (US, CT and MRI) in retroperitoneal schwannoma. Materials and methods: 5 patients (3 male and 2 females) with a diagnosis of retroperitoneal schwannoma were retrospectively evaluated. Ages ranged from 33 to 63 years (means 54 years). The images (US, CT and MR) were analyzed and correlated to histopathologic results. Results: The most frequent clinical finding was abdominal pain (60%). A presumptive diagnosis prior to surgery was suggested in 3/5 cases that had well-defined masses with a predominant cystic appearance. All patients underwent surgery with tumoral resection. Only 2 patients (40%) had recurrence within a three years period of follow-up. Conclusion: Retroperitoneal schwannoma is an infrequent tumor. In our series, no pathognomotic features were observed on US, CT or MRI. However, 3/5 tumors showed high signal intensity on T2-weighted images due to cystic areas. (author)

  16. Imaging mammary diagnostics. Diagnostic techniques, archetypical findings, differential diagnostcs and interventions. 2. rev. and enl. ed.

    Heywang-Koebrunner, S.; Schreer, I.

    2008-01-01

    The book includes the following chapters: I. Methodology: anamnesis and interview; clinical evidence, mammography, sonography, magnetic resonance tomography, new imaging techniques (scintigraphy, PET), transcutaneous biopsy, pre-operative marking; II. phenotypes: normal mammary glands, mastopathics, cysts, benign tumors, inflammatory diseases, in-situ carcinomas, invasive carcinomas, lymphomas, other semi-malign and malign tumors, post-traumatic, post-surgical and post-therapeutic changes, skin changes, male mamma, screening, continuative diagnostics of screening evidence and problem solving for symptomatic patients

  17. DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE.

    Peyvasteh, Mehran; Askarpour, Shahnam; Ostadian, Nasrollah; Moghimi, Mohammad-Reza; Javaherizadeh, Hazhir

    2016-01-01

    Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema. This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from 2012, April. Sixty patients were enrolled. Inclusion criteria were: neonates with failure to pass meconium, abdominal distention, and refractory constipation who failed to respond with medical treatment. Transitional zone, delay in barium evacuation after 24 h, rectosigmoid index (maximum with of the rectum divided by maximum with of the sigmoid; abnormal if de Hirschsprung é a causa mais comum de obstrução intestinal pediátrica. Enema baritado é usado para a avaliação dos pacientes com o diagnóstico . Avaliar a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de achados radiológicos para diagnóstico de Hirschsprung em pacientes submetidos ao enema opaco. Este estudo transversal foi realizado em Imam Khomeini Hospital por um ano a partir de abril de 2012. Sessenta pacientes foram incluídos. Os critérios de inclusão foram: recém-nascidos com insuficiência de passagem de mecônio, distensão abdominal, e constipação refratária sem resposta ao tratamento médico. Foram avaliadas no enema zona de transição, atraso na evacuação de bário após 24 h, índice retossigmoide (máximo do diâmetro do reto dividido pelo máximo do sigmóide; anormal se casos com a doença de Hirschsprung e sem foi 17,90±18,29 meses e 17,8±18,34 meses, respectivamente (p=0,983). Confirmou-se em 30 (M=20, F=10) dos casos. Falha no mecônio foi encontrada em 21 (70%) casos. Sensibilidade, especificidade, VPP e VPN foram de 90%, 80%, 81,8% e 88,8%, respectivamente, para a zona de transição no enema

  18. Efficient strategies to find diagnostic test accuracy studies in kidney journals.

    Rogerson, Thomas E; Ladhani, Maleeka; Mitchell, Ruth; Craig, Jonathan C; Webster, Angela C

    2015-08-01

    Nephrologists looking for quick answers to diagnostic clinical questions in MEDLINE can use a range of published search strategies or Clinical Query limits to improve the precision of their searches. We aimed to evaluate existing search strategies for finding diagnostic test accuracy studies in nephrology journals. We assessed the accuracy of 14 search strategies for retrieving diagnostic test accuracy studies from three nephrology journals indexed in MEDLINE. Two investigators hand searched the same journals to create a reference set of diagnostic test accuracy studies to compare search strategy results against. We identified 103 diagnostic test accuracy studies, accounting for 2.1% of all studies published. The most specific search strategy was the Narrow Clinical Queries limit (sensitivity: 0.20, 95% CI 0.13-0.29; specificity: 0.99, 95% CI 0.99-0.99). Using the Narrow Clinical Queries limit, a searcher would need to screen three (95% CI 2-6) articles to find one diagnostic study. The most sensitive search strategy was van der Weijden 1999 Extended (sensitivity: 0.95; 95% CI 0.89-0.98; specificity 0.55, 95% CI 0.53-0.56) but required a searcher to screen 24 (95% CI 23-26) articles to find one diagnostic study. Bachmann 2002 was the best balanced search strategy, which was sensitive (0.88, 95% CI 0.81-0.94), but also specific (0.74, 95% CI 0.73-0.75), with a number needed to screen of 15 (95% CI 14-17). Diagnostic studies are infrequently published in nephrology journals. The addition of a strategy for diagnostic studies to a subject search strategy in MEDLINE may reduce the records needed to screen while preserving adequate search sensitivity for routine clinical use. © 2015 Asian Pacific Society of Nephrology.

  19. Tumor markers in finding recurrent disease iin colorectal cancer: a diagnostic review

    Verberne, Charlotte; de Jong, W.H.; Grossmann, Irene

    2013-01-01

    Aim: In the search for evidence-based follow-up of patients after resection for colorectal cancer, numerous tumor markers have been proposed. This review has evaluated these markers and comments on the diagnostic accuracy in finding recurrent disease in relation to Carcino-Embryonic Antigen (CEA...

  20. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain.

    Cadogan, Angela; McNair, Peter J; Laslett, Mark; Hing, Wayne A

    2016-01-01

    The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP) defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP. In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR) criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction)) demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity). A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100); LR+ 6.2; 95% CI 1.5, 25.7)). Imaging did not improve the ability to rule-out a PAR. Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

  1. THE HIGH-PERFORMANCE RESOURCE-SPARING TECHNOLOGIES IN THE DIAGNOSTIC MAMMOLOGY (On the fifth anniversary of the Russian association of mammologists

    N. I. Rozhkova

    2008-01-01

    Full Text Available There have been presented the main achievements in the field of mammologic service development in Russia owing to creation and introduction of the domestic mammographic stationary digital and mobile mammographs, organization of the system of the continuous education of the specialists on basis of interdisciplinary integration, as well as introduction of the novel technologies of the radiologi- cal examination, interventional radiology, molecular biology, informational technologies, realization of the wide-ranging information- al educational work. The diagnostic mammology development perspectives are outlined.

  2. The diagnostic significance of clinical and radiological findings in osteogenesis imperfection

    Xu Deyong; Xu Zushan; Shen Qijie

    1997-01-01

    Purpose: To define the diagnostic criteria of osteogenesis imperfection. Materials and methods: The clinical and radiologic manifestations of 68 patients with osteogenesis imperfection were studied retrospectively. Results: (1) A generalized decrease in osseous density (osteoporosis or osteopenia) with abnormal fragility of bone (68 cases). (2) Blue sclera (61 cases). (3) Dentinogenesis imperfection with opalescent bluish-gray tint (49 cases). (4) Progressive hearing loss (prior to the age of 40 years)-premature otosclerosis (38 cases). Other abnormalities such as abnormal contour and structure (68 cases), growth retardation (49 cases), episodic diaphoresis (24 cases), with abnormal temperature regulation (16 cases), hyperplastic scars (11 cases) and tendency of subcutaneous bruise (6 cases), all these were not characteristic features. Conclusion: Among all clinical and radiological findings, osteopenia with abnormal fragility of bone; blue sclera dentinogenesis imperfection with opalescent bluish-gray tint and premature otosclerosis are the most common and characteristic findings which can be taken as the diagnostic criteria of osteogenesis imperfection

  3. Value of noninvasive diagnostic procedures in cardiology: typical findings in hypertrophic obstructive cardiomyopathy

    Riebeling, V.; Bubenheimer, P.

    1984-01-01

    Routine chest X-ray often yields poor information for diagnosis of heart disease. The diagnostic value of invasive procedures in cardiology is generally accepted. The patient's as well as the physician's risk of the examination, however, has to be considered. A high number of heart diseases, e.g. hypertrophic obstructive cardiomyopathy (HOCM) is mainly detected by noninvasive procedures such as auscultation, electrocardiography, phonomechanocardiography, echocardiography, physical manoeuvres, and pharmacological provocation tests. Typical findings in hypertrophic obstructive cardiomyopathy are demonstrated. (orig.) [de

  4. Clinical findings and diagnostic imaging of small intestinal rupture due to blunt abdominal trauma

    Takahashi, Hitoshi; Sakata, Ikuhiro; Ogawa, Masaaki; Izumoto, Gentaro; Kim, Akio; Maeda, Shigenari; Yasutomi, Masayuki; Yamamoto, Toshio

    1987-01-01

    Eight patients with small intestinal rupture due to blunt abdominal trauma were analyzed by their clinical findings and diagnostic imaging (plain film, ultrasound and computed tomography). Computed tomography was most useful for identification of intraabdominal extraluminal free air (pneumoperitoneum) and this finding was obtained in seven out of the eight patients (87.5 %). Intraabdominal fluid collection was observed in All the patients and was most clearly detectable by ultrasound and computed tomography. These examinations may be applied to identification of properties of the fluid collection. All the patients eventually developed peritonitis when laparotomy was decided. Thus, close follow up observation of abdominal physical signs was also of critical importance. (author)

  5. Plain abdominal radiographs in patients with Crohn’s disease: Radiological findings and diagnostic value

    O’Regan, K.; O’Connor, O.J.; O’Neill, S.B.; Mc Laughlin, P.D.; Desmond, A.; McWilliams, S.R.; Quigley, E.M.M.; Shanahan, F.; Maher, M.M.

    2012-01-01

    Aim: To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn’s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required. Materials and methods: One hundred and seventy-seven CD patients underwent 643 PFAs during the period September 1992 to August 2008. Two radiologists blinded to the clinical details independently evaluated individual PFAs and/or their reports for abnormal findings using the following criteria: normal, small bowel (SB) findings; colonic findings, acute CD complications, extra-colonic findings; global assessment/impression. The results of additional imaging studies performed within 5 days of PFA were recorded and findings were analysed. Results: A mean of 3.6 (range 1–22) PFAs was performed per patient during the study period. Almost 70% of films were normal (n = 449). SB abnormalities were detected in 21.8% (n = 140) PFAs; most commonly dilated loops (18.8%, n = 121) and mucosal oedema (5%, n = 32). Colonic abnormalities were present in 11.4% (n = 73); most commonly mucosal oedema (7.5%, n = 48) and dilated loops (5%, n = 32). Four cases of pneumoperitoneum were detected. There was no case of toxic megacolon. There was one case in which intra-abdominal abscess/collection was suspected and two cases of obstruction/ileus. Extracolonic findings (renal calculi, sacro-iliitis, etc.) were identified in 7.5% (n = 48). PFAs were followed by additional abdominal imaging within 5 days of PFA in 273/643 (42.5%) of cases. Conclusion: Despite the high rates of utilization of PFA in CD patients, there is a low incidence of abnormal findings (32.5%). Many of the findings are non-specific and clinically irrelevant and PFA is frequently followed by additional abdominal imaging examinations.

  6. Acute appendicitis: sensitivity, specificity and diagnostic accuracy of thin-section contrast-enhanced CT findings

    Lee, Ji Yon; Choi, Dong Il; Park, Hae Won; Lee, Young Rae; Kook, Shin Ho; Kwang, Hyon Joo; Kim, Seung Kwon; Chung, Eun Chul

    2002-01-01

    To assess the sensitivity, specificity, and diagnostic accuracy of individual contrast-enhanced helical CT findings of acute appendicitis. We retrospectively reviewed the appendiceal helical CT scans, obtained after intravenous contrast administration (abdomen; 7-mm collimation, abdominopelvic junction; 5-mm collimation), of 50 patients with surgically proven acute appendicitis and 112 with alternative diagnoses. The following parameters were analysed by three radiologists: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), (appendiceal) intraluminal air, abscess, lymphadenopathy, terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The CT findings of acute appendicitis that statistically distinguished it from alternative diagnoses were an enlarged appendix (sensitivity; 92%, specificity; 93%, diagnostic accuracy; 93%), appendiceal wall thickening (for these three parameters: 68%, 96% and 88%, respectively), periappendiceal fat stranding (90%, 79%, 82%), appendiceal wall enhancement (72%, 86%, 82%), appendicolith (16%, 100%, 74%), and focal cecal apical thickening (14%, 100%, 74%) (for each, p<0305). On thin-section contrast-enhanced helical CT, an enlarged appendix and periappendiceal fat stranding were found in 90% or more patients with acute appendicitis. Appendiceal wall thickening and enhancement were alearly demonstrated and significant findings for diagnosis. Less common but specific findings include appendicolith, focal cecal apical thickening and intramural air, can also help us establish a diagnosis of acute appendicitis

  7. Spare Items validation

    Fernandez Carratala, L.

    1998-01-01

    There is an increasing difficulty for purchasing safety related spare items, with certifications by manufacturers for maintaining the original qualifications of the equipment of destination. The main reasons are, on the top of the logical evolution of technology, applied to the new manufactured components, the quitting of nuclear specific production lines and the evolution of manufacturers quality systems, originally based on nuclear codes and standards, to conventional industry standards. To face this problem, for many years different Dedication processes have been implemented to verify whether a commercial grade element is acceptable to be used in safety related applications. In the same way, due to our particular position regarding the spare part supplies, mainly from markets others than the american, C.N. Trillo has developed a methodology called Spare Items Validation. This methodology, which is originally based on dedication processes, is not a single process but a group of coordinated processes involving engineering, quality and management activities. These are to be performed on the spare item itself, its design control, its fabrication and its supply for allowing its use in destinations with specific requirements. The scope of application is not only focussed on safety related items, but also to complex design, high cost or plant reliability related components. The implementation in C.N. Trillo has been mainly curried out by merging, modifying and making the most of processes and activities which were already being performed in the company. (Author)

  8. 201Th chloride scintiscanning in myocardial infarction - correlation with ECG findings - diagnostic potential

    Kostka, I.

    1980-01-01

    The author intended to find out in how far myocardial scintiscanning with 201 Th chloride is a necessary auxiliary investigation in diagnosing acute myocardial infarction and whether there are correlations between ECG, increase of enzyme levels, and pressure measured in the lesser circulatory system. The scintiscans were evaluated by a new method: Defect sizes were determined using a transparent template and recorded in angular degrees. Also the reduced activity was considered. Especially posterior myocardial infarctions can be localized more easily and clearly by means of myocardial scintiscanning at rest, and also infarction sizes can be judged more easily. For a diagnosis of small myocardial infarctions or in patients with a block in their ECG picture, scintiscanning is a necessary part of the diagnostic spectrum. The findings of myocardial scintiscanning correspond well with those of other methods. As for the pressure increase in the lesser circulatory system, it is well correlated with the defect size shown by the scintiscan. 201 Th scintiscanning offers a good diagnostic possibility in those myocardial infarctions where ECG findings are ambiguous. (orig./MG) [de

  9. [Psychopathic personality in women. Diagnostics and experimental findings in the forensic setting and the business world].

    Eisenbarth, H

    2014-03-01

    Highly psychopathic women are rare in the context of forensic psychiatry; however, the concept of psychopathy plays an important role in diagnostics, for court expertises as well as for treatment. Another so far neglected yet relevant field is the business world. The so-called successful female psychopaths are characterized by highly psychopathic traits but low antisocial behavior, at least with reference to criminal behavior. The basis for investigating and interpreting gender differences is the assessment of psychopathy. Gender differences have been repeatedly demonstrated, especially in the assessment of antisocial behavior and the differentiation of borderline personality disorder and psychopathy which have to be addressed. Group comparisons based on these diagnostic methods found lower inhibitory deficits but less aggressive behavior in female participants with respect to the first main symptom category. For the second symptom category, emotional detachment, so far there are almost no findings reporting gender differences but only few direct gender comparisons have been carried out. However, highly psychopathic women from the general population demonstrate a stronger correlation between psychopathic traits and self-perception as negotiation partner compared to men: they make more use of manipulation and perceive themselves as more powerful in negotiation situations. Future studies should address the diagnostic variability, direct gender comparisons in experimental tasks and the relationship between psychopathic traits, the core symptom categories and career-related success.

  10. Sporadic Creutzfeldt-Jakob disease with focal findings: caveats to current diagnostic criteria

    Mader, Edward C.; El-Abassi, Rima; Villemarette-Pittman, Nicole R.; Santana-Gould, Lenay; Olejniczak, Piotr W.; England, John D.

    2013-01-01

    The clinical diagnosis of Creutzfeldt-Jakob disease (CJD) is largely based on the 1998 World Health Organization diagnostic criteria. Unfortunately, rigid compliance with these criteria may result in failure to recognize sporadic CJD (sCJD), especially early in its course when focal findings predominate and traditional red flags are not yet present. A 61-year-old man presented with a 3-week history of epilepsia partialis continua (jerking of the left upper extremity) and a 2-week history of forgetfulness and left hemiparesis; left hemisensory neglect was also detected on admission. Repeated brain magnetic resonance imaging (MRI) showed areas of restricted diffusion in the cerebral cortex, initially on the right but later spreading to the left. Electroence-phalography (EEG) on hospital days 7, 10, and 14 showed right-sided periodic lateralized epileptiform discharges. On day 20, the EEG showed periodic sharp wave complexes leading to a diagnosis of probable sCJD and subsequently to definite sCJD with brain biopsy. Neurological decline was relatively fast with generalized myoclonus and akinetic mutism developing within 7 weeks from the onset of illness. CJD was not immediately recognized because of the patient's focal/lateralized manifestations. Focal/lateralized clinical, EEG, and MRI findings are not uncommon in sCJD and EEG/MRI results may not be diagnostic in the early stages of sCJD. Familiarity with these caveats and with the most current criteria for diagnosing probable sCJD (University of California San Francisco 2007, MRI-CJD Consortium 2009) will enhance the ability to recognize sCJD and implement early safety measures. PMID:23717780

  11. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value.

    O'Regan, K

    2012-08-01

    To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn\\'s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required.

  12. Pulmonary actinomycosis: CT studies of diagnostic and post-treatment findings

    Kim, Su Jung; Song, Sun Wha; Bo, Seal Hwang; Park, Hyun Jin; Kim, Hyeon Sook; Kim, Ki Jun; Kim, Horrim; Park, Seog Hee [College of Medicine, the Catholic University of Korea, Uijeongbu (Korea, Republic of)

    2008-05-15

    To investigate the value of the computed tomography (CT) in the study of diagnostic and post-treatment findings of pulmonary actinomycosis. Clinical data and CT findings were retrospectively analyzed in 10 patients with histopathologically confirmed pulmonary actinomycosis. We analyzed the initial CT findings in search of patterns and distributions which suggest possible lung abnormalities and found the pleura, chest wall, and lymphadenopathy to be involved as part of the indicators of lung abnormalities. We analyzed follow-up CT findings for changes in the lungs after antibiotic therapy and recurrence after surgery. Of the 10 patients analyzed by CT for lung lesions, seven had been diagnosed with alcoholism and nine were male. The initial CTs (n = 10) indicated that all the pulmonary lesions were solitary without chest wall involvement. However, a transfissural extension was observed in 20% of the study population (n = 2). Furthermore, peripheral lung distribution and adjacent pleural thickening was observed in 70% of the study population (n = 7). Within the consolidation (n = 6) or mass (n = 4), a central low density with peripheral enhancement was seen in 70% of the study population (n = 7). A follow-up CT of the seven cases following antiobiotic therapy revealed that four cases showed minimal improvement or aggravation of their lung lesions, whereas three cases showed resolution or improvement. The improvement of the central low density was related to the improvement of consolidation or mass. Furthermore the presence of fibrosis was observed after the resolution of pulmonary lesions (n = 2). No relationship was found between the duration and response of antibiotic therapy. A follow-up CT (n = 4) subsequent to a lung resection revealed the onset of chest wall actinomycosis and a thickened pleura in one case. The results of this study highlight the value of the CT in pulmonary actinomycosis in order to diagnose and evaluate antibiotic responses, complications, or

  13. MRI findings and diagnostic value of intervertebral disc free pulpiform nucleus in lumbar intraspinal

    Cai Jinhua; Fang Huasheng; Li Dongyuan

    2011-01-01

    Objective: To determine the MRI findings and diagnostic value of intervertebral disc free pulpiform nucleus in lumbar intraspinal. Methods: MRI findings of 46 cases with free pulpiform nucleus proved by surgery and pathology were retrospectively analyzed, and compared with pathological results. Results: Of all cases, the free pulpiform nucleus located at extradural foreside. 9 cases of the free pulpiform nucleus dissociated upon in spinal, 32 cases moved down and 5 cases removed backwards. Of 46 patients, 22 cases of the free pulpiform nucleus inhabited right, 17 cases left and 7 cases in midline. The lesion was single in all case with round, oval or anormaly shape. The free pulpiform nucleus had the same equal or low signal with provided intervertebral disc. The calcification, if any, presented as low -signal area. Among these 11 cases which were injected with GD-DTPA had no enhancement in the center, mild and high enhancement at periphery. Among all cases, MRI diagnosis were agreed with the pathology results with diagnosis accuracy of 100%. Conclusion: MRI can clearly demonstrate the intervertebral disc free pulpiform nucleus in lumbar intraspinal and make a correct diagnosis. Therefore, MRI is the best choice for diagnosis of intervertebral disc free pulpiform nucleus in lumbar intraspinal. (authors)

  14. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging

    Romano, Luigia; Giovine, Sabrina; Guidi, Guido; Tortora, Giovanni; Cinque, Teresa; Romano, Stefania

    2004-01-01

    Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT findings

  15. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging

    Romano, Luigia; Giovine, Sabrina; Guidi, Guido; Tortora, Giovanni; Cinque, Teresa; Romano, Stefania E-mail: stefromano@libero.it

    2004-04-01

    Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash when the wheel causes a compressive effect on thorax and abdomen. Associated lesions to left hepatic lobe injuries correlated to this mechanism are: sternal fractures, pancreatic, myocardial, gastrointestinal tract injuries. Lesions of the caudal lobe are extremely rare, usually not isolated and noted with other large parenchymal lesions. The Institution of Specialized Trauma Centers and the technical progress in imaging methodology developed in the last years a great reduction of mortality. New diagnostic methodologies allow a reduction of negatives laparotomies and allow the possibility of conservative treatment of numerous traumatic lesions; however, therapy depends from imaging findings and clinical conditions of the patient. Computed tomography (CT) certainly presents a large impact on diagnosis and management of patients with lesions from blunt abdominal traumas. It is important to establish a prognostic criteria allowing decisions for conservative or surgical treatment; CT

  16. Diagnostics

    Donné, A.J.H.; Costley, A.E.; Barnsley, R.

    2007-01-01

    of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

  17. Comparative analysis of cytological findings and diagnostic categories of independent сytopathologists

    G V Semkina

    2013-09-01

    Full Text Available The article is devoted to the relevance of the application of the Bethesda classification system of interpretation of FNA in practice. In this study was investigated 104 cytological specimens of the thyroid gland from patients with var ious diseases of the thyroid gland. Revision of the cytological results was carried out by four highly qualified cytopathologists, working on the basis of three leading medical centers in the Russian Federation. Also, the respons es of each cytopathologist by diagnostic categories Bethesda Classification were compared. Statistical analysis showed that by the revision of the biopsy specimens there were no statistically significant differences between the ini tial cytologic findings and the results of independent cytopathologists. In analyzing the data, it was found that the fundamental error of cytological diagnosis were papillary carcinoma, medullary carcinoma, as well as “follicular neoplasm”. Comparing the results of histological examination with the responses of the cytopathologists was found that the major fault was the definition of papillary carcinoma and “follicular neoplasm”. The results suggest that Bethesda Classification allows to achieve the best results in the interpretation of the results of FNA, which leads to a more elaborate tactics of treatment of the patient.

  18. [Diagnostic imaging of high-grade astrocytoma: heterogeneity of clinical manifestation, image characteristics, and histopathological findings].

    Okajima, Kaoru; Ohta, Yoshio

    2012-10-01

    Recent developments in diagnostic radiology, which have enabled accurate differential diagnoses of brain tumors, have been well described in the last three decades. MR and PET imaging can also provide information to predict histological grades and prognoses that might influence treatment strategies. However, high-grade astrocytomas consist of many different subtypes that are associated with different imaging and histological characteristics. Hemorrhage and necrosis results in a variety of imaging features, and infiltrative tumor growth entrapping normal neurons may cause different clinical manifestations. We reviewed patients with high-grade astrocytomas that showed various imaging characteristics, with special emphasis on initial symptoms and histological features. Clinicopathological characteristics of astrocytomas were also compared with other malignant tumors. Neurological deficits were not notable in patients with grade 3-4 astrocytomas when they showed infiltrative tumor growth, while brain metastases with compact cellular proliferation caused more neurological symptoms. Infiltrative tumors did not show any enhancing masses on MR imaging, but these tumors may show intratumor heterogeneity. Seizures were reported to be more frequent in low-grade glioma and in secondary glioblastoma. Tumor heterogeneity was also reported in molecular genetic profile, and investigators identified some subsets of astrocytomas. They investigated IHD1/2 mutation, EGFR amplification, TP53 mutation, Ki-67 index, etc. In summary, high-grade astrocytomas are not homogenous groups of tumors, and this is associated with the heterogeneity of clinical manifestation, image characteristics, and histopathological findings. Molecular studies may explain the tumor heterogeneity in the near future.

  19. Tumor markers in finding recurrent disease in colorectal cancer: a diagnostic review

    Anneke Muller Kobold

    2013-02-01

    Full Text Available Aim: In the search for evidence-based follow-up of patients after resection for colorectal cancer, numerous tumor markers have been proposed. This review has evaluated these markers and comments on the diagnostic accuracy in finding recurrent disease in relation to Carcino-Embryonic Antigen (CEA. Methods: A comprehensive literature review (1985-2010 was performed by two independent reviewers. Sensitivity and specificity of markers mentioned in the articles were checked by recalculation. A validated quality score system was used to estimate study quality. Results: Seventeen studies focusing on eight different markers were included. Three markers were shown to have comparable or better accuracy than CEA: TPA, CA 242 and CA 72-4 in at least one study. These three markers, from four independent studies, showed a tumor marker sensitivity of > 60% in combination with an outperformance of CEA in follow-up. These results were not confirmed by six other studies investigating the same markers. Conclusion: This review revealed three tumor markers other than CEA that have been shown to adequately indicate recurrences in colorectal cancer. However, comparability of studies was difficult. Therefore a prospective study of these markers seems necessary to investigate their real value, and to overcome design and inclusion biases.

  20. Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry.

    Maria Karanika

    Full Text Available BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM were collected from the Meningitis Registry (MR. Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta and SPSS (version 15.0-Chicago software. Statistically significant (p or = 15000/microL (OR 2.19 with a PPV of 77.8% (95%CI 40.0-97.2. For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61, age > or = 1 year (OR 2.04, absence of headache (OR 3.01, CSF Glu < 40 mg/dL (OR 3.62 and peripheral WBC < 15,000/microL (OR 1.74 with a PPV of 58.5% (95%CI 42.1-73.7. CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.

  1. Condition based spare parts supply

    Lin, X.; Basten, Robertus Johannes Ida; Kranenburg, A.A.; van Houtum, Geert-Jan

    2012-01-01

    We consider a spare parts stock point that serves an installed base of machines. Each machine contains the same critical component, whose degradation behavior is described by a Markov process. We consider condition based spare parts supply, and show that an optimal, condition based inventory policy

  2. Second Line of Defense Spares Program

    Henderson, Dale L.; Holmes, Aimee E.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.; Thorsen, Darlene E.

    2012-11-20

    During Fiscal Year 2012, a team from the Pacific Northwest National Laboratory (PNNL) conducted an assessment and analysis of the Second Line of Defense (SLD) Sustainability spare parts program. Spare parts management touches many aspects of the SLD Sustainability Program including contracting and integration of Local Maintenance Providers (LMP), equipment vendors, analyses and metrics on program performance, system state of health, and maintenance practices. Standardized spares management will provide better data for decisions during site transition phase and will facilitate transition to host country sustainability ownership. The effort was coordinated with related SLD Sustainability Program initiatives, including a configuration items baselining initiative, a metrics initiative, and a maintenance initiative. The spares study has also led to pilot programs for sourcing alternatives that include regional intermediate inventories and partnering agreements that leverage existing supply chains. Many partners from the SLD Sustainability program contributed to and were consulted in the course of the study. This document provides a description of the findings, recommendations, and implemented solutions that have resulted from the study.

  3. Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

    Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

    2015-01-01

    Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38

  4. Decerebrate posturing following traumatic brain injury: MRI findings and their diagnostic value

    Woischneck, D.; Skalej, M.; Firsching, R.; Kapapa, T.

    2015-01-01

    Aim: To determine the pathomorphological and clinical background to decerebrate posturing in humans following serious traumatic brain injury. Materials and methods: One hundred and twenty patients who had been unconscious for more than 24 h underwent diagnostic MRI within 8 days after trauma. The presence of decerebrate rigidity as the clinical parameter was correlated to MRI findings, such as traumatic lesions in defined brain areas. Significance was presumed as p < 0.05. Results: On the day of MRI 43 (36%) patients exhibited decerebrate posturing: 19 (23%) cases were unilateral and 24 (77%) bilateral. There was a significant correlation between midbrain lesions and the presence of rigidity. If a midbrain lesion was found in the absence of pontine lesions, decerebrate rigidity could be concluded (p < 0.05). There was no significant correlation to the rigidity in the case of midbrain lesions accompanied by pontine lesions, and no correlation to the rigidity could be detected for other regions of the brain. Both the occurrence of decerebrate posturing and the detection of brainstem lesions at MRI correlated with the Glasgow Outcome Scale. The combination of both parameters improved the probability of predicting the outcome. Conclusion: The rate of decerebrate posturing increases significantly in the presence of midbrain lesions. The presence of pontine lesions appears to be of secondary importance. The chances of predicting the Glasgow Outcome Scale are improved by the combination of clinical information (decerebrate posturing) and radiological parameters (type of brainstem lesion). - Highlights: • The pathomorphology of decerebrate posturing after TBI is not known for certain. • Midbrain lesions on MRI were correlated significantly to decerebrate posturing. • A combination of decerebrate posturing and brainstem lesions predict poor outcome

  5. Diagnostic imaging of lobular carcinoma of the breast. Mammographic, US and MR findings

    Bazzocchi, M.; Facecchia, I.; Zuiani, C.; Smania, S.; Puglisi, F.; Di Loreto, C.

    2000-01-01

    Purpose of this article is to evaluate the most frequent mammographic, US and MR findings of invasive lobular carcinoma and the role of MRI in defining multifocality and/or multi centricity of this tumor histotype. 45 lobular carcinomas in 39 patients were studied and selected from 421 breast cancers. Core biopsy with a 14G needle was performed in 39 cases, under US guidance in 36/39 and under mammographic guidance in 3/39 cases. Surgical biopsy was performed in 2 cases and the diagnosis could be made only after mastectomy in 5 cases. All patients were examined with mammography and US and (10-13 MHz) and 8 also with MRI. 28/46 palpable lesions (60.9%). Core biopsy correctly diagnosed 38/39 lesions (97.4%). The most frequent mammographic findings was that of a nodular opacity without microcalcifications (34.8%), followed by a mass with spiculate d borders (30.4%). Microcalcifications were seen in one case only (2.2%). Mammography detected no abnormalities in 15.2% of cases, but US showed a lesion in 2 of these cases. The most frequent US pattern was that of a hypoechoic lesion (43.5%), followed by posterior US beam attenuation. No US signs of abnormality were seen 15.2%. MRI correctly detected 13 lesions. Contrast enhancement was greater than 70% at one minute in 10 cases and greater than 40% in one case; two lesions exhibited atypical slow contrast enhancement, peaking at 5 minutes. MRI detected 5 lesions missed both mammography and US and showed multifocal (3 and 2) lesions where the other techniques had detected one lesion only. At mammography and US invasive lobular carcinoma exhibits no different features than ductal carcinoma but is difficult to identify especially in its early stages. US is a useful tool especially to characterize mammography-detected lesions but in the experience it also demonstrated 2 lesions missed at mammography. MRI is a precious examination to define the multifocal, multi centric or bilateral character of invasive lobular carcinoma

  6. Nontraumatic femoral head necrosis. Classification of bone scintigraphic findings and diagnostic value of SPECT following planar imaging

    Minoshima, Satoshi; Uchida, Yoshitaka; Anzai, Yoshimi; Uno, Kimiichi; Arimizu, Noboru [Chiba Univ. (Japan). School of Medicine

    1994-09-01

    This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n=2), systemic lupus erythematosus (n=22), aplastic anemia (n=1), and renal transplantation (n=1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n=3, 2), C (n=1, 3), PH+C (n=2, 8), RH+C (n=2, 3), PH (n=9, 2), and DH (n=7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n=16, 12), C (n=0, 6), and DH (n=3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively. In nineteen femoral heads with normal planar findings (N), SPECT correctly identified avascular necrosis in two femoral heads and misidentified six normal femoral heads as avascular necrosis. In nineteen femoral heads with nondiagnostic abnormalities (PH, DH), SPECT correctly identified avascular necrosis in seven femoral heads and showed no false positive. Diagnostic planar findings in five femoral heads were concordant with SPECT diagnosis. These results indicate that SPECT imaging is most valuable when planar images show nondiagnostic abnormalities based on the proposed classification of scintigraphic findings. (author).

  7. Nontraumatic femoral head necrosis. Classification of bone scintigraphic findings and diagnostic value of SPECT following planar imaging

    Minoshima, Satoshi; Uchida, Yoshitaka; Anzai, Yoshimi; Uno, Kimiichi; Arimizu, Noboru

    1994-01-01

    This study was conducted to determine bone scintigraphic findings in nontraumatic femoral head avascular necrosis and diagnostic value of SPECT imaging following a conventional planar imaging. Forty-three femoral heads in twenty-six cases with idiopathic femoral head necrosis (n=2), systemic lupus erythematosus (n=22), aplastic anemia (n=1), and renal transplantation (n=1) were studied. The diagnosis for femoral head necrosis was based on magnetic resonance imaging as well as other diagnostic studies in all cases. Scintigraphic findings of planar and SPECT images were classified into six categories: normal (N); cold or decrease (C); partial increase with cold or decrease (PH+C); ring-like increase with a cold center (RH+C); partial increase (PH); diffuse and/or irregular increase (DH). Avascular necrosis was confirmed in twenty-four femoral heads, in which planar and SPECT images showed scintigraphic findings of N (n=3, 2), C (n=1, 3), PH+C (n=2, 8), RH+C (n=2, 3), PH (n=9, 2), and DH (n=7, 6), respectively. Femoral heads without avascular necrosis demonstrated planar and SPECT findings of N (n=16, 12), C (n=0, 6), and DH (n=3, 1), respectively. When considering C, PH+C, and RH+C as diagnostic findings for avascular necrosis, sensitivities of planar and SPECT images were 21% and 58%, and specificities were 100% and 68%, respectively. In nineteen femoral heads with normal planar findings (N), SPECT correctly identified avascular necrosis in two femoral heads and misidentified six normal femoral heads as avascular necrosis. In nineteen femoral heads with nondiagnostic abnormalities (PH, DH), SPECT correctly identified avascular necrosis in seven femoral heads and showed no false positive. Diagnostic planar findings in five femoral heads were concordant with SPECT diagnosis. These results indicate that SPECT imaging is most valuable when planar images show nondiagnostic abnormalities based on the proposed classification of scintigraphic findings. (author)

  8. [Whiplash injury as a function of the accident mechanism. Neuro-otological differential diagnostic findings].

    Geiger, G; Aliyev, R M

    2012-07-01

    Depending on the type of collision, car occupants who are involved in traffic accidents are often exposed to the unexpected effects on the cervical spine of traumatic stimuli from different directions. In a rear-end collision or a frontal collision of the car it is most likely that there is an effect of linear acceleration and a lateral or side impact acceleration of axial rotation on the cervical spine. The neuro-otological manifestations of whiplash injuries that can occur in response to various trauma mechanisms have not yet been sufficiently investigated. Data from 64 patients who suffered a whiplash injury were selected for analysis. In 32 patients the trauma mechanism was a sudden action on the cervical spine from a linear impulse caused by a head-on collision of cars or rear-end collision. In the other 32 patients the trauma mechanism was a sudden action of an axial neck rotation at a side impact collision or a cross collision. The study compared the results of neuro-otological findings between the two patient groups. A comparison of the neuro-otological examination data of 64 patients revealed that there were 32 patients who had a sudden injury mechanism of cervical axial rotation, the prevalence of central vestibular and sensory impairments, such as pathological central nystagmus disinhibition, pathological changes in the auditory brainstem evoked potentials (ABEP), the auditory evoked cortical potentials (ALEP) and visual evoked potentials (VEP). In the second group of patients where the injury mechanism consisted of an unexpected linear momentum, peripheral vestibular and sensory disorders were predominant. The observed differences in neuro-otological manifestations of whiplash trauma, which occur depending on the trauma mechanism, can be used for differential diagnostic purposes. The whiplash injuries of the cervical spine induced by an axial rotation acceleration showed a prevalence of central vestibular and sensory disturbances, while the whiplash

  9. The importance of masticatory functional analysis in the diagnostic finding and treatment planning for prosthodontic rehabilitation

    Harry Laksono

    2012-06-01

    Full Text Available Background: The masticatory system as a biologic system is subjected to harmful influences of varying severity. Almost half of routine patients requesting prosthodontic treatment indicated at least one sign or symptom of temporomandibular disorders. Analysis of the masticatory system often neglected by dentist. Untreated temporomandibular disorders may significantly implicated in the perpetuation of the disorder and may interfere with routine prosthodontic clinical procedures. It would be resulted unsuccessful long term goal of prosthodontic rehabilitation because of the uncompleted diagnoses and treatment plan. Purpose: The purpose of this case report was to give the information of the importance of masticatory functional analysis in the diagnostic finding for treatment planning in the prosthodontic rehabilitation. Case: A 45 year - old male patient, partial dentate with reduced chewing efficiency, mild pain in right preauricular region in function, left click in opening mouth, severe attrition on all anterior lower teeth with vertical dimension of occlusion decreased due to loss of posterior support. He wanted to make a new denture. Case management: Record and analyze of active and passive mandibular movement, opening pathway, muscle and temporomandibular joints palpation, load testing, and vertical dimension of occlusion with manual functional analysis (MFA, occlusal condition and radiographic examination. Treatment plan was formulated into 3 phases: stabilization of the masticatory system, definitive treatment and periodical control. The result of this treatment excellent for 1 year evaluation after permanent cementation. Conclusion: Masticatory functional analysis is very important and must be done in the diagnosis finding for treatment planning in every case of prosthodontic rehabilitation.Latar belakang: Sistem pengunyahan sebagai sistem biologis sewaktu-waktu dapat terjadi gangguan dengan berbagai derajat keparahan. Hampir setengah dari

  10. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

    Kim, Mi Sung; Kwon, Heon-Ju; Kang, Kyung A; Do, In-Gu; Park, Hee-Jin; Kim, Eun Young; Hong, Hyun Pyo; Choi, Yoon Jung; Kim, Young Hwan

    2018-02-01

    To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.

  11. Imaging of hepatic steatosis and fatty sparing

    Karcaaltincaba, Musturay [Department of Radiology, Hacettepe University School of Medicine, Ankara 06100 (Turkey)]. E-mail: musturayk@yahoo.com; Akhan, Okan [Department of Radiology, Hacettepe University School of Medicine, Ankara 06100 (Turkey)

    2007-01-15

    Radiology has gained importance in the non-invasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced CT with or without dual kVp measurement and MRI with in and out of phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate non-alcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop shop evaluation of potential liver donors has become possible by CT and MRI integrating vascular, parenchymal, volume and steatosis evaluation. Moreover hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal and perivenular), hypersteatosis and sparing (geographic, nodular and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing, quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing.

  12. Imaging of hepatic steatosis and fatty sparing

    Karcaaltincaba, Musturay; Akhan, Okan

    2007-01-01

    Radiology has gained importance in the non-invasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced CT with or without dual kVp measurement and MRI with in and out of phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate non-alcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop shop evaluation of potential liver donors has become possible by CT and MRI integrating vascular, parenchymal, volume and steatosis evaluation. Moreover hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal and perivenular), hypersteatosis and sparing (geographic, nodular and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing, quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing

  13. Can a finding of cervical vestibular evoked myogenic potentials contribute to vestibular migraine diagnostics?

    Tihana Vešligaj

    2016-02-01

    Full Text Available Aim To investigate differences in vestibular evoked myogenic potentials (VEMP results with patients suffering from vestibular migraine and healthy people, taking into consideration values of threshold and latency of occurrence of the characteristic wave complex, size of amplitude, and interaural amplitude ratio. According to the results, determine the importance and usefulness of VEMP in vestibular migraine diagnostics. Methods A total number of 62 subjects were included in the study, 32 of them belonging to a group of patients suffering from vestibular migraine (VM, while other 30 were in a control group of healthy subjects. Information was collected during the diagnostic evaluation. General and otoneurological history of patients and bedside tests, audiological results, videonystagmography and cervical vestibular evoked myogenic potentials (cVEMP were made. Results There was a difference in an interaural ratio of amplitudes in the experimental and control groups, but it was not found to be clinically significant. By ToneBurst 500 Hz method, the interaural amplitude ratio higher than 35% was measured in 46.97% subjects, while the response was totally unilaterally missing in 28.8% patients. Conclusion Even the sophisticated method as cVEMP does not give the ultimate result confirming the vestibular migraine diagnosis, and neither do other diagnostic methods. cVEMP result can contribute to the completion of full mosaic of vestibular migraine diagnostics.

  14. Diagnosis of gastrointestinal stromal tumors from minute specimens: cytomorphology, immunohistochemistry, and molecular diagnostic findings.

    Layfield, Lester J; Wallander, Michelle L

    2012-06-01

    Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm arising from the gastrointestinal tract. Workup of these lesions includes morphologic study and immunohistochemical and often molecular diagnostic analysis. Historically, these neoplasms had been included under a number of diagnostic categories including leiomyoma, leiomyosarcoma, schwannoma, and leiomyoblastoma. The lesions that were clearly sarcomatous were difficult to treat and therapeutically refractory to chemotherapeutic agents. Significant progress in our understanding of these neoplasms and our ability to successfully treat them occurred following the discovery that they were immunoreactive for KIT protein and harbored activating mutations in the KIT gene. Many are initially diagnosed by fine-needle aspiration (FNA) but workup may include mutational analysis to help direct therapy. This review outlines a practical approach to the cytologic diagnosis of GISTs and their molecular workup on small specimens obtained by FNA or core biopsy. Copyright © 2012 Wiley Periodicals, Inc.

  15. The Identification of Novel Diagnostic Marker Genes for the Detection of Beer Spoiling Pediococcus damnosus Strains Using the BlAst Diagnostic Gene findEr.

    Jürgen Behr

    Full Text Available As the number of bacterial genomes increases dramatically, the demand for easy to use tools with transparent functionality and comprehensible output for applied comparative genomics grows as well. We present BlAst Diagnostic Gene findEr (BADGE, a tool for the rapid prediction of diagnostic marker genes (DMGs for the differentiation of bacterial groups (e.g. pathogenic / nonpathogenic. DMG identification settings can be modified easily and installing and running BADGE does not require specific bioinformatics skills. During the BADGE run the user is informed step by step about the DMG finding process, thus making it easy to evaluate the impact of chosen settings and options. On the basis of an example with relevance for beer brewing, being one of the oldest biotechnological processes known, we show a straightforward procedure, from phenotyping, genome sequencing, assembly and annotation, up to a discriminant marker gene PCR assay, making comparative genomics a means to an end. The value and the functionality of BADGE were thoroughly examined, resulting in the successful identification and validation of an outstanding novel DMG (fabZ for the discrimination of harmless and harmful contaminations of Pediococcus damnosus, which can be applied for spoilage risk determination in breweries. Concomitantly, we present and compare five complete P. damnosus genomes sequenced in this study, finding that the ability to produce the unwanted, spoilage associated off-flavor diacetyl is a plasmid encoded trait in this important beer spoiling species.

  16. The Identification of Novel Diagnostic Marker Genes for the Detection of Beer Spoiling Pediococcus damnosus Strains Using the BlAst Diagnostic Gene findEr.

    Behr, Jürgen; Geissler, Andreas J; Schmid, Jonas; Zehe, Anja; Vogel, Rudi F

    2016-01-01

    As the number of bacterial genomes increases dramatically, the demand for easy to use tools with transparent functionality and comprehensible output for applied comparative genomics grows as well. We present BlAst Diagnostic Gene findEr (BADGE), a tool for the rapid prediction of diagnostic marker genes (DMGs) for the differentiation of bacterial groups (e.g. pathogenic / nonpathogenic). DMG identification settings can be modified easily and installing and running BADGE does not require specific bioinformatics skills. During the BADGE run the user is informed step by step about the DMG finding process, thus making it easy to evaluate the impact of chosen settings and options. On the basis of an example with relevance for beer brewing, being one of the oldest biotechnological processes known, we show a straightforward procedure, from phenotyping, genome sequencing, assembly and annotation, up to a discriminant marker gene PCR assay, making comparative genomics a means to an end. The value and the functionality of BADGE were thoroughly examined, resulting in the successful identification and validation of an outstanding novel DMG (fabZ) for the discrimination of harmless and harmful contaminations of Pediococcus damnosus, which can be applied for spoilage risk determination in breweries. Concomitantly, we present and compare five complete P. damnosus genomes sequenced in this study, finding that the ability to produce the unwanted, spoilage associated off-flavor diacetyl is a plasmid encoded trait in this important beer spoiling species.

  17. Spares management for improved maintenance

    Moncrief, E.C.; Schroder, R.M.

    1987-01-01

    A recent survey by the US Nuclear Regulatory Commission (NRC) of maintenance practices at US nuclear power plants confirms that spare parts availability is, to some extent, a problem at all but a few plants, and that 57% of the plants sometimes operated in a limiting condition for operation over the last year due to unavailability of spare parts. That's the bad news. The good news is that significant improvement is possible without ballooning inventory. The vast majority of total dollar value of spare parts inventory at power generation stations, whether nuclear or fossil, is rarely used (parts or components that are used 12 or less times per year including many with a history of no use for many years). Inventory Solutions of Akron, Ohio, has developed such a tool, called rarely used inventory stocking logic (RUSL) which is a user-friendly decision support tool for setting spare parts reorder points. Based on statistical computations enhanced to include the most advanced techniques developed for use in aerospace and military combat readiness, RUSL calculates the optimum stocking level to achieve the desired spare part availability at the station. In doing so, it considers the importance of the part in preventing an outage, as well as key economic ordering parameters, such as part cost, carrying cost, number of parts in service, historical observed usage, anticipated future usage, and lead time to replenish

  18. Joint optimization of redundancy level and spare part inventories

    Sleptchenko, Andrei; Heijden, Matthieu van der

    2016-01-01

    We consider a “k-out-of-N” system with different standby modes. Each of the N components consists of multiple part types. Upon failure, a component can be repaired within a certain time by switching the failed part by a spare, if available. We develop both an exact and a fast approximate analysis to compute the system availability. Next, we jointly optimize the component redundancy level with the inventories of the various spare parts. We find that our approximations are very accurate and suitable for large systems. We apply our model to a case study at a public organization in Qatar, and find that we can improve the availability-to-cost ratio by reducing the redundancy level and increasing the spare part inventories. In general, high redundancy levels appear to be useful only when components are relatively cheap and part replacement times are high. - Highlights: • We analyze a redundant system (k-out-of-N) with multiple parts and spares. • We jointly optimize the redundancy level and the spare part inventories. • We develop an exact method and an approximation to evaluate the system availability. • Adding spare parts and reducing the redundancy level cuts cost by 50% in a case study. • The availability is not very sensitive to the shape of the failure time distribution.

  19. Computed tomography of neurodegenerative disease in childhood. Serial CT findings and their diagnostic values

    Kataoka, Kenkichi; Nakagawa, Yoshihiro; Hojo, Hiroatsu

    1984-12-01

    Serial computed tomographic scans were performed on seven children with neurodegenerative disorders. In two cases of white-matter diseases (Krabbe's disease and metachromatic leukodystrophy), diffuse, low-density lesions of white matter were visible in the early stage of the diseases. In one case of adrenoleukodystrophy, regional low-density lesions of the white matter around the posterior horns and peculiar high-density strip lesions were visible in the early stage. In two cases of storage-type gray-matter diseases (Tay-Sachs' and infantile Gaucher's disease), there were no abnormalities in the early stage, but diffuse cortical atrophies in the late stage. In one case of Leigh's disease, there were small, low-density lesions of the basal ganglia and multiple low-density lesions of the gray matter in the early stage. In one case of subacute sclerosing panencephalitis, there were no abnormalities in the early stage, but small, low-density lesions of the basal ganglia and diffuse cerebral atrophies in the late stage. Diagnostic values were recognized dominantly in two cases of adrenoleukodystrophy and Leigh's disease. In the other cases, however, serial CT scans were useful in the diagnostic process. (author).

  20. Childhood Enuresis: Current Diagnostic Formulations, Salient Findings, and Effective Treatment Modalities.

    Thurber, Steven

    2017-06-01

    Enuresis constitutes a frequently encountered problem area for children that may adversely affect social and emotional adjustment. This type of incontinence has been of concern to the human family for centuries. A brief history of enuresis is presented followed by current conceptualizations, diagnostic criteria, prevalence rates and psychiatric comorbidities. Historic notions of causation together with ineffective, sometimes barbaric treatments are then discussed, ending with a presentation of evidence-based treatment modalities, with the urine alarm being an essential element of effective treatment. An intervention termed dry bed training combines the urine alarm with a series of procedures designed in part to reduce relapse potential and should be a primary consideration for implementation by treatment professionals. Finally, a brief case study is presented illustrating special etiological and treatment considerations with juvenile psychiatric patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

    Buyukkoyuncu Pekel, Nilufer; Nar Senol, Pelin; Yildiz, Demet; Kilic, Ahmet Kasim; Kamaci Sener, Deniz; Seferoglu, Meral; Gunes, Aygul

    2017-01-01

    Objective. The aim of the study was to examine the relation between clinical findings, neurological examination and electrophysiological studies in diagnosing carpal tunnel syndrome (CTS) and share our institutional experience in patients with CTS. Methods. Patients presenting with complaints of pain, paresthesia, and weakness in hands who diagnosed CTS between 2014 and 2015 were examined retrospectively. Demographic characteristics, clinical and neurological examination findings and electrod...

  2. Clinical Evaluation of Iliopsoas Strain with Findings from Diagnostic Musculoskeletal Ultrasound in Agility Performance Canines – 73 Cases

    Robert Cullen

    2017-06-01

    Full Text Available Objective: Iliopsoas injury and strain is a commonly diagnosed disease process, especially amongst working and sporting canines. There has been very little published literature regarding iliopsoas injuries and there is no information regarding the ultrasound evaluation of abnormal iliopsoas muscles. This manuscript is intended to describe the ultrasound findings in 73 canine agility athletes who had physical examination findings consistent with iliopsoas discomfort. The population was chosen given the high incidence of these animals for the development of iliopsoas injury; likely due to repetitive stress.Methods: Medical records of 73 agility performance canines that underwent musculoskeletal ultrasound evaluation of bilateral iliopsoas muscle groups were retrospectively reviewed. Data included signalment, previous radiographic findings, and ultrasound findings. A 3-tier grading scheme for acute strains was used while the practitioner also evaluated for evidence of chronic injury and bursitis.Results: The majority of pathologies were localised to the tendon of insertion, with the majority being low grade I-II strains (80.8%. Tendon fibre disruption (71.2% and indistinct hypoechoic lesions (91.8% were the most common of acute changes noted. Hyperechoic chronic changes were noted in 84.9 percent of cases. Acute and chronic changes were commonly seen together (62.8%.Conclusion: Diagnostic musculoskeletal ultrasound was used to identify lesions of the iliopsoas tendon consistent with acute and chronic injury, as well as identifying the region of pathology. The majority of agility performance dogs had low grade acute strains based on the tiered system, with mixed acute and chronic lesions being noted frequently.Application: Diagnostic musculoskeletal ultrasound provides a non-invasive diagnostic modality for patients suspected of having an iliopsoas strain.

  3. Managing spares for improved availability

    Moncrief, E.C.; Schroder, R.M.

    1987-01-01

    A recent survey by the U.S. Nuclear Regulatory Commission of maintenance practices at U.S. nuclear power plants confirms that spare parts availability is, to some extent, a problem at all but a few plants. Fortunately, significant improvement is possible without ballooning inventory. The vast majority of total dollar value of spare parts inventory at power generation stations, whether nuclear or fossil, is rarely used (parts or components that are used 12 or less times per year including many with a history of no use for many years). Because rarely used inventory is not effectively managed with traditional inventory management techniques, opportunities exist both to increase availability and to reduce investment. But this requires a unique statistical tool that can recommend an unbiased, economic reorder point to be used in the materials management system. Inventory Solutions Inc. (ISI) of Akron, Ohio, has developed such a tool, rarely used inventory stocking logic (RUSL), which is a user friendly decision support tool for setting spare parts reorder points. RUSL, based on statistical computations enhanced to include the most advanced techniques developed for use in aerospace and military combat-readiness, calculates the optimum stocking level to achieve the desired spare part availability at the station

  4. Foveal sparing in stargardt disease

    Huet, R.A.C. van; Bax, N.M.; Westeneng-van Haaften, S.C.; Muhamad, M.; Zonneveld-Vrieling, M.N.; Hoefsloot, L.H.; Cremers, F.P.M.; Boon, C.J.F.; Klevering, B.J.; Hoyng, C.B.

    2014-01-01

    PURPOSE: To provide a clinical and genetic description of a patient cohort with Stargardt disease (STGD1) with identifiable foveal sparing. METHODS: Patients with retinal atrophy (defined as an absence of autofluorescence) that surrounded the fovea by at least 180 degrees and did not include the

  5. Correlation of diagnostic imaging and autopsy findings of eight patients with acquired immune deficiency syndrome

    Li Hongjun; Zhang Yuzhong; Cheng Jingliang

    2009-01-01

    Objective: To investigate the imaging findings with pathologic correlation in patients with acquired immune deficiency syndrome (AIDS). Methods: Imaging findings, autopsy and pathological data were retrospectively analyzed in eight patients with AIDS. Routine CT scanning of different body parts was performed during their hospitalization. CT scanning was performed from the skull to the pelvis immediately following their death. After routine formalin fixing, 7 cadavers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each sections and organs for pathological examinations. Results: The autopsy data showed parasitic infections (5 cases), bacterial infections (3 cases), fungal infections (2 cases), virus infections (2 cases), lymphoma (1 case) and cerebrovascular diseases (1 case)in eight patients with AIDS. The CT scanning demonstrated symmetrical ground glass liked shadows with pulmonary hilus as the center in 5 cases of pulmonary PCP infection; pulmonary patchy shadows, scattering distribution of nodular shadows, extensive military nodular shadows with even distribution and tuberculous pleurisy; cloudy shadows for 2 cases of fungi infection with multiple foci of chronic inflammation; pulmonary net-like parenchymal changes for 2 cases of pulmonary CMV infection; thickened intestinal wall and narrowed intestinal lumen for 1 case of intestinal tumor; low density shadows of brain tissue for 1 case of CMV encephalitis and MRI findings of high T 1 and high T 2 signals as well as MRA findings of broken vascular channels in liquefied areas of brain tissues; patchy low density areas inside a cyst of brain for one case of brain toxoplasmosis infection; multiple small patchy low density areas in cerebral basal ganglia for one case of brain cryptococcus infection. Conclusions: In AIDS patients, infection and tumor may occur in various organs resulting in complex symptoms, which makes it more complicated and difficult to make

  6. The diagnostic role of abdominal CT imaging findings in adults intussusception: Focused on the vascular compromise

    Park, Sung Bin; Ha, Hyun Kwon; Kim, Ah Young; Lee, Seung Soo; Kim, Hye Jin; Park, Beom Jin; Jin, Yong Hyun; Park, Seong Ho; Kim, Kyoung Won

    2007-01-01

    Intussusception is defined as telescoping of one segment of the gastrointestinal tract into an adjacent one. Unlike that in children, adult intussusception is a relatively rare condition. More than 90% of patients with adult intussusception have been reported to have an organic cause, with benign or malignant tumors for accounting for approximately 65% of the cases. In general, the diagnosis is easily made by means of computed tomography (CT) or magnetic resonance (MR) imaging. The imaging appearance of a bowel-within-bowel configuration with or without contained fat and mesenteric vessels, is pathognomonic. As the intussusceptum enters into the intussuscipiens, the mesentery is carried forward and trapped between the overlapping layers of bowel. The twisting or severe constriction of the mesenteric vessels may result in vascular compromise with subsequent edematous thickening of the involved bowel. In these circumstances, ischemic necrosis may develop if timely intervention is not undertaken. Therefore, determination of the presence or absence of intestinal necrosis in intussusception is important in patient management. On CT, the presence of well-known diagnostic CT criteria for strangulated obstruction (especially severe engorgement or twisting of the mesenteric vessels) as well as evidence of loss of the layered pattern, accumulation of extraluminal fluid collection, and bowel perforation, may suggest the diagnosis of intestinal necrosis. CT and MR imaging are limited in determining the primary disease causing intussusception. However, CT and MR provide excellent pre-operative evaluation, including the possible extension and/or dissemination of a malignant tumor. CT and MR imaging may also be useful in suggesting the presence of vascular compromise

  7. Spare Parts Management of Aging Capital Products

    M. Hekimoğlu (Mustafa)

    2015-01-01

    textabstractSpare parts are critical for operations of capital products such as aircraft, refineries, trucks, etc/, which require maintenance regularly. Original Equipment Manufacturers (OEMs) bear the responsibility of undisrupted maintenance service and spare parts flow for their capital products.

  8. Diagnostic findings in infants presenting to a pediatric emergency department for lethargy or feeding complaints.

    Webb, Tara; Nugent, Melodee; Simpson, Pippa; Melzer-Lange, Marlene

    2014-03-01

    Lethargy is a common complaint among infants in the pediatric emergency department (ED), yet there is little data to guide appropriate evaluation. The objectives of the study were (1) to determine the frequency of diagnoses requiring intervention/monitoring and (2) to identify predictors of these diagnoses. A retrospective chart review of patients aged 0 to 6 months with a chief complaint of lethargy or poor feeding from January 2004 to December 2009 was performed. Patients were excluded if they had a fever, hypothermia, a chronic medical condition, or a history of trauma. Charts were reviewed by a single investigator; 10% were reviewed by a second investigator for agreement. History, examination, laboratory and radiology results, ED and inpatient diagnoses, as well as return visits within 7 days were recorded. Frequencies of diagnoses and interventions were described, and history and examination findings associated with these categories were determined. Two hundred seventy-two patients were included; 34 patients (12.5%; 95% confidence interval [CI], 8.8%-17%) required intervention/monitoring. These patients were classified into 6 categories. Eighteen had hematologic disorders (6.6%; 95% CI, 4.0%-10.3%), 8 had dehydration (2.9%; 95% CI, 1.3%-5.7%), 2 had intracranial bleeds (0.7%; 95% CI, 0.09%-2.6%), 3 had serious bacterial infections (1%; 95% CI, 0.2%-3.2%), 1 had a cardiac disorder (0.4%; 95% CI, 0.009%-2%), and 2 had neurologic disorders (0.7%; 95% CI, 0.9%-2.6%). Of the patients, 76% had conditions that were clinically evident (dehydration and hyperbilirubinemia requiring phototherapy). The patients with cardiac disorders, neurologic disorders, and intracranial bleeds all had abnormal examination findings in the ED. The 3 patients with serious bacterial infections were younger than 2 months of age and ill appearing; all had urinary tract infections. Infants with lethargy or poor feeding who require an intervention are likely to have conditions that are

  9. Diagnostic value of computed tomographic findings of nutcracker syndrome: Correlation with renal venography and renocaval pressure gradients

    Kim, Kyung Won; Cho, Jeong Yeon; Kim, Seung Hyup; Yoon, Jeong-Hee; Kim, Dae Sik; Chung, Jin Wook; Park, Jae Hyung

    2011-01-01

    Purpose: To evaluate the diagnostic values of CT findings of nutcracker syndrome (NCS). Methods and materials: Twenty seven subjects that underwent CT and renal venography, were divided into three groups based on the venographic renocaval pressure gradient (PG) and collateral veins of the left renal vein (LRV): non-compensated NCS patients with PG ≥ 3 mm Hg (group 1, n = 12), partially compensated NCS patients with borderline PG (1 2 test). Mean values of all quantitative CT parameters differed significantly only between groups 1 and 3 (P < .05, one-way ANOVA test). For differentiating the non-compensated NCS from the control group, the beak sign showed 91.7% sensitivity and 88.9% specificity. Of the various CT parameters, the beak sign and LRV diameter ratio of ≥4.9 showed the greatest diagnostic accuracy (AUC 0.903, ROC analysis). Conclusion: Beak sign of the LRV and CT findings can be useful in diagnosing the non-compensated NCS.

  10. Radiological diagnosis of pulmonary metastases: imaging findings and diagnostic accuracy; Bildgebende Diagnose und Differenzialdiagnose von Lungenmetastasen

    Diederich, S. [Institut fuer Diagnostische und Interventionelle Radiologie/Nuklearmedizin, Marienhospital Duesseldorf (Germany)

    2004-07-01

    Pulmonary metastases typically present as mostly multiple and bilateral, well-defined, non-calcified pulmonary nodules with predominantly basal and peripheral location. Ill-defined, cavitating, calcified and endobronchial metastases are uncommon. In the absence of pathognomonic findings precise differentiation from other - even benign - pulmonary nodules is almost impossible. Demonstration of contrast enhancement at CT or MRI or evidence of growth at serial examinations support the diagnosis of pulmonary metastases. In uncertain cases percutaneous fine-needle aspiration or cutting needle biopsy will allow diagnosis with acceptable risk of complications and patient discomfort. The only relatively common complication of pneumothorax can and should be controlled by the interventional radiologist by aspiration or drainage. (orig.) [German] Lungenmetastasen stellen sich bildgebend typischerweise als meist multiple und bilaterale, scharf begrenzte weichteildichte Lungenrundherde mit basal und peripher betonter Lokalisation dar. Unscharfe Begrenzung, Einschmelzungen, Verkalkungen oder endobronchiale Lage sind selten. Aufgrund fehlender pathognomonischer Befunde ist eine eindeutige differenzialdiagnostische Abgrenzung von anderen - auch benignen - Lungenrundherden jedoch kaum moeglich. Der computertomographische oder magnetresonanztomographische Nachweis einer Kontrastmittelaufnahme oder von Wachstum in Verlaufsuntersuchungen unterstuetzt die Diagnose. In Zweifelsfaellen fuehrt die perkutane Biopsie als Feinnadelaspiration oder Stanzbiopsie bei vertretbarer Belastung des Patienten meist zur Diagnose. Die einzige relativ haeufige Nebenwirkung - der postpunktionelle Pneumothorax - kann und sollte vom interventionellen Radiologen durch Aspiration oder Katheterdrainage selbst therapiert werden. (orig.)

  11. West Nile virus in raptors from Virginia during 2003: clinical, diagnostic, and epidemiologic findings.

    Joyner, Priscilla H; Kelly, Sean; Shreve, Allison A; Snead, Sarah E; Sleeman, Jonathan M; Pettit, Denise A

    2006-04-01

    Sixty-one birds of prey admitted to The Wildlife Center of Virginia (WCV; Waynesboro, Virginia, USA) from June to November 2003 were tested for West Nile virus (WNV) infection. Choanal and/or cloacal swabs were obtained and submitted to Virginia's Division of Consolidated Laboratory Services (Richmond, Virginia, USA) for analysis with real-time reverse transcriptase polymerase chain reaction (RT-PCR). Forty birds of prey were positive for WNV by RT-PCR. Five avian families and nine species of raptors were represented, with great horned owls (Bubo virginianus) and red-tailed hawks (Buteo jamaicensis) most frequently affected. Presenting clinical signs were consistent with previous reports of WNV infection in raptors; however, these differed between species. Of WNV positive birds, nonspecific signs of illness were the most common clinical findings, particularly in red-tailed hawks; signs included dehydration (n = 20), emaciation (n = 18), and depression (n = 15). Neurologic abnormalities were frequently identified, especially in great horned owls, and included head tremors (n = 17), ataxia (n = 13), head incoordination (n = 7), torticollis (n = 3), nystagmus (n = 3), and head tilt (n = 3). Great horned owls exhibited anemia and leukocytosis with heterophilia, eosinophilia, and monocytosis consistent with chronic inflammation. Red-tailed hawks were anemic with a heterophilic leukocytosis and regenerative left shift. The majority of WNV cases occurred during August and September; there was a marked increase in the number of raptors admitted to WCV during these months followed by a marked decrease during October, November, and December. This pattern differed from mean monthly admissions during the previous 10 years and suggests a negative impact on local raptor populations. The effects of WNV on avian populations are largely unknown; however, because of their ecological importance, further investigation of the effects of WNV on raptor populations is warranted.

  12. Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

    Delgado Oliva, F., E-mail: frandelgol@hotmail.com; Arlandis Guzman, S.; Bonillo García, M.; Broseta Rico, E.; Boronat Tormo, F.

    2016-10-15

    Objectives: To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. Material and methods: A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4–20 ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. Results: Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3 ± 7.01 years (95% CI, 63.75–64.70); mean total PSA was 8.9 ± 3.61 ng/mL (95% CI, 8.67–9.13) and the mean prostate volume was 56.2 ± 29 cc (95% CI, 54.2–58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16

  13. Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

    Delgado Oliva, F; Arlandis Guzman, S; Bonillo García, M; Broseta Rico, E; Boronat Tormo, F

    2016-10-01

    To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value0

  14. Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

    Delgado Oliva, F.; Arlandis Guzman, S.; Bonillo García, M.; Broseta Rico, E.; Boronat Tormo, F.

    2016-01-01

    Objectives: To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. Material and methods: A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4–20 ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. Results: Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3 ± 7.01 years (95% CI, 63.75–64.70); mean total PSA was 8.9 ± 3.61 ng/mL (95% CI, 8.67–9.13) and the mean prostate volume was 56.2 ± 29 cc (95% CI, 54.2–58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16

  15. Renal-sparing strategies in cardiac transplantation

    Gustafsson, Finn; Ross, Heather J

    2009-01-01

    PURPOSE OF REVIEW: Renal dysfunction due to calcineurin inhibitor (CNI) toxicity is a major clinical problem in cardiac transplantation. The aim of the article is to review the efficacy and safety of various renal sparing strategies in cardiac transplantation. RECENT FINDINGS: Small studies have...... reduction in terms of preserving renal function. Patients with longstanding CNI treatment or proteinuria are less likely to respond favourably to a switch from a CNI-based regimen to a proliferation signal inhibitor-based regimen. SUMMARY: Each cardiac transplant recipient with renal dysfunction must...... documented that late initiation of CNI is safe in patients treated with induction therapy at the time of transplantation. Use of mycophenolate is superior when compared with azathioprine to allow for CNI reduction. More substantial reduction in CNI levels is safe and effective with the introduction...

  16. Focal sparing around the gallbladder in fatty liver

    Chen, Kemin; Hiramatsu, Yoshihiro; Yunoki, Masanori; Hirano, Yoko

    1989-01-01

    In evaluating fatty liver with CT, the residual normal liver tissues without fat deposits are occasionally detected on CT as high attenuation regions, especially surrounding the gallbladder. This study examined the incidence of this phenomenon in terms of the diagnostic value of CT in fatty liver. Fifty-seven patients with fatty liver were examined with CT. The incidence of focal sparing area was the highest in the gallbladder bed (42/57, 74%), followed by the interlobar fissure or subcapsular area (13, 23%), quadrate lobe (8, 14%), caudate lobe (2, 4%), and right lobe (one, 1.8%). These CT appearances were of spot, band, ring, and the mixed type. In 38 patients, fatty liver was too moderate to be detected without CT attenuation numbers. Among them, 27 patients (71%) had focal sparing area surrounding the gallbladder. This CT appearance seemed to be of significance in preventing the missing of moderate fatty liver. (Namekawa, K)

  17. Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: A systematic review.

    Owora, Arthur H; Carabin, Hélène; Reese, Jessica; Garwe, Tabitha

    2016-09-01

    Growing recognition of the interrelated negative outcomes associated with major depression disorder (MDD) among mothers and their children has led to renewed public health interest in the early identification and treatment of maternal MDD. Healthcare providers, however, remain unsure of the validity of existing case-finding instruments. We conducted a systematic review to identify the most valid maternal MDD case-finding instrument used in the United States. We identified articles reporting the sensitivity and specificity of MDD case-finding instruments based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by systematically searching through three electronic bibliographic databases, PubMed, PsycINFO, and EMBASE, from 1994 to 2014. Study eligibility and quality were evaluated using the Standards for the Reporting of Diagnostic Accuracy studies and Quality Assessment of Diagnostic Accuracy Studies guidelines respectively. Overall, we retrieved 996 unduplicated articles and selected 74 for full-text review. Of these, 14 articles examining 21 different instruments were included in the systematic review. The 10 item Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale had the most stable (lowest variation) and highest diagnostic performance during the antepartum and postpartum periods (sensitivity range: 0.63-0.94 and 0.67-0.95; specificity range: 0.83-0.98 and 0.68-0.97 respectively). Greater variation in diagnostic performance was observed among studies with higher MDD prevalence. Factors that explain greater variation in instrument diagnostic performance in study populations with higher MDD prevalence were not examined. Findings suggest that the diagnostic performance of maternal MDD case-finding instruments is peripartum period-specific. Published by Elsevier B.V.

  18. Systematic overview finds variation in approaches to investigating and reporting on sources of heterogeneity in systematic reviews of diagnostic studies

    Naaktgeboren, Christiana A.; van Enst, Wynanda A.; Ochodo, Eleanor A.; de Groot, Joris A. H.; Hooft, Lotty; Leeflang, Mariska M.; Bossuyt, Patrick M.; Moons, Karel G. M.; Reitsma, Johannes B.

    2014-01-01

    To examine how authors explore and report on sources of heterogeneity in systematic reviews of diagnostic accuracy studies. A cohort of systematic reviews of diagnostic tests was systematically identified. Data were extracted on whether an exploration of the sources of heterogeneity was undertaken,

  19. Core sampling system spare parts assessment

    Walter, E.J.

    1995-01-01

    Soon, there will be 4 independent core sampling systems obtaining samples from the underground tanks. It is desirable that these systems be available for sampling during the next 2 years. This assessment was prepared to evaluate the adequacy of the spare parts identified for the core sampling system and to provide recommendations that may remediate overages or inadequacies of spare parts

  20. Valve-sparing aortic root replacement†

    Koolbergen, David R.; Manshanden, Johan S. J.; Bouma, Berto J.; Blom, Nico A.; Mulder, Barbara J. M.; de Mol, Bas A. J. M.; Hazekamp, Mark G.

    2015-01-01

    To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed.

  1. Cultural activities in primary school students' spare time

    Mikanović Brane

    2014-01-01

    Full Text Available Culture is a form of creative expression of a human being through which he reshapes the world, acts on it adding it value and creating new, cultural values. A human being is able to create a product of culture only when he is free and able to express himself. A contemporary man can incorporate various cultural activities into his spare time. They are especially important when they concern children and young people: regardless of whether they are used in institutional settings or in spare time. The authors conducted an empirical research of students' assumptions and beliefs concerning cultural activities in their free time. The sample comprised 233 fifth grade students. The findings show that in their spare time fifth graders: engage in various cultural activities; that students who live in urban areas attend more cultural events; that students have the opportunity to engage in extra-curricular activities in the area of culture - join cultural and artistic groups and associations and engage in various creative pursuits at different levels of participation (as consumers, full participants; and that students' attitudes concerning the influence of parents and teachers on the selection of cultural activities to be pursued do not vary greatly by gender, location or school achievement. Cultural activities do play a significant part in the free time of primary school students. This is why it is important that guidance provided in school and in spare time should be brought in greaer harmony.

  2. Sparing land for biodiversity at multiple spatial scales

    Johan eEkroos

    2016-01-01

    Full Text Available A common approach to the conservation of farmland biodiversity and the promotion of multifunctional landscapes, particularly in landscapes containing only small remnants of non-crop habitats, has been to maintain landscape heterogeneity and reduce land-use intensity. In contrast, it has recently been shown that devoting specific areas of non-crop habitats to conservation, segregated from high-yielding farmland (‘land sparing’, can more effectively conserve biodiversity than promoting low-yielding, less intensively managed farmland occupying larger areas (‘land sharing’. In the present paper we suggest that the debate over the relative merits of land sparing or land sharing is partly blurred by the differing spatial scales at which it is suggested that land sparing should be applied. We argue that there is no single correct spatial scale for segregating biodiversity protection and commodity production in multifunctional landscapes. Instead we propose an alternative conceptual construct, which we call ‘multiple-scale land sparing’, targeting biodiversity and ecosystem services in transformed landscapes. We discuss how multiple-scale land sparing may overcome the apparent dichotomy between land sharing and land sparing and help to find acceptable compromises that conserve biodiversity and landscape multifunctionality.

  3. Colonoscopic Diagnostic Findings in Patients Undergoing Colonoscopy In Qom Hazrat-e-Masoome Hospital During 2007-2008

    M.R Ghadir

    2012-05-01

    Full Text Available

    Background and Objectives: In recent years there have been noticeable changes in diagnosis and treatment of colon disorders by colonoscopy and direct vision. Along with its international development, this useful equipment is being used in Iran to treat various disorders. It should be mentioned that there are no exact statistics of these disorders to date. This study was done with aim of evaluating the diagnostic findings in patients undergoing colonoscopy in Qom during 2007-2008.

     

    Methods: This descriptive-cross sectional study was done on 500 patients having referred to colonoscopy ward of Hazrate-e-Masoome Hospital in Qom. After colonoscopy, patient data were entered into a special questionnaire and then pathologic findings were added to it. The data were taken for statistical analysis.

     

    Results: Out of 500 patients undergoing colonoscopy 279 were male (55.8% and 221 female (44.2%. In all groups and both sexes the most common reason for carrying out colonoscopy was abdominal pain (46.6% rectorrhagia (41%. As regards diagnosis, a total of 199 cases (39.8% of all 500 colonoscopies had normal colonoscopy,124 cases (24.8% had hemorrhoid, 64 cases (12.8% had polyp, 55 cases (11% had inflammatory bowel diseases (IBD, 30 cases (6% had tumor, 17 cases(3.2% had diverticulosis and 12 cases (2.4% had solitary rectal ulcer. There was a significant relationship between abdominal pain and tumor, polyp and diverticulosis. (p<0.001 There was also a significant relationship between age and the aforementioned disorders. (p<0.001

     

    Conclusion: Based on the findings of this study, the prevalence of cancer and IBD is higher in men

  4. Centralização de fluxo sanguíneo fetal: comparação entre os índices diagnósticos Brain-sparing effect: comparison of diagnostic indices

    Cleide Mara Mazzotti de Oliveira Franzin

    2010-01-01

    intensivos neonatais, fetos pequenos para a idade gestacional, septicemia, enterocolite necrosante, insuficiência renal, doença de membrana hialina e anemia. Não houve diferença significativa entre um ou outro índice para resultados perinatais adversos.PURPOSE: to describe adverse perinatal outcomes in patients with fetal blood flow centralization, using the relationship between the pulsatility indexes of the middle cerebral and umbilical arteries (MCAPI/UAPI, and between the resistance indexes of the middle cerebral and umbilical arteries (MCARI/UARI, as well as to compare both diagnostic indexes. METHODS: 151 pregnant women with diagnosis of blood flow centralization, attended to at the maternity hospital of Universidade Estadual de Campinas, whose delivery occurred up to 15 days after the ultrasonographic diagnosis, were included. It was considered as adverse perinatal outcomes: Apgar index lower than 7 at the fifth minute, permanence in neonatal ICU, small fetus for the gestational age, severe fetal suffering, perinatal death, hypoglycemia, polycythemia, necrotizing enterocolitis, brain hemorrhage, lung hemorrhage, anemia, septicemia, hyaline membrane disease, convulsive syndromes, hyperreflexia syndrome and kidney insufficiency. Rates of the perinatal adverse outcomes (PAO for the brain-placentary ratios have been compared, using Fisher's exact or Pearson's χ2 tests, at 5% significance level. Adverse perinatal outcomes according to the gestational age have been evaluated using the Cochrane-Armitage test for trend. RESULTS: the adverse perinatal outcomes for the group with the two indexes altered were: 62.5% of the newborns needed to be placed in an ICU, 75.2% were small for the gestational age (SGA, 35.3% were under severe fetal suffering, 84.4% had hypoglycemia, 8.3% polycythemia, 4.2% necrotizing enterocolitis, and 2.1% brain hemorrhage. There has been significant association between the MCAPI/UAPI and MCARI/UARI ratios along the gestational age, and the need

  5. A prenatally detected adrenal cyst treated by adrenal-sparing surgery

    A neonatal case of left adrenal cyst detected in utero and successfully treated by adrenal-sparing surgery is presented and discussed with review of the literature. Incidentally discovered prenatal adrenal masses present a diagnostic dilemma. Benign and malignant conditions can present as a fetal suprarenal mass. There is ...

  6. Homonymous Hemianopia with Macular Sparing: Clinical and ...

    Dr. Osoba

    peripheral vision function in the cerebral cortex is located. Sparing ... Key words: brain, magnetic resonance imaging, macula, occipital lobe, vision ... luminance right homonymous hemianopia affecting inferior and superior ... infarction in left.

  7. Pancreatic neuroendocrine tumour (PNET): Staging accuracy of MDCT and its diagnostic performance for the differentiation of PNET with uncommon CT findings from pancreatic adenocarcinoma

    Kim, Jung Hoon; Lee, Jeong Min; Han, Joon Koo; Choi, Byung-Ihn [Seoul National University Hospital, Department of Radiology, 101 Daehangno, Jongno-gu, Seoul (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul (Korea, Republic of); Eun, Hyo Won [Yonsei University College of Medicine, Department of Radiology, Severance Hospital, Seodaemun-ku, Seoul (Korea, Republic of); Kim, Young Jae [Soonchunhyang University Hospital, Department of Radiology, 657 Hannam-Dong, Youngsan-Ku, Seoul (Korea, Republic of)

    2016-05-15

    To investigate staging accuracy of multidetector CT (MDCT) for pancreatic neuroendocrine tumour (PNET) and diagnostic performance for differentiation of PNET from pancreatic adenocarcinoma. We included 109 patients with surgically proven PNET (NETG1 = 66, NETG2 = 31, NEC = 12) who underwent MDCT. Two reviewers assessed stage and presence of predefined CT findings. We analysed the relationship between CT findings and tumour grade. Using PNETs with uncommon findings, we also estimated the possibility of PNET or adenocarcinoma. Accuracy for T stage was 85-88 % and N-metastasis was 83-89 %. Common findings included well circumscribed, homogeneously enhanced, hypervascular mass, common in lower grade tumours (p < 0.05). Uncommon findings included ill-defined, heterogeneously enhanced, hypovascular mass and duct dilation, common in higher grade tumours (p < 0.05). Using 31 PNETs with uncommon findings, diagnostic performance for differentiation from adenocarcinoma was 0.760-0.806. Duct dilatation was an independent predictor for adenocarcinoma (Exp(B) = 4.569). PNETs with uncommon findings were associated with significantly worse survival versus PNET with common findings (62.7 vs. 95.7 months, p < 0.001). MDCT is useful for preoperative evaluation of PNET; it not only accurately depicts the tumour stage but also prediction of tumour grade, because uncommon findings were more common in higher grade tumours. (orig.)

  8. Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

    Heidi Buvarp Dyrop

    2016-01-01

    Full Text Available Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients. Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires. Results. 102 patients (18.7% had a sarcoma; 68 (12.5% had other malignancies. Median interval for the patient (time from first symptom to first doctor visit, primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days and diagnostic intervals (+19 days than patients with benign conditions. Median primary care (−19 days and sarcoma center (−4 days intervals were shorter for patients with a lump versus no lump. Median patient (+40 days, primary care (+12 days, diagnostic (+17 days, and total intervals (+78 days were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days and total intervals (−104 days. Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

  9. Diagnostic methods in finding out the causes of infertility, results of HSG examination and laparoscopy in infertile women examined at the Gynecological Ward of the City Hospital

    Kwasniewski, S.; Kukulski, P.; Szymanski, J.; Kwasniewska, A.

    1993-01-01

    The paper presents diagnostic methods and the results of hysterosalpingography (HSG) and laparoscopy examination, with special attention being drawn to the usefulness of these methods in finding out the causes of infertility. 51 patients with primary and second infertility were examined. HSG and laparoscopy make it possible to diagnose correctly the cause of infertility. They also enable adequate and early classification of patients for further diagnosis and treatment at highly specialized centers dealing with the problems of infertility. (author)

  10. Macula-Sparing rhegmatogenous retinal detachment: Is emergent surgery necessary?

    Sasan Mahmoudi

    2016-01-01

    Full Text Available The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours. In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.

  11. Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography.

    Yoo, Yeon Hwa; Kim, Jeong-Ah; Son, Eun Ju; Youk, Ji Hyun; Kwak, Jin Young; Kim, Eun-Kyung; Park, Cheong Soo

    2013-12-01

    To analyze sonographic findings suggesting central lymph node metastasis of papillary thyroid carcinoma and to evaluate the influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography for predicting central lymph node metastasis. A total of 124 patients (101 female and 23 male; mean age, 47.5 years; range, 21-74 years) underwent sonographically guided fine-needle aspiration in central lymph nodes from January 2008 to July 2011. Sonographic features of size, shape, margin, thickening of the cortex, cortical echogenicity, presence of a hilum, cystic changes, calcification, and vascularity of enlarged lymph nodes were analyzed before fine-needle aspiration and classified into 2 categories (probably benign and suspicious). Sonographic findings were correlated with the pathologic diagnosis and associated chronic lymphocytic thyroiditis. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of sonography for predicting central lymph node metastasis according to the associated thyroiditis. Fifty-one lymph nodes (39.5%) were malignant, and 73 (60.5%) were benign. On univariate analysis, size, shape, margin, cortical thickening, cortical echogenicity, cystic changes, calcification, and vascularity were significantly different between the benign and metastatic nodes (P thyroiditis-positive patients and 0.971 (95% CI, 0.938-1.000) in negative patients. Eccentric cortical thickening and cortical hyperechogenicity were the sonographic findings predictive of central lymph node metastasis from papillary thyroid carcinoma. The diagnostic performance of sonography for predicting metastasis was superior in chronic lymphocytic thyroiditis-negative patients than in positive patients.

  12. Testicular sparing surgery in small testis masses: A multinstitutional experience

    Andrea B. Galosi

    2016-12-01

    Full Text Available Introduction: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. Materials and methods: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397 which comprises: 1 testicular tumor markers, 2 repeated scrotal ultrasound at the tertiary center, 3 surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. Results: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15. Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3% with immediate radical orchiectomy and 17/28 (60.7% with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma, benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma, benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis, and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. Conclusions: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single

  13. Mammographic findings of women recalled for diagnostic work-up in digital versus screen-film mammography in a population-based screening program

    Lipasti, Seppo; Pamilo, Martti; Anttila, Ahti

    2010-01-01

    Background: Limited information is available concerning differences in the radiological findings of women recalled for diagnostic work-up in digital mammography (DM) versus screen-film mammography (SFM) screening. Purpose: To compare the radiological findings, their positive predictive values (PPVs) for cancer and other process indicators of DM screening performed by computed radiography (CR) technology and SFM screening in a population-based program. Material and Methods: The material consisted of women, 50-59 years of age, who were invited for screening: 30 153 women with DM in 2007-2008 and 32 939 women with SFM in 1999-2000. The attendance rate was 77.7% (23 440) in the DM arm and 83.8% (27 593) in the SFM arm. In the DM arm, 1.71% of those screened (401) and in the SFM arm 1.59% (438) were recalled for further work-up. The images resulting in the recall were classified as: 1) tumor-like mass, 2) parenchymal distortion/asymmetry, 3) calcifications, and 4) combination of mass and calcifications. The distributions of the various radiological findings and their PPVs for cancer were compared in both study groups. The recall rates, cancer detection rates, test specificities, and PPVs of the DM and SFM groups were also compared. Results: Women were recalled for diagnostic work-up most often due to tumor-like mass. It was more common in SFM (1.08% per woman screened) than in DM (0.93%). The second most common finding was parenchymal distortion and asymmetry, more often in DM (0.58%) than in SFM (0.37%). Calcifications were the third most common finding. DM exposed calcifications more often (0.49%) than SFM (0.26%). The PPVs for cancer of the recalls were higher in DM than in SFM in all subgroups of radiological findings. The test specificities were similar (DM 98.9%, SFM 98.8%). Significantly more cancers were detected by DM (cancer detection rate 0.623% per woman screened, n=146) than by SFM (cancer detection rate 0.406% per woman screened, n=112). The PPVs for

  14. Unexpected findings at diagnostic laparoscopy: caecal incarceration with concurrent appendicitis in a patient with bilateral broad ligament defects

    Onida, S; Lynes, K; Whitehouse, PA

    2010-01-01

    Internal herniations through broad ligament defects are very rare. We present the first report of the triad of broad ligament defect, internal herniation of the caecum and appendicitis. A 36-year-old woman with phocomelia presented with right iliac fossa pain and vomiting. The patient had no previous history of trauma or surgery. Abdominal ultrasound showed a small amount of free fluid. At laparoscopy, bilateral broad ligament defects were found, with herniation of the caecum and an inflamed appendix through the right-sided defect. A laparoscopic salpingo-oophorectomy was required for reduction of the herniated bowel, and an appendicectomy was performed. Broad ligament defects may be congenital or acquired. In this case, in light of the limb abnormality and absence of previous surgery, a congenital aetiology is more likely. Ultrasound scan is not reliable and, although computed tomography may be of help, a diagnostic laparoscopy is the best investigation. PMID:20566032

  15. Histologic Findings and Cytological Alterations in Thyroid Nodules After Radioactive Iodine Treatment for Graves' Disease: A Diagnostic Dilemma.

    El Hussein, Siba; Omarzai, Yumna

    2017-06-01

    Unlike the well-documented relation between radiation to the neck and development of papillary thyroid carcinoma, a causal association between radioactive iodine treatment for Graves' disease and development of thyroid malignancy is less defined. However, patients with a background of thyroid dysfunction presenting with clinically palpable thyroid nodules are followed more closely than the average population, and fine needle aspiration is recommended in such circumstances. Cytological examination of aspirates, and histologic examination of tissue provided from patients with a known history of Graves' disease, managed by radioactive iodine therapy can create a diagnostic dilemma, as the distinction between radiation effect and a malignant primary thyroid neoplasm can be very challenging. Thus, pathologists should be aware of the existence of these changes in the setting of radiation therapy for Graves' disease. Providing pathologists with appropriate clinical history of Graves' disease treated with radioactive iodine is of paramount importance in order to prevent an overdiagnosis of malignancy.

  16. Diagnostic value of plain chest roentgenogram and CT scan findings in four cases of massive thymic hyperplasia

    Kobayashi, T.; Hirabayashi, Y.; Kobayashi, Y.

    1986-01-01

    Massive thymic hyperplasia (MTH) is rare in the pediatric age group, especially in infants. However, because of a wide variation in size and weight of the thymus, an enlarged gland is often resected because of suspicion of a neoplasm or a cyst. Some cases of thymoma resembling pulmonary acute infection occur less frequently than MTH, but if respiratory problems are accompanied by a large thymus immediate diagnosis is often necessary to differentiate between these two conditions. Four infants (14 days to 4 months of age) with MTH were recently studied, all having an acute onset an of severe respiratory distress. The infants were referred to our center with a tentative diagnosis of thymic or other intrathoracic tumors. The following case reports illustrate our diagnostic approach to evaluate patients with symptoms suggesting MTH and the response to the ''steroid test''. (orig.)

  17. The role of colposcopy and typization of human papillomavirus in further diagnostic proceedings in patients with ASC-US cytological finding of the uterine cervix

    Živadinović Radomir

    2009-01-01

    Full Text Available Background/Aim. Bethesda system of classification of cytological findings was introduced in 2001 two subcategories in the category of atypical squamous cells (ASC findings: ASC of undetermined significance (ASC-US and ASC which cannot exclude high-grade intraepithelial lesions (ASC-H. The aim of our study was to assess a possible association of these two subcategories with pathologic biopsy finding and to find out the best further diagnostic proceedings. Methods. At the Clinic of Gynecology and Obstetrics, Niš 130 patients with ASC findings were analyzed. Colposcopy was performed in all study participants. Patients with pathological colposcopic findings underwent cervical biopsy. In 10 patients with pathologic histologic and 15 with benign findings human papilloma virus (HPV typization was done using the Hybrid Capture method. Results. Patients with ASC-H finding had significantly more pathologic biopsies compared with patients with ASC-US finding (57.84: 20.72. Conclusion. Colposcopy was exhibited somewhat higher sensitivity compared to HPV typization (94.7 : 90, but lower sensitivity (79.27 : 86.6. The usage of HPV typization in the triage of patients with ASC cytologic smear induces statistically significant reduction of unnecessary percentage of cervical biopsies.

  18. Diagnostic Performance of Breast Magnetic Resonance Imaging in Non-Calcified Equivocal Breast Findings: Results from a Systematic Review and Meta-Analysis.

    Barbara Bennani-Baiti

    Full Text Available To evaluate the performance of MRI for diagnosis of breast cancer in non-calcified equivocal breast findings.We performed a systematic review and meta-analysis of peer-reviewed studies in PubMed from 01/01/1986 until 06/15/2015. Eligible were studies applying dynamic contrast-enhanced breast MRI as an adjunct to conventional imaging (mammography, ultrasound to clarify equivocal findings without microcalcifications. Reference standard for MRI findings had to be established by histopathological sampling or imaging follow-up of at least 12 months. Number of true or false positives and negatives and other characteristics were extracted, and possible bias was determined using the QUADAS-2 applet. Statistical analyses included data pooling and heterogeneity testing.Fourteen out of 514 studies comprising 2,316 lesions met our inclusion criteria. Pooled diagnostic parameters were: sensitivity (99%, 95%-CI: 93-100%, specificity (89%, 95%-CI: 85-92%, PPV (56%, 95%-CI: 42-70% and NPV (100%, 95%-CI: 99-100%. These estimates displayed significant heterogeneity (P<0.001.Breast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging. However, considering the substantial heterogeneity with regard to prevalence of malignancy, problem solving criteria need to be better defined.

  19. Diagnostic performance of MR imaging findings and quantitative values in the differentiation of seromucinous borderline tumour from endometriosis-related malignant ovarian tumour

    Kurata, Yasuhisa; Kido, Aki; Moribata, Yusaku; Kameyama, Kyoko; Himoto, Yuki; Togashi, Kaori [Kyoto University Graduate School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan); Minamiguchi, Sachiko [Kyoto University Graduate School of Medicine, Department of Diagnostic Pathology, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan); Konishi, Ikuo [Kyoto University Graduate School of Medicine, Department of Gynecology and Obstetrics, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto (Japan)

    2017-04-15

    To evaluate the diagnostic performance of quantitative values and MRI findings for differentiating seromucinous borderline tumours (SMBTs) from endometriosis-related malignant ovarian tumours (MT). This retrospective study examined 19 lesions from SMBT and 84 lesions from MT. The following quantitative values were evaluated using receiver-operating characteristic analysis: overall and solid portion sizes, fluid signal intensity (SI), degree of contrast-enhancement, and mean and minimum apparent diffusion coefficient (ADC) values of the solid portion. Two radiologists independently evaluated four MRI findings characteristic of SMBT, fluid SI on the T1-weighted image and SI of the solid portion on diffusion-weighted image. The diagnostic values of these findings and interobserver agreement were assessed. For diagnosing SMBT, the mean ADC value of the solid portion showed the greatest area under the curve (0.860) (cut-off value: 1.31 x 10{sup -3} mm{sup 2}/s, sensitivity: 1.00, specificity: 0.61). The T2-weighted image (T2WI) high SI solid portion was the most useful finding, with high specificity and interobserver agreement (sensitivity, 0.58; specificity, 0.95-0.96, kappa = 0.96), followed by T2WI low SI core (sensitivity, 0.48-0.63; specificity, 0.98, kappa = 0.68). Mean ADC values of the solid portion, T2WI high SI solid portion, and T2WI low SI core were useful for differentiating SMBT from MT. (orig.)

  20. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Duran, O.; Roda, I.; Macchi, M.

    2016-01-01

    Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  1. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Duran, O.; Roda, I.; Macchi, M.

    2016-07-01

    Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  2. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Orlando Duran

    2016-12-01

    Full Text Available Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC. Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view. Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO. Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  3. Diagnostic accuracy of the clinical and CT findings for differentiating Kikuchi's disease and tuberculous lymphadenitis presenting with cervical lymphadenopathy.

    Baek, Hye Jin; Lee, Jeong Hyun; Lim, Hyun Kyung; Lee, Ha Young; Baek, Jung Hwan

    2014-11-01

    To determine the optimal clinical and CT findings for differentiating Kikuchi's disease (KD) and tuberculous lymphadenitis (TB) in patients presenting with cervical lymphadenopathy. From 2006 to 2010, 87 consecutive patients who were finally diagnosed with KD or TB were enrolled. Two radiologists performed independent analysis of contrast-enhanced neck CT images with regard to the involvement pattern, nodal or perinodal changes, and evidence of the previous infection. Significant clinical and CT findings of KD were determined by statistical analyses. Of the 87 patients, 27 (31%) were classified as having KD and 60 (69%) as having TB. Statistically significant findings of KD patients were younger age, presence of fever, involvement of ≥5 nodal levels or the bilateral neck, no or minimal nodal necrosis, marked perinodal infiltration, and no evidence of upper lung lesion or mediastinal lymphadenopathy. The presence of four or more statistically significant clinical and CT findings of KD had the largest area under the receiver-operating characteristic curve (A z = 0.861; 95% confidence intervals 0.801, 0.909), with a sensitivity of 89% and specificity of 83%. CT can be a helpful tool for differentiating KD from TB, especially when it is combined with the clinical findings.

  4. Shoulder complaints after nerve sparing neck dissections

    van Wilgen, CP; Dijkstra, PU; van der Laan, BFAM; Plukker, JTM; Roodenburg, JLN

    The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least I year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the

  5. Spare part management of an electricity distribution network

    Lauronen, J.

    1998-07-01

    Electricity distribution companies are required to improve their operational cost effectiveness. The storage systems of the companies have traditionally been based on the 'adequate' number of stores with plenty of different components. Therefore, they are potential objects for cost reduction. The effective operation of spare part management of an electricity distribution network requires that the spare components can be delivered at the fault site quickly in order to avoid excessive outage costs. In a fault situation the stores form a net structure. Currently the rural electricity distribution companies lack suitable methods for designing a spare part storage system. This thesis presents a suitable method for the designing problem. The models assume that faults of a distribution network are stochastic. Therefore, they are best suited for component types installed in large quantities. Improved methods for defining the outage, material and total costs for perpetual order quantity and periodic order-up-to-level storage control systems are described. The method for determining the control parameters of the stores is also presented and ways for finding the necessary initial parameter values are introduced. The developed method is tested in Haemeen Saehko Oy (HSOY). The results of the calculations are given. The key findings are: Small differences in the designing results can increase costs remarkably. For example, in HSOY too low stock levels can result in even eight folds higher outage costs than in the proper design. The best number of stores is not the same for all component types. For example, in HSOY the best number of stores is seven for the 50 kVA transformers and one for the 315 kVA transformers in a summer. If the stock levels are increased the protection against the demand variations is the better the shorter the duration of the review period and/or the replenishment lead time is. (orig.)

  6. Spare part management of an electricity distribution network

    Lauronen, J

    1998-07-01

    Electricity distribution companies are required to improve their operational cost effectiveness. The storage systems of the companies have traditionally been based on the 'adequate' number of stores with plenty of different components. Therefore, they are potential objects for cost reduction. The effective operation of spare part management of an electricity distribution network requires that the spare components can be delivered at the fault site quickly in order to avoid excessive outage costs. In a fault situation the stores form a net structure. Currently the rural electricity distribution companies lack suitable methods for designing a spare part storage system. This thesis presents a suitable method for the designing problem. The models assume that faults of a distribution network are stochastic. Therefore, they are best suited for component types installed in large quantities. Improved methods for defining the outage, material and total costs for perpetual order quantity and periodic order-up-to-level storage control systems are described. The method for determining the control parameters of the stores is also presented and ways for finding the necessary initial parameter values are introduced. The developed method is tested in Haemeen Saehko Oy (HSOY). The results of the calculations are given. The key findings are: Small differences in the designing results can increase costs remarkably. For example, in HSOY too low stock levels can result in even eight folds higher outage costs than in the proper design. The best number of stores is not the same for all component types. For example, in HSOY the best number of stores is seven for the 50 kVA transformers and one for the 315 kVA transformers in a summer. If the stock levels are increased the protection against the demand variations is the better the shorter the duration of the review period and/or the replenishment lead time is. (orig.)

  7. Follow-up of coronary artery bypass graft patency: diagnostic efficiency of high-pitch dual-source 256-slice MDCT findings.

    Yuceler, Zeyneb; Kantarci, Mecit; Yuce, Ihsan; Kizrak, Yesim; Bayraktutan, Ummugulsum; Ogul, Hayri; Kiris, Adem; Celik, Omer; Pirimoglu, Berhan; Genc, Berhan; Gundogdu, Fuat

    2014-01-01

    Our aim was to evaluate the diagnostic accuracy of 256-slice, high-pitch mode multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Eighty-eight patients underwent 256-slice MDCT angiography to evaluate their graft patency after CABG surgery using a prospectively synchronized electrocardiogram in the high-pitch spiral acquisition mode. Effective radiation doses were calculated. We investigated the diagnostic accuracy of high-pitch, low-dose, prospective, electrocardiogram-triggering, dual-source MDCT for CABG patency compared with catheter coronary angiography imaging findings. A total of 215 grafts and 645 vessel segments were analyzed. All graft segments had diagnostic image quality. The proximal and middle graft segments had significantly (P < 0.05) better mean image quality scores (1.18 ± 0.4) than the distal segments (1.31 ± 0.5). Using catheter coronary angiography as the reference standard, high-pitch MDCT had the following sensitivity, specificity, positive predictive value, and negative predictive value of per-segment analysis for detecting graft patency: 97.1%, 99.6%, 94.4%, and 99.8%, respectively. In conclusion, MDCT can be used noninvasively with a lower radiation dose for the assessment of restenosis in CABG patients.

  8. CT-Guided Transthoracic Core Biopsy for Pulmonary Tuberculosis: Diagnostic Value of the Histopathological Findings in the Specimen

    Fukuda, Hozumi; Ibukuro, Kenji; Tsukiyama, Toshitaka; Ishii, Rei

    2004-01-01

    We evaluated the value of CT-guided transthoracic core biopsy for the diagnosis of mycobacterial pulmonary nodules. The 30 subjects in this study had pulmonary nodules that had been either diagnosed histopathologically as tuberculosis or were suspected as tuberculosis based on a specimen obtained by CT-guided transthoracic core biopsy. The histopathological findings, the existence of acid-fast bacilli in the biopsy specimens, and the clinical course of the patients after the biopsy were reviewed retrospectively. Two of the three histological findings for tuberculosis that included epithelioid cells, multinucleated giant cells and caseous necrosis were observed in 21 of the nodules which were therefore diagnosed as histological tuberculosis. Six of these 21 nodules were positive for acid-fast bacilli, confirming the diagnosis of tuberculosis. Thirteen of the 21 nodules did not contain acid-fast bacilli but decreased in size in response to antituberculous treatment and were therefore diagnosed as clinical tuberculosis. Seven nodules with only caseous necrosis were diagnosed as suspected tuberculosis, with a final diagnosis of tuberculosis being made in 4 of the nodules and a diagnosis of old tuberculosis in 2 nodules. Two nodules with only multinucleated giant cells were diagnosed as suspected tuberculosis with 1 of these nodules being diagnosed finally as tuberculosis and the other nodule as a nonspecific granuloma. When any two of the three following histopathological findings - epithelioid cells, multinucleated giant cells or caseous necrosis - are observed in a specimen obtained by CT-guided transthoracic core biopsy, the diagnosis of tuberculosis can be established without the detection of acid-fast bacilli or Mycobacterium tuberculosis

  9. Liquid crystalthermography as compared to X-ray diagnostics, clinical findings and capillary microscopy in sclerodermia progressiva

    Loreck, D.; Buehler, G.; Brenke, A.; Schmidt, P.; Heerdegen, I.; Huege, H.

    1985-01-01

    The hands of 55 patients suffering from progressive sclerodermia were examined by liquid crystal thermography. The findings were compared with those of X-ray diagnosis and with clinical results. In 20 patients also capillary microscopy was applied. All patients revealed hypothermias in the fingers, independent from X-ray results, duration of the disease and Raynaud's phenomenon. Hypothermia could involve all fingers and was localized proximally or distally. In most of the patients also hyperthermias, not to be cooled, were found. They were diarthrodial and vasal, respectively

  10. 19 CFR 10.537 - Accessories, spare parts, or tools.

    2010-04-01

    ... parts, or tools will be taken into account as originating or non-originating materials, as the case may... 19 Customs Duties 1 2010-04-01 2010-04-01 false Accessories, spare parts, or tools. 10.537 Section... Free Trade Agreement Rules of Origin § 10.537 Accessories, spare parts, or tools. Accessories, spare...

  11. Inventory Centralization Decision Framework for Spare Parts

    Gregersen, Nicklas; Herbert-Hansen, Zaza Nadja Lee

    2018-01-01

    Within the current literature, there is a lack of a holistic and multidisciplinary approach to managing spare parts and their inventory configuration. This paper addresses this research gap by examining the key contextual factors which influence the degree of inventory centralization and proposes...... a novel holistic theoretical framework, the Inventory Centralization Decision Framework (ICDF), useful for practitioners. Through an extensive review of inventory management literature, six contextual factors influencing the degree of inventory centralization have been identified. Using the ICDF...... practitioners can assess the most advantageous inventory configuration of spare parts. The framework is tested on a large global company which, as a result, today actively uses the ICDF; thus showing its practical applicability....

  12. The spares provisioning problem with parts inventory

    Abboud, Nadim E.

    1990-01-01

    In this research, we consider the spares provisioning problem, where a finite population of homogeneous machines are being deployed to meet a constant demand. While a machine is operating, it could become inoperable due to the failure of a critical built-in part in the machine. Before repairs on the machine can be initiated, however, a replacement part must be obtained. If a replacement part is available from stock, the machine is immediately transferred to the repair subsystem...

  13. Lumbar internal disc derangement in patients with chronic low back pain: diagnostic value of the MR imaging findings as compared with provoked discography as the standard

    Park, Hyeon Seon; Park, Jee Young; Lee, Sang Ho; Ahn, Yong; Lee, Sang Yeun

    2006-01-01

    The aim of this study was to evaluate the diagnostic value of the MR imaging findings with provoked discography used as the standard for painful lumbar disc derangement. Two hundred patients (412 discs), (age rang: 21-77 year), with chronic low back pain underwent MRI and provoked discography. We evaluated the MRI T2-WI findings such as disc degeneration, high-Intensity zones and endplate abnormalities. Subsequently, provocative discography was independently performed with using MR imaging, and a painful disc was defined when moderate to severe and concordant pain was provoked. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the MRI findings with using provoked discography as the standard. 400 discs showed abnormal findings such as disc degeneration, HIZ and endplate abnormalities on the T2-WI images. 12 discs showed normal finding. HIZ or endplate abnormalities were always combined with disc degeneration. The prevalence of each findings were disc degeneration (400 discs: 97.1%), HIZ (111 discs: 26.9%), type I endplate abnormalities (34 discs: 8.3%), type II endplate abnormalities (75 discs: 18.2%), the combined findings of HIZ and type I endplate abnormalities (2 discs: 0.5%) and the combined findings of HIZ and type II endplate abnormalities (7 discs: 1.7%). The disc degeneration showed high sensitivity (99.5%) and low specificity (5.0%), so only the NPV (91.7%) was significant, and not the PPV (47.8%). Each findings of HIZ (sensitivity, 36.5%, specificity, 81.4%; PPV, 63.18%; NPV, 59.5%), type I endplate abnormalities (11.0%, 94.1%, 61.8% and 54.8%, respectively), type II endplate abnormalities (19.8%, 83.2%, 50.7% and 54.3%, respectively), the combined findings of HIZ and type I endplate abnormalities (0.5%, 99.6%, 50.0% and 53.4%, respectively) and the combined findings of HIZ and type II endplate abnormalities (26.0%, 99.1%, 71.4% and 53.8%, respectively) show high specificity, but low

  14. Lumbar internal disc derangement in patients with chronic low back pain: diagnostic value of the MR imaging findings as compared with provoked discography as the standard

    Park, Hyeon Seon; Park, Jee Young; Lee, Sang Ho; Ahn, Yong [Wooridul spine Hospital, Seoul (Korea, Republic of); Lee, Sang Yeun [Puchon Daesung Hospital, Puchon (Korea, Republic of)

    2006-04-15

    The aim of this study was to evaluate the diagnostic value of the MR imaging findings with provoked discography used as the standard for painful lumbar disc derangement. Two hundred patients (412 discs), (age rang: 21-77 year), with chronic low back pain underwent MRI and provoked discography. We evaluated the MRI T2-WI findings such as disc degeneration, high-Intensity zones and endplate abnormalities. Subsequently, provocative discography was independently performed with using MR imaging, and a painful disc was defined when moderate to severe and concordant pain was provoked. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the MRI findings with using provoked discography as the standard. 400 discs showed abnormal findings such as disc degeneration, HIZ and endplate abnormalities on the T2-WI images. 12 discs showed normal finding. HIZ or endplate abnormalities were always combined with disc degeneration. The prevalence of each findings were disc degeneration (400 discs: 97.1%), HIZ (111 discs: 26.9%), type I endplate abnormalities (34 discs: 8.3%), type II endplate abnormalities (75 discs: 18.2%), the combined findings of HIZ and type I endplate abnormalities (2 discs: 0.5%) and the combined findings of HIZ and type II endplate abnormalities (7 discs: 1.7%). The disc degeneration showed high sensitivity (99.5%) and low specificity (5.0%), so only the NPV (91.7%) was significant, and not the PPV (47.8%). Each findings of HIZ (sensitivity, 36.5%, specificity, 81.4%; PPV, 63.18%; NPV, 59.5%), type I endplate abnormalities (11.0%, 94.1%, 61.8% and 54.8%, respectively), type II endplate abnormalities (19.8%, 83.2%, 50.7% and 54.3%, respectively), the combined findings of HIZ and type I endplate abnormalities (0.5%, 99.6%, 50.0% and 53.4%, respectively) and the combined findings of HIZ and type II endplate abnormalities (26.0%, 99.1%, 71.4% and 53.8%, respectively) show high specificity, but low

  15. Inventory management of spare parts in an energy company

    Guajardo, Mario; Roennqvist, Mikael; Halvorsen, Ann Mari; Kallevik, Svein Inge

    2012-06-15

    We address a problem of inventory management of spare parts in the context of a large energy company, producer of oil and gas. Spare parts are critical for assuring operational conditions in offshore platforms. About 200,000 different items are held in several inventory plants. The inventory system implemented at the company corresponds to a min-max system. The control parameters are decided based mainly on the expert judgment of the planners. Also, though the inventory plants can in practice be supplied from each other, the inventory planning is performed separately by the plant planners. This is because of different ownership structures where the studied company has the operative responsibility. The company is pursuing a system in which all planners conform to the same inventory management approach and evaluation, as well as being more cost efficient. Our work focuses on supporting this goal. We apply methods to decide the inventory control parameters for this system under a service level constraint. The methodology we use distinguishes unit-size and lot-size demand cases. We perform computational experiments to find control parameters for a sample of items. After the control parameters are found, we use them to explore the impact of risk pooling among the plants and inaccuracy arising from duplicate item codes.(Author)

  16. Large Omental Cystic Lymphangioma Masquerading as Mucinous Ovarian Neoplasia in an 8-Year-Old Premenarchal Girl: The Findings from Diagnostic Imaging and Laparoscopic-Assisted Excision.

    Takeda, Akihiro; Ito, Hiroaki; Nakamura, Hiromi

    2017-12-01

    Omental cystic lymphangioma is an extremely rare abdominal mass caused by congenital malformation. An 8-year-old premenarchal girl reported abdominal pain. Diagnostic imaging revealed a large multicystic mass measuring 22 cm in diameter, which occupied the entire abdominal cavity with ascites. Emergency laparoscopy revealed a ruptured large cystic mass originating from the greater omentum; this was followed by successful laparoscopic-assisted excision. The pathological diagnosis was omental cystic lymphangioma. The present findings show that omental cystic lymphangioma masquerading as mucinous ovarian neoplasia was a rare cause of acute abdominal events in a young girl. The present case shows that minimally invasive surgery can be a feasible option, which might achieve a favorable outcome in a young patient with an omental cystic lymphangioma. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Post-nerve-sparing prostatectomy, dose-escalated intensity-modulated radiotherapy: effect on erectile function

    Bastasch, Michael D.; Teh, Bin S.; Mai, W.-Y.; Carpenter, L. Steven; Lu, Hsin H.; Chiu, J. Kam; Woo, Shiao Y.; Grant, Walter H.; Miles, Brian J.; Kadmon, Dov; Butler, E. Brian

    2002-01-01

    longer than that of the impotent group, 13.0 months (p<0.001). Conclusion: This is the first report on the effects of dose-escalated IMRT on men who have undergone nerve-sparing prostatectomy. Despite the high dose (mean dose 69.6 Gy) to the prostate bed and nerves, postoperative IMRT had no negative effect on erectile function for the patients who remained potent after nerve-sparing prostatectomy. Longer term follow-up and a larger cohort of patients are warranted to confirm these findings

  18. Valve-sparing aortic root replacement†.

    Koolbergen, David R; Manshanden, Johan S J; Bouma, Berto J; Blom, Nico A; Mulder, Barbara J M; de Mol, Bas A J M; Hazekamp, Mark G

    2015-02-01

    To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed. Median age was 40.3 (range: 13.4-68.6) years and 67 (69.1%) were male. Seven (7.2%) patients were younger than 18 years, the youngest being 13.4 years. Fifty-four (55.7%) had Marfan syndrome, 2 (2.1%) other fibrous tissue diseases, 15 (15.5%) bicuspid aortic valve and 3 (3.1%) had earlier Fallot repair. The reimplantation technique was used in all, with a straight vascular prosthesis in 11 (26-34 mm) and the Valsalva prosthesis in 86 (26-32 mm). Concomitant aortic valve repair was performed in 43 (44.3%), mitral valve repair in 10 (10.3%), tricuspid valve repair in 5 (5.2%) and aortic arch replacement in 3 (3.1%). Mean follow-up was 4.2 ± 2.4 years. Follow-up was complete in all. One 14-year old patient died 1.3 years post-surgery presumably of ventricular arrhythmia. One patient underwent reoperation for aneurysm of the proximal right coronary artery after 4.9 years and 4 patients required aortic valve replacement, 3 of which because of endocarditis after 0.1, 0.8 and 1.3 years and 1 because of cusp prolapse after 3.8 years. No thrombo-embolic complications occurred. Mortality, root reoperation and aortic regurgitation were absent in 88.0 ± 0.5% at 5-year follow-up. Results of valve-sparing root replacement are good, even in association with a high incidence of concomitant valve repair. Valve-sparing aortic root replacement can be performed at a very young age as long as an adult size prosthesis can be implanted. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. Sistem Pendukung Keputusan Pengalokasian Spare Part

    Rita Wiryasaputra

    2013-01-01

    Full Text Available Abstrak Era informasi yang semakin berkembang mempengaruhi lingkungan bisnis. Pengaruhnya dapat dilihat pada proses pengambilan keputusan. Proses pengambilan keputusan terhadap sejumlah alternatif dan sejumlah tujuan diselesaikan dengan sebuah sistem. Sistem  yang bermodelkan Multi Attribute Decision Making (MADM dan Multi Objective Decision Making (MODM. Model MODM digunakan untuk menyelesaikan perancangan alternatif terbaik dan model MADM digunakan untuk menyelesaikan penyeleksian terhadap beberapa alternatif dalam jumlah yang terbatas. Salah satu pendekatan model MADM adalah TOPSIS (Technique for Order Preference by Similarity to Ideal Solution. Konsep utama TOPSIS adalah alternatif preferensi terbaik memiliki jarak terpendek dari solusi ideal positif dan memiliki jarak terjauh dari solusi ideal negatif. Hasil metode TOPSIS adalah perankingan terhadap sejumlah alternatif. Salah satu masukan dari metode TOPSIS adalah nilai pembobotan kriteria. Nilai pembobotan kriteria dapat diberikan secara langsung oleh pengambil keputusan atau dihitung melalui sebuah metode. Penelitian akan menghitung nilai pembobotan kriteria dengan metode Entropy. Tujuannya adalah untuk memberikan objektifitas pembobotan kriteria. Penelitian mengangkat kasus tentang pengalokasian spare part ke sejumlah store. Alternatif terbaik dengan sumber daya yang terbatas, beberapa tujuan yang saling bertentangan didekati dengan metode Goal programming. Pengambilan keputusan akan lebih terarah karena sistem menghasilkan perankingan store spare part, dan menampilkan  informasi alokasi spare part.   Kata kunci— Sistem Pendukung Keputusan, Entropy, TOPSIS, Goal Programming   Abstract The capabilities of computrized systems facilitate decision support in a number of ways, such as speed computations, increased productivity ,improved data management and others. Decisions are often made by individuals. There may be conflicting objectives even for a  decision maker. The conflicting

  20. Stochastic model of forecasting spare parts demand

    Ivan S. Milojević

    2012-01-01

    hypothesis of the existence of phenomenon change trends, the next step in the methodology of forecasting is the determination of a specific growth curve that describes the regularity of the development in time. These curves of growth are obtained by the analytical representation (expression of dynamic lines. There are two basic stages in the process of expression and they are: - The choice of the type of curve the shape of which corresponds to the character of the dynamic order variation - the determination of the number of values (evaluation of the curve parameters. The most widespread method of forecasting is the trend extrapolation. The basis of the trend extrapolation is the continuing of past trends in the future. The simplicity of the trend extrapolation process, on the one hand, and the absence of other information on the other hand, are the main reasons why the trend extrapolation is used for forecasting. The trend extrapolation is founded on the following assumptions: - The phenomenon development can be presented as an evolutionary trajectory or trend, - General conditions that influenced the trend development in the past will not undergo substantial changes in the future. Spare parts demand forecasting is constantly being done in all warehouses, workshops, and at all levels. Without demand forecasting, neither planning nor decision making can be done. Demand forecasting is the input for determining the level of reserve, size of the order, ordering cycles, etc. The question that arises is the one of the reliability and accuracy of a forecast and its effects. Forecasting 'by feeling' is not to be dismissed if there is nothing better, but in this case, one must be prepared for forecasting failures that cause unnecessary accumulation of certain spare parts, and also a chronic shortage of other spare parts. All this significantly increases costs and does not provide a satisfactory supply of spare parts. The main problem of the application of this model is that each

  1. Nipple- and areola-sparing mastectomy for the treatment of breast cancer.

    Mota, Bruna S; Riera, Rachel; Ricci, Marcos Desidério; Barrett, Jessica; de Castria, Tiago B; Atallah, Álvaro N; Bevilacqua, Jose Luiz B

    2016-11-29

    mastectomy (MRM). No participants underwent areola-sparing mastectomy. There was a high risk of confounding for all reported outcomes. For overall survival, the hazard ratio (HR) for NSM compared to SSM was 0.70 (95% CI 0.28 to 1.73; 2 studies; 781 participants) and the HR for NSM compared to MRM was 0.72 (95% CI 0.46 to 1.13; 2 studies, 1202 participants). Local recurrence was evaluated in two studies, the HR for NSM compared to MRM was 0.28 (95% CI 0.12 to 0.68; 2 studies, 1303 participants). The overall risk of complications was different in NSM when compared to other types of mastectomy in general (RR 0.10, 95% CI 0.01 to 0.82, 2 studies, P = 0.03; 1067 participants). With respect to skin necrosis, there was no evidence of a difference with NSM compared to other types of mastectomy, but the confidence interval was wide (RR 4.22, 95% CI 0.59 to 30.03, P = 0.15; 4 studies, 1948 participants). We observed no difference among the three types of mastectomy with respect to the risk of local infection (RR 0.95, 95% CI 0.44 to 2.09, P = 0.91, 2 studies; 496 participants). Meta-analysis was not possible when assessing cosmetic outcomes and quality of life, but in general the NSM studies reported a favourable aesthetic result and a gain in quality of life compared with the other types of mastectomy. The quality of evidence was considered very low for all outcomes due to the high risk of selection bias and wide confidence intervals. The findings from these observational studies of very low-quality evidence were inconclusive for all outcomes due to the high risk of selection bias.

  2. Incorporating single-side sparing in models for predicting parotid dose sparing in head and neck IMRT

    Yuan, Lulin; Wu, Q. Jackie; Yin, Fang-Fang; Yoo, David; Jiang, Yuliang; Ge, Yaorong

    2014-01-01

    Purpose: Sparing of single-side parotid gland is a common practice in head-and-neck (HN) intensity modulated radiation therapy (IMRT) planning. It is a special case of dose sparing tradeoff between different organs-at-risk. The authors describe an improved mathematical model for predicting achievable dose sparing in parotid glands in HN IMRT planning that incorporates single-side sparing considerations based on patient anatomy and learning from prior plan data. Methods: Among 68 HN cases analyzed retrospectively, 35 cases had physician prescribed single-side parotid sparing preferences. The single-side sparing model was trained with cases which had single-side sparing preferences, while the standard model was trained with the remainder of cases. A receiver operating characteristics (ROC) analysis was performed to determine the best criterion that separates the two case groups using the physician's single-side sparing prescription as ground truth. The final predictive model (combined model) takes into account the single-side sparing by switching between the standard and single-side sparing models according to the single-side sparing criterion. The models were tested with 20 additional cases. The significance of the improvement of prediction accuracy by the combined model over the standard model was evaluated using the Wilcoxon rank-sum test. Results: Using the ROC analysis, the best single-side sparing criterion is (1) the predicted median dose of one parotid is higher than 24 Gy; and (2) that of the other is higher than 7 Gy. This criterion gives a true positive rate of 0.82 and a false positive rate of 0.19, respectively. For the bilateral sparing cases, the combined and the standard models performed equally well, with the median of the prediction errors for parotid median dose being 0.34 Gy by both models (p = 0.81). For the single-side sparing cases, the standard model overestimates the median dose by 7.8 Gy on average, while the predictions by the combined

  3. The Value of Diffusion-Weighted Imaging in Combination With Conventional Magnetic Resonance Imaging for Improving Tumor Detection for Early Cervical Carcinoma Treated With Fertility-Sparing Surgery.

    Li, Xiulei; Wang, Ling; Li, Yong; Song, Peiji

    2017-10-01

    This study aimed to investigate the value of diffusion-weighted imaging (DWI) in combination with conventional magnetic resonance imaging (MRI) for improving tumor detection in young patients treated with fertility-sparing surgery because of early cervical carcinoma. Fifty-four patients with stage Ia or Ib1 cervical carcinoma were enrolled into this study. Magnetic resonance examinations were performed for these patients using conventional MRI (including T1-weighted imaging, T2-weighted imaging, and dynamic contrast-enhanced MRI) and DWI. The apparent diffusion coefficient (ADC) values of cervical carcinoma were analyzed quantitatively and compared with that of adjacent epithelium. Sensitivity, positive predictive value, and accuracy of 2 sets of MRI sequences were calculated on the basis of histologic results, and the diagnostic ability of conventional MRI/DWI combinations was compared with that of conventional MRI. The mean ADC value from cervical carcinoma (mean, 786 × 10 mm/s ± 100) was significantly lower than that from adjacent epithelium (mean, 1352 × 10 mm/s ± 147) (P = 0.01). When the threshold ADC value set as 1010 × 10 mm/s, the sensitivity and specificity for differentiating cervical carcinoma from nontumor epithelium were 78.2% and 67.2%, respectively. The sensitivity and accuracy of conventional MRI for tumor detection were 76.0% and 70.4%, whereas the sensitivity and accuracy of conventional MRI/DWI combinations were 91.7% and 90.7%, respectively. Conventional MRI/DWI combinations revealed a positive predictive value of 97.8% and only 4 false-negative findings. The addition of DWI to conventional MRI considerably improves the sensitivity and accuracy of tumor detection in young patients treated with fertility-sparing surgery, which supports the inclusion quantitative analysis of ADC value in routine MRI protocol before fertility-sparing surgery.

  4. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: Comparison with arthroscopic findings

    Amin, Mohammed Farghally; Youssef, Ahmed Omar

    2012-01-01

    Purpose: The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery Material and methods: This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings. Main outcome measures: Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum. Results: Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results. The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients. Conclusion: MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy

  5. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: Comparison with arthroscopic findings

    Amin, Mohammed Farghally, E-mail: Mohammed_amin37@yahoo.com [Department of Radiodiagnosis ElMinya University, ElMinya High Road, ElMinya (Egypt); Youssef, Ahmed Omar [Department of Orthropedic Surgery El Minya University, ElMinya (Egypt)

    2012-09-15

    Purpose: The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery Material and methods: This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings. Main outcome measures: Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum. Results: Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results. The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients. Conclusion: MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy.

  6. Electronic spare-parts catalogue, an elementary module of spare-parts supply; Elektronischer Ersatzteilkatalog als elementarer Baustein der Ersatzteilversorgung

    Nienhaus, Karl; Bartnitzki, Thomas [RWTH Aachen (Germany). Inst. fuer Maschinentechnik der Rohstoffindustrie; Stoll, Andrea [Bucyrus HEX GmbH, Dortmund (Germany). Abt. Technische Dokumentation

    2011-01-15

    Developments in recent years in the supply of spare parts at Bucyrus HEX GmbH have revealed the increasing importance of quick and error-free ordering of spare parts by means of electronic spare-parts catalogues. The spare-parts catalogue has meanwhile become the central component in order to enter eCommerce with the after sales services. These higher requirements will lead to further optimisation and automation of the publishing process on the manufacturer's side and to quicker acceptance of the new digital media and the linking of the electronic spare-parts catalogues to maintenance planning systems on the customer's side. The authors agree that these are exciting times with regard to electronic spare-parts catalogues. (orig.)

  7. Unexpected Findings in a Child with Atypical Hemolytic Uremic Syndrome: An Example of How Genomics Is Changing the Clinical Diagnostic Paradigm

    Eleanor G. Seaby

    2017-05-01

    Full Text Available CBL is a tumor suppressor gene on chromosome 11 encoding a multivalent adaptor protein with E3 ubiquitin ligase activity. Germline CBL mutations are dominant. Pathogenic de novo mutations result in a phenotype that overlaps Noonan syndrome (1. Some patients with CBL mutations go on to develop juvenile myelomonocytic leukemia (JMML, an aggressive malignancy that usually necessitates bone marrow transplantation. Using whole exome sequencing methods, we identified a known mutation in CBL in a 4-year-old Caucasian boy with atypical hemolytic uremic syndrome, moyamoya phenomenon, and dysmorphology consistent with a mild Noonan-like phenotype. Exome data revealed loss of heterozygosity across chromosome 11q consistent with JMML but in the absence of clinical leukemia. Our finding challenges conventional clinical diagnostics since we have identified a pathogenic variant in the CBL gene previously only ascertained in children presenting with leukemia. The increasing affordability of expansive sequencing is likely to increase the scope of clinical profiles observed for previously identified pathogenic variants and calls into question the interpretability and indications for clinical management.

  8. Second Line of Defense Spares Program Assessment

    Henderson, Dale L.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.

    2012-11-20

    The Office of the Second Line of Defense (SLD) is part of the Department of Energy‘s (DOE) National Nuclear Security Administration (NNSA). The SLD Program accomplishes its critical global security mission by forming cooperative relationships with partner countries to install passive radiation detection systems that augment traditional inspection and law enforcement measures by alerting border officials to the presence of special nuclear or other radiological materials in cross-border traffic. An important tenet of the program is to work collaboratively with these countries to establish the necessary processes, procedures, infrastructure and conditions that will enable them to fully assume the financial and technical responsibilities for operating the equipment. As the number of operational deployments grows, the SLD Program faces an increasingly complex logistics process to promote the timely and efficient supply of spare parts.

  9. Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana-findings from the DETECT HIV-TB study

    Bjerrum, Stephanie; Kenu, Ernest; Lartey, Margaret

    2015-01-01

    BACKGROUND: Rapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy. METHODS: HIV-infected adults eligible...

  10. The diagnostic performance of a single GeneXpert MTB/RIF assay in an intensified tuberculosis case finding survey among HIV-infected prisoners in Malaysia.

    Haider Abdulrazzaq Abed Al-Darraji

    Full Text Available Delays in tuberculosis (TB diagnosis, particularly in prisons, is associated with detrimental outcomes. The new GeneXpert MTB/RIF assay (Xpert offers accurate and rapid diagnosis of active TB, but its performance in improving case detection in high-transmission congregate settings has yet to be evaluated. We assessed the diagnostic accuracy of a single Xpert assay in an intensified case finding survey among HIV-infected prisoners in Malaysia.HIV-infected prisoners at a single site provided two early-morning sputum specimens to be examined using fluorescence smear microscopy, BACTEC MGIT 960 liquid culture and a single Xpert. The sensitivity, specificity, negative and positive predictive values of Xpert were calculated relative to gold-standard results using MGIT 960 liquid culture. Relevant clinical and demographic data were used to examine correlates of active TB disease.The majority of enrolled subjects with complete data (N=125 were men (90.4%, age <40 years (61.6% and had injected drugs (75.2%. Median CD4 lymphocyte count was 337 cells/µL (IQR 149-492; only 19 (15.2% were receiving antiretroviral therapy. Of 15 culture-positive TB cases, single Xpert assay accurately detected only eight previously undiagnosed TB cases, resulting in a sensitivity, specificity, positive predictive value and negative predictive value of 53.3% (95% CI 30.12-75.2%, 100% (95% CI 96.6-100%, 100% (95% CI 67.56-100% and 94.0% (95% CI 88.2-97.1%, respectively. Only 1 of 15 (6.7% active TB cases was smear-positive. The prevalence (12% of undiagnosed active pulmonary TB (15 of 125 prisoners was high and associated with longer duration of drug use (AOR 1.14, 95% CI 1.03-1.26, for each year of drug use.Single Xpert assay improved TB case detection and outperformed AFB smear microscopy, but yielded low screening sensitivity. Further examination of the impact of HIV infection on the diagnostic performance of the new assay alongside other screening methods in correctional

  11. Inventory Control of Spare Parts for Operating Nuclear Power plants

    Park, Jong-Hyuck; Jang, Se-Jin; Hwang, Eui-Youp; Yoo, Sung-Soo; Yoo, Keun-Bae; Lee, Sang-Guk; Hong, Sung-Yull [Korea Electric Power Research Institute, Taejon (Korea, Republic of)

    2006-07-01

    Inventory control of spare parts plays an increasingly important role in operation management. The trade-off is clear: on one hand a large number of spare parts ties up a large amount of capital, while on the other hand too little inventory may result in extremely costly emergency actions. This is why during the last few decades inventory of spare parts control has been the topics of many publications. Recently management systems such as manufacturing resources planning (MRP) and enterprise resource planning (ERP) have been added. However, most of these contributions have similar theoretical background. This means the concepts and techniques are mainly based on mathematical assumptions and modeling inventory of spare parts situations Nuclear utilities in Korea have several problems to manage the optimum level of spare parts though they used MRP System. Because most of items have long lead time and they are imported from United States, Canada, France and so on. In this paper, we will examine the available inventory optimization models which are applicable to nuclear power plant and then select optimum model and assumptions to make inventory of spare parts strategies. Then we develop the computer program to select and determine optimum level of spare parts which should be automatically controlled by KHNP ERP system. The main contribution of this paper is an inventory of spare parts control model development, which can be applied to nuclear power plants in Korea.

  12. 48 CFR 217.7506 - Spare parts breakout program.

    2010-10-01

    ..., DoD Supply Chain Materiel Management Regulation, Chapter 8, Section C8.3, for spare parts breakout... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Spare parts breakout program. 217.7506 Section 217.7506 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS...

  13. System-oriented inventory models for spare parts

    Basten, R.J.I.; Houtum, van G.J.J.A.N.

    2014-01-01

    Stocks of spare parts, located at appropriate locations, can prevent long downtimes of technical systems that are used in the primary processes of their users. Since such downtimes are typically very expensive, generally system-oriented service measures are used in spare parts inventory control.

  14. Inventory Control of Spare Parts for Operating Nuclear Power plants

    Park, Jong-Hyuck; Jang, Se-Jin; Hwang, Eui-Youp; Yoo, Sung-Soo; Yoo, Keun-Bae; Lee, Sang-Guk; Hong, Sung-Yull

    2006-01-01

    Inventory control of spare parts plays an increasingly important role in operation management. The trade-off is clear: on one hand a large number of spare parts ties up a large amount of capital, while on the other hand too little inventory may result in extremely costly emergency actions. This is why during the last few decades inventory of spare parts control has been the topics of many publications. Recently management systems such as manufacturing resources planning (MRP) and enterprise resource planning (ERP) have been added. However, most of these contributions have similar theoretical background. This means the concepts and techniques are mainly based on mathematical assumptions and modeling inventory of spare parts situations Nuclear utilities in Korea have several problems to manage the optimum level of spare parts though they used MRP System. Because most of items have long lead time and they are imported from United States, Canada, France and so on. In this paper, we will examine the available inventory optimization models which are applicable to nuclear power plant and then select optimum model and assumptions to make inventory of spare parts strategies. Then we develop the computer program to select and determine optimum level of spare parts which should be automatically controlled by KHNP ERP system. The main contribution of this paper is an inventory of spare parts control model development, which can be applied to nuclear power plants in Korea

  15. 19 CFR 10.600 - Accessories, spare parts, or tools.

    2010-04-01

    ...-Central America-United States Free Trade Agreement Rules of Origin § 10.600 Accessories, spare parts, or... parts, or tools are customary for the good. (a) Regional value content. If the good is subject to a regional value content requirement, the value of the accessories, spare parts, or tools is taken into...

  16. Cattle ranching intensification in Brazil can reduce global greenhouse gas emissions by sparing land from deforestation.

    Cohn, Avery S; Mosnier, Aline; Havlík, Petr; Valin, Hugo; Herrero, Mario; Schmid, Erwin; O'Hare, Michael; Obersteiner, Michael

    2014-05-20

    This study examines whether policies to encourage cattle ranching intensification in Brazil can abate global greenhouse gas (GHG) emissions by sparing land from deforestation. We use an economic model of global land use to investigate, from 2010 to 2030, the global agricultural outcomes, land use changes, and GHG abatement resulting from two potential Brazilian policies: a tax on cattle from conventional pasture and a subsidy for cattle from semi-intensive pasture. We find that under either policy, Brazil could achieve considerable sparing of forests and abatement of GHGs, in line with its national policy targets. The land spared, particularly under the tax, is far less than proportional to the productivity increased. However, the tax, despite prompting less adoption of semi-intensive ranching, delivers slightly more forest sparing and GHG abatement than the subsidy. This difference is explained by increased deforestation associated with increased beef consumption under the subsidy and reduced deforestation associated with reduced beef consumption under the tax. Complementary policies to directly limit deforestation could help limit these effects. GHG abatement from either the tax or subsidy appears inexpensive but, over time, the tax would become cheaper than the subsidy. A revenue-neutral combination of the policies could be an element of a sustainable development strategy for Brazil and other emerging economies seeking to balance agricultural development and forest protection.

  17. Ocular findings and reference values for selected ophthalmic diagnostic tests in the macaroni penguin (Eudyptes chrysolophus) and southern rockhopper penguin (Eudyptes chrysocome).

    Bliss, Cassandra D; Aquino, Susette; Woodhouse, Sarah

    2015-01-01

    To describe ophthalmic examination findings and standard diagnostic test results in 2 penguin species. Macaroni & Southern Rockhopper Penguins. Complete ophthalmic examinations including Schirmer tear test (STT), modified phenol red thread test (PTT), tonometry, and echobiometry were performed on penguins housed at the Detroit Zoo. Mean and standard deviation of ophthalmic tests are reported and compared for significance using two sample t-tests with significance set at P Penguins, and 68% of Rockhopper Penguins. There were anterior segment anomalies in all eyes with cataracts consistent with lens-induced uveitis. The mean modified PTT for the Macaronis was 24.7 ± 6.37 mm/15 s and 25.1 ± 7.07 mm/15 s in the Rockhoppers. The mean STT value for the Macaronis was 12.1 ± 5.43 mm/min and 11.0 ± 3.96 mm/min in the Rockhoppers. Mean intraocular pressure (IOP) for the Macaronis was 21.9 ± 7.05 mmHg measured by applanation tonometry and 29.1 ± 7.16 mmHg using rebound tonometry. The Rockhoppers had a mean IOP of 20.0 ± 5.77 mmHg and 24.1 ± 5.09 mmHg for applanation and rebound tonometry, respectively. In both populations, there was a significant difference in IOP measurement between the two instruments. In the Macaroni penguins, the presence of cataracts correlated significantly with increased age and lower IOP readings. Anterior chamber distance and axial globe length were significantly greater in males than in females in both penguin species. © 2013 American College of Veterinary Ophthalmologists.

  18. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer

    Eisbruch, Avraham; Kim, Hyungjin M.; Terrell, Jeffrey E.; Marsh, Lon H.C.; Dawson, Laura A.; Ship, Jonathan A.

    2001-01-01

    Purpose: To assess long-term xerostomia in patients receiving parotid-sparing radiation therapy (RT) for head-and-neck cancer, and to find the patient and therapy-related factors that affect its severity. Patients and Methods: From March 1994 through January 2000, 84 patients received comprehensive bilateral neck RT using conformal and multisegmental intensity-modulated RT (IMRT) aiming to spare the major salivary glands. Before RT and periodically through 2 years after the completion of RT, salivary flow rates from each of the major salivary glands were selectively measured. At the same time intervals, each patient completed an 8-item self-reported xerostomia-specific questionnaire (XQ). To gain a relative measure of the effect of RT on the minor salivary glands, whose output could not be measured, the surfaces of the oral cavity (extending to include the surface of the base of tongue) were outlined in the planning CT scans. The mean doses to the new organ ('oral cavity') were recorded. Forty-eight patients receiving unilateral neck RT were similarly studied and served as a benchmark for comparison. Factors predicting the XQ scores were analyzed using a random-effects model. Results: The XQ was found to be reliable and valid in measuring patient-reported xerostomia. The spared salivary glands which had received moderate doses in the bilateral RT group recovered to their baseline salivary flow rates during the second year after RT, and the spared glands in the unilateral RT group, which had received very low doses, demonstrated increased salivary production beyond their pre-RT levels. The increase in the salivary flow rates during the second year after RT paralleled an improvement in xerostomia in both patient groups. The improvement in xerostomia was faster in the unilateral compared with the bilateral RT group, but the difference narrowed at 2 years. The major salivary gland flow rates had only a weak correlation with the xerostomia scores. Factors found to be

  19. Laboratory Astrophysics Using a Spare XRS Microcalorimeter

    Audley, M. Damian; Beiersdorfer, Peter; Porter, Frederick Scott; Brown, Gregory; Boyce, Kevin R.; Brekosky, Regis; Brown, Gregory V.; Gendreau, Keith C.; Gygax, John; Kahn, Steve; hide

    2000-01-01

    The XRS instrument on Astro-E is a fully self-contained microcalorimeter x-ray instrument capable of acquiring optimally filtering, and characterizing events for 32 independent pixels. With the launch of the Astro-E spacecraft, a full flight spare detector system has been integrated into a laboratory cryostat for use on the electron beam ion trap (EBIT) at Lawrence Livermore National Laboratory. The detector system contains a microcalorimeter array with 32 instrumented pixels heat sunk to 60 mK using an adiabatic demagnetization refrio,erator. The instrument has a composite resolution of 8eV at 1 keV and 12eV at 6 keV with a minimum of 95% quantum efficiency. This will allow high spectral resolution, broadband observations of collisionally excited plasmas which are produced in the EBIT experiment. Unique to our instrument are exceptionally well characterized 1000 Angstrom thick aluminum on polyimide infrared blocking filters. The detailed transmission function including the edc,e fine structure of these filters has been measured in our laboratory using an erect field grating spectrometer. This will allow the instrument to perform the first broadband absolute flux measurements with the EBIT instrument. The instrument performance as well as the results of preliminary measurements will be discussed. Work performed under the auspices of the U.S. D.o.E. by Lawrence Livermore National Laboratory under contract W-7405-ENG-48 and was supported by the NASA High Energy Astrophysics Supporting Research and Technology Program.

  20. An expert system for spare parts inventory control

    Kim, K.Y.; Chen, P.Y.C.; Okrent, D.

    1987-01-01

    This paper describes an expert system which can handle spare part requirements not only in corrective maintenance (CM) or preventive maintenance (PM), but also when failure rates of components or parts are updated by new data or by predictive maintenance (PDM), and which can also decide optimum stocking level of each spare part. This expert system provides a maintenance (or inventory) manager with an improved basis for decision making in the maintenance related to spare parts. The definitions of PM and PDM from NUREG-1212 (USNRC 1986) are used herein. This expert system used Intellignece/Compiler (Intelligence Ware, 1986) as a language/tool in the IBM-PC

  1. Differences in diagnostic activity in general practice and findings for individuals invited to the danish screening programme for colorectal cancer: a population-based cohort study.

    Juul, Jakob Søgaard; Andersen, Berit; Laurberg, Søren; Carlsen, Anders Helles; Olesen, Frede; Vedsted, Peter

    2018-06-22

    To investigate the diagnostic activity in general practice and the cumulative incidence of colorectal cancer (CRC) in individuals invited to the Danish national screening programme for CRC. A historical population-based cohort study. The Danish CRC screening programme and general practice. The 376,198 individuals invited to the Danish CRC screening programme from 1 March to 31 December 2014. The diagnostic activity (consultations and haemoglobin measures) in general practice in the year preceding the screening invitation and the cumulated incidence of CRC in the year following the screening invitation. Screening participants had significantly higher diagnostic activity than non-participants. Individuals with a positive faecal immunochemical test (FIT) had higher diagnostic activity compared to individuals with a negative FIT, and a small increase in the months leading up to the invitation. Individuals with a screen-detected CRC had lower diagnostic activity than individuals with no CRC. In total, 308 (25.3%) of CRCs diagnosed in the invited population were diagnosed outside the screening programme. Non-participants with CRC more often had low socio-economic status, high comorbidity and stage IV CRC than participants with CRC. There was a tendency that participants and those with a positive FIT had a higher diagnostic activity the year before the screening. This was not seen for those with CRC detected through screening. CRC must still be diagnosed in general practice in the invited population and non-participants are of special interest as they have higher risk of late stage CRC. Key Points Current awareness:Individuals with colorectal cancer (CRC) in screening may be symptomatic and CRC may still occur outside screening in the invited population. Most important points:The majority of individuals with CRC in screening cannot be expected to be diagnosed on symptomatic presentation in general practice GPs have to be aware that CRC still occurs outside screening in

  2. The Protein-Sparing Modified Fast Diet

    Marwan Bakhach MD

    2016-01-01

    Full Text Available Objectives: The protein-sparing modified fast (PSMF is a rigorous way of rapidly losing a large amount of weight. Although adult studies have shown the PSMF to be effective, data in adolescents are lacking. The aim of this study was to determine the efficacy and safety of the PSMF in severely obese adolescents. Methods: 12 subjects who were evaluated in the Obesity Management Program at the Cleveland Clinic from 2011 to 2014 were included. The subjects were initiated on the PSMF after failing other conventional methods of weight loss. Once the goal weight was achieved, subjects were transitioned to the refeeding phase for weight maintenance. Results: Follow-up was scheduled at 3-month (11 patients and 6-month (6 patients intervals. At the 6-month follow-up visit, the average weight loss was 11.19 kg (95% confidence interval = -5.4, -27.8, P = .028, with average of 9.8% from baseline. Fifty percent of subjects had >5% weight loss and 20% had >10% weight loss. Four patients were lost to the follow-up (40%. An improvement was noted in total cholesterol and high-density lipoprotein. Due to a small sample size these results were not statistically significant. Side effects reported by subjects were mild dehydration due to nausea (2 patients, decreased energy (1 patient, and transient labile mood (1 patient. No life-threatening side effects were reported. Conclusion: Our results show that the PSMF diet can be used as an effective and safe method in the outpatient setting for rapid weight loss in adolescents with severe obesity.

  3. Necrotizing fasciitis of soft tissues. Diagnostic imaging findings and literature review; Le fascite necrotizzante dei tessuti molli. Ruolo della diagnostica per immagini e revisione della letteratura

    Parenti, G.C.; Marri, C. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Servizio di Radiodiagnostica; Calandra, G. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Unita' operativa di Pronto Soccorso; Morisi, C. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Servizio di Anatomia Patologica; Zabberoni, W. [Ospedale Civile S. Maria delle Croci, Ravenna (Italy). Div. di Malattie Infettive, Gruppo di rilevamento dati sulle INPS-ASL

    2000-05-01

    It retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of the cases of necrotizing fasciitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. 130 patients with progressive necrotizing soft tissue infections were examined from May 1991 to February 1998. In 32 of them (22-84 years old) the retrospective pathologic diagnosis was necrotizing fasciitis. Involved sites were the limbs (26/32), the cervical region (5/32) and the perineal region (1/32). Nineteen patients were submitted to conventional radiography, also for soft tissue studies. US was performed in an emergency setting in all the 32 cases, by a selected group of US operators particularly skilled in this kind of soft tissue condition. Contrast enhanced CT was performed in 9 cases. B-mode and Doppler US yielded useful and reliable information for prompt and correct diagnosis. Particularly these techniques showed changes as shown at US and histologic findings, but US missed changes in subcutaneous soft tissue and muscle in 11 cases (3/32 and 8/32, respectively) with subsequent histologic confirmation. Contrast enhanced CT better defined the extent of disease and possible complications, especially in sites that are difficult to study with US. Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fasciitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment. [Italian] Scopo di questo lavoro e' di valutare retrospettivamente i casi di fascite necrotizzante giunti all'esame diagnostico con particolare riguardo ai segni radiologici, ecografici e TC che possono essere utili per l'inquadramento diagnostico precoce e corretto. Da

  4. Morphine sparing effect of low dose ketamine during patient ...

    Adele

    2003-09-12

    Sep 12, 2003 ... KEY WORDS: Ketamine, morphine sparing effect, patient controlled intravenous analgesia. ... Measurements: Morphine consumption, visual analogue pain score (VAPS), pulse ..... Brain Research, 1990; 518: 218-222. 7.

  5. [Aortic valve-sparing root reconstruction in Marfan syndrome].

    Ogino, H; Sasaki, H; Hanafusa, Y; Hirata, M; Numata, S; Ando, M; Yagihara, T; Kitamura, S

    2002-07-01

    The outcome of aortic valve-sparing root reconstruction in Marfan syndrome was reviewed. Thirteen patients with Marfan syndrome underwent aortic valve-sparing root reconstruction for annuloaortic ectasia or aortic root dissection between 1994 and 1999. The grade of preoperative aortic regurgitation was I in 4, II in 2, III in 5, IV in 2 patients. The procedures of aortic valve-sparing were reimplantation in 7 and remodeling in 5 patients. There was no hospital and late death. Recurrence of aortic regurgitation greater than moderate grade developed in 1 patient immediately after the surgery and in the other 4 patients in the late stage. One patient of them required aortic valve replacement for it. Aortic valve-sparing root reconstruction is applicable in Marfan patients, although the indication should be cautious. Close observation is needed for recurrence of aortic regurgitation.

  6. Protein Sparing Effects of Lipids in The Practical Diets of ...

    ABSTRACT: A feeding trial was conducted to establish the protein sparing effects of various lipid sources in ... reported to utilize vegetable oil that is high in omega 6 .... origin up to 15 % without any negative effects on ..... Committee on Animal.

  7. Land sharing not sparing in the “green economy”

    Dressler, Wolfram; Koning, de Jessica; Montefrio, Marvin; Firn, Jennifer

    2016-01-01

    In Southeast Asia's green economy, conservation interventions intensify the production of resources as commodities through land sparing activities and zoning in extensively used landscapes. Such initiatives encounter problems where poor resource users diversify livelihoods in multi-functional

  8. Defense Acquisitions: Prices of Marine Corps Spare Parts Have Increased

    2000-01-01

    ...) examine spare part prices to determine whether these were increasing at a rate faster than inflation and the extent to which surcharges, suppliers' prices, and other factors contributed to price increases...

  9. A novel ABCD1 mutation detected by next generation sequencing in presumed hereditary spastic paraplegia: A 30-year diagnostic delay caused by misleading biochemical findings.

    Koutsis, Georgios; Lynch, David S; Tucci, Arianna; Houlden, Henry; Karadima, Georgia; Panas, Marios

    2015-08-15

    To present a Greek family in which 5 male and 2 female members developed progressive spastic paraplegia. Plasma very long chain fatty acids (VLCFA) were reportedly normal at first testing in an affected male and for over 30 years the presumed diagnosis was hereditary spastic paraplegia (HSP). Targeted next generation sequencing (NGS) was used as a further diagnostic tool. Targeted exome sequencing in the proband, followed by Sanger sequencing confirmation; mutation segregation testing in multiple family members and plasma VLCFA measurement in the proband. NGS of the proband revealed a novel frameshift mutation in ABCD1 (c.1174_1178del, p.Leu392Serfs*7), bringing an end to diagnostic uncertainty by establishing the diagnosis of adrenomyeloneuropathy (AMN), the myelopathic phenotype of X-linked adrenoleukodystrophy (ALD). The mutation segregated in all family members and the diagnosis of AMN/ALD was confirmed by plasma VLCFA measurement. Confounding factors that delayed the diagnosis are presented. This report highlights the diagnostic utility of NGS in patients with undiagnosed spastic paraplegia, establishing a molecular diagnosis of AMN, allowing proper genetic counseling and management, and overcoming the diagnostic delay that can be rarely caused by false negative VLCFA analysis. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Reliability Based Spare Parts Management Using Genetic Algorithm

    Rahul Upadhyay

    2015-08-01

    Full Text Available Effective and efficient inventory management is the key to the economic sustainability of capital intensive modern industries. Inventory grows exponentially with complexity and size of the equipment fleet. Substantial amount of capital is required for maintaining an inventory and therefore its optimization is beneficial for smooth operation of the project at minimum cost of inventory. The size and hence the cost of the inventory is influenced by a large no of factors. This makes the optimization problem complex. This work presents a model to solve the problem of optimization of spare parts inventory. The novelty of this study lies with the fact that the developed method could tackle not only the artificial test case but also a real-world industrial problem. Various investigators developed several methods and semi-analytical tools for obtaining optimum solutions for this problem. In this study non-traditional optimization tool namely genetic algorithms GA are utilized. Apart from this Coxs regression analysis is also used to incorporate the effect of some environmental factors on the demand of spares. It shows the efficacy of the applicability of non-traditional optimization tool like GA to solve these problems. This research illustrates the proposed model with the analysis of data taken from a fleet of dumper operated in a large surface coal mine. The optimum time schedules so suggested by this GA-based model are found to be cost effective. A sensitivity analysis is also conducted for this industrial problem. Objective function is developed and the factors like the effect of season and production pressure overloading towards financial year-ending is included in the equations. Statistical analysis of the collected operational and performance data were carried out with the help of Easy-Fit Ver-5.5.The analysis gives the shape and scale parameter of theoretical Weibull distribution. The Coxs regression coefficient corresponding to excessive loading

  11. Neurocognitive sparing of desktop microbeam irradiation.

    Bazyar, Soha; Inscoe, Christina R; Benefield, Thad; Zhang, Lei; Lu, Jianping; Zhou, Otto; Lee, Yueh Z

    2017-08-11

    Normal tissue toxicity is the dose-limiting side effect of radiotherapy. Spatial fractionation irradiation techniques, like microbeam radiotherapy (MRT), have shown promising results in sparing the normal brain tissue. Most MRT studies have been conducted at synchrotron facilities. With the aim to make this promising treatment more available, we have built the first desktop image-guided MRT device based on carbon nanotube x-ray technology. In the current study, our purpose was to evaluate the effects of MRT on the rodent normal brain tissue using our device and compare it with the effect of the integrated equivalent homogenous dose. Twenty-four, 8-week-old male C57BL/6 J mice were randomly assigned to three groups: MRT, broad-beam (BB) and sham. The hippocampal region was irradiated with two parallel microbeams in the MRT group (beam width = 300 μm, center-to-center = 900 μm, 160 kVp). The BB group received the equivalent integral dose in the same area of their brain. Rotarod, marble burying and open-field activity tests were done pre- and every month post-irradiation up until 8 months to evaluate the cognitive changes and potential irradiation side effects on normal brain tissue. The open-field activity test was substituted by Barnes maze test at 8th month. A multilevel model, random coefficients approach was used to evaluate the longitudinal and temporal differences among treatment groups. We found significant differences between BB group as compared to the microbeam-treated and sham mice in the number of buried marble and duration of the locomotion around the open-field arena than shams. Barnes maze revealed that BB mice had a lower capacity for spatial learning than MRT and shams. Mice in the BB group tend to gain weight at the slower pace than shams. No meaningful differences were found between MRT and sham up until 8-month follow-up using our measurements. Applying MRT with our newly developed prototype compact CNT-based image-guided MRT system

  12. Heuristics for multi-item two-echelon spare parts inventory control subject to aggregate and individual service measures

    Topan, E.; Bayindir, Z.P.; Tan, T.

    2017-01-01

    We consider a multi-item two-echelon spare parts inventory system in which the central warehouse operates under a (Q, R) policy and local warehouses implement (S−1,S) policy. The objective is to find the policy parameters minimizing expected system-wide inventory holding and fixed ordering subject

  13. Pathological confirmation of nerve-sparing types performed during robot-assisted radical prostatectomy (RARP).

    Ko, Woo Jin; Hruby, Gregory W; Turk, Andrew T; Landman, Jaime; Badani, Ketan K

    2013-03-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Incremental nerve-sparing techniques (NSTs) improve postoperative erectile function after robot-assisted radical prostatectomy (RARP). However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confirmed that the surgeon performed the nerve preservation as his intended NSTs during RARP. Also, we found that there was more variability in fascia width outcome on the left side compared with the right. Therefore, when performing nerve preservation on the surgeon's non-dominant side, we need to pay more close attention. To confirm that the surgeon achieved true intended histological nerve sparing during robot-assisted radical prostatectomy (RARP) by studying RP specimens. To aid the novice robotic surgeon to develop the skills of RARP. Between June 2008 and May 2009, 122 consecutive patients underwent RARP by a single surgeon (K.K.B.). The degree of nerve sparing (wide resection [WR], interfascial nerve sparing [ITE-NS], intrafascial nerve sparing [ITR-NS]) on both sides was recorded. The posterior sectors of RP specimens from distal, mid, and proximal parts were evaluated. Fascia width (FW) of each position in RP specimens were compared across nerve-sparing types (NSTs). FW was recorded at 15 ° intervals (3-9 o'clock position), measured as the distance between the outermost prostate gland and surgical margin. The slides were reviewed by an experienced uropathologist who was 'blinded' to the NST. In all, 93 men were included. The overall mean (sd) FW was the greatest in the order of WR, ITE-NS, and ITR-NS, at 2.42 (1.62), 1.71 (1.40) and 1.16 (1.08) mm, respectively (P ITE-NS, bilateral ITE-NS, ITE-NS/WR, and bilateral WR, respectively. To further validate and confirm these preliminary findings, additional studies involving multicentre cohorts would be required. The surgeon intended dissection and FW correlate, with ITR

  14. Autopsy-confirmed hippocampal-sparing Alzheimer's disease with delusional jealousy as initial manifestation.

    Fujishiro, Hiroshige; Iritani, Shuji; Hattori, Miho; Sekiguchi, Hirotaka; Matsunaga, Shinji; Habuchi, Chikako; Torii, Youta; Umeda, Kentaro; Ozaki, Norio; Yoshida, Mari; Fujita, Kiyoshi

    2015-09-01

    Alzheimer's disease (AD) is clinically characterized by gradual onset over years with worsening of cognition. The initial and most prominent cognitive deficit is commonly memory dysfunction. However, a subset of AD cases has less hippocampal atrophy than would be expected relative to the predominance of cortical atrophy. These hippocampal-sparing cases have distinctive clinical features, including the presence of focal cortical clinical syndromes. Given that previous studies have indicated that severe hippocampal atrophy corresponds to prominent loss of episodic memory, it is likely that memory impairment is initially absent in hippocampal-sparing AD cases. Here, we report on a patient with an 8-year history of delusional jealousy with insidious onset who was clinically diagnosed as possible AD and pathologically confirmed to have AD with relatively preserved neurons in the hippocampus. This patient had delusional jealousy with a long pre-dementia stage, which initially was characterized by lack of memory impairment. Head magnetic resonance imaging findings showed preserved hippocampal volume with bilateral enlarged ventricles and mild-to-moderate cortical atrophy. Head single-photon emission computed tomography revealed severely decreased regional cerebral blood flow in the right temporal lobe. The resolution of the delusion was attributed to pharmacotherapy by an acetylcholinesterase inhibitor, suggesting that the occurrence of delusional jealousy was due to the disease process of AD. Although the neural basis of delusional jealousy remains unclear, this hippocampal-sparing AD case may be classified as an atypical presentation of AD. © 2015 The Authors. Psychogeriatrics © 2015 Japanese Psychogeriatric Society.

  15. Correlation of (99m) Tc-DPD SPECT/CT Scan Findings and Diagnostic Blockades of Lumbar Medial Branches in Patients with Unspecific Low Back Pain in a Randomized-Controlled Trial.

    Freiermuth, David; Kretzschmar, Martin; Bilecen, Denis; Schaeren, Stefan; Jacob, Augustinus Ludwig; Aeschbach, Armin; Ruppen, Wilhelm

    2015-10-01

    Zygapophyseal joints are the origin of pain in up to 30% of those with unspecific chronic low back pain. Until recently, no reliable clinical tests have been found to identify the patients who would benefit from denervation of the zygapophyseal joints by medial branch blockades. We performed a prospective randomized placebo-controlled trial to evaluate the value of high-resolution single-photon emission computed tomography (SPECT)/computed tomography (CT) of the lumbar spine prior to any diagnostic infiltration of the medial branches. Patients with suspected zygapophyseal joint-related pain were included in the study. After obtaining a SPECT/CT scan of the lumbar spine a set of infiltrations of the medial branches was done with local anesthetics and placebo on different days. Patients and anesthetists were blinded to the results of SPECT/CT and to the infiltrated agents. In a total of 29 study patients, 7 had positive and 22 negative infiltration tests, and 9 had positive and 20 negative SPECT/CT findings. Sensitivity of SPECT/CT for a positive response after diagnostic infiltration was 0.57 (95% confidence interval [CI] 0.18-0.90); specificity was 0.77 (CI 95% 0.55-0.92); odds ratio was 4.53 (CI 95% 0.75-27.40); and diagnostic accuracy was 0.72. Compared with diagnostic infiltrations SPECT/CT scans showed only a moderate sensitivity and specificity and, therefore, may not be recommended as a first line diagnostic tool prior to diagnostic infiltrations. Wiley Periodicals, Inc.

  16. Disseminated Acanthamoeba Infection Presenting With Cutaneous Lesions in an Immunocompromised Patient: A Case Report, Review of Histomorphologic Findings, and Potential Diagnostic Pitfalls.

    Morrison, Annie O; Morris, Robert; Shannon, Amie; Lauer, Scott R; Guarner, Jeannette; Kraft, Colleen S

    2016-02-01

    Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two well-demarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalin-fixed, paraffin-embedded tissue. Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of free-living amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Thyroid diagnostics

    Scriba, P C; Boerner, W; Emrich, S; Gutekunst, R; Herrmann, J; Horn, K; Klett, M; Krueskemper, H L; Pfannenstiel, P; Pickardt, C R

    1985-03-01

    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

  18. Thyroid diagnostics

    Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.; Reiners, C.; Reinwein, D.; Schleusener, H.

    1985-01-01

    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted. (orig./MG) [de

  19. A hot-spare injector for the APS linac

    Lewellen, J. W.

    1999-01-01

    Last year a second-generation SSRL-type thermionic cathode rf gun was installed in the Advanced Photon Source (APS) linac. This gun (referred to as ''gun2'') has been successfully commissioned and now serves as the main injector for the APS linac, essentially replacing the Koontz-type DC gun. To help ensure injector availability, particularly with the advent of top-up mode operation at the APS, a second thermionic-cathode rf gun will be installed in the APS linac to act as a hot-spare beam source. The hot-spare installation includes several unique design features, including a deep-orbit Panofsky-style alpha magnet. Details of the hot-spare beamline design and projected performance are presented, along with some plans for future performance upgrades

  20. SNS Central Helium Liquefier spare Carbon Bed installation and commissioning

    Degraff, Brian D. [ORNL; Howell, Matthew P. [ORNL; Kim, Sang-Ho [ORNL; Neustadt, Thomas S. [ORNL

    2017-07-01

    The Spallation Neutron Source (SNS) Central Helium Liquefier (CHL) at Oak Ridge National Laboratory (ORNL) has been without major operations downtime since operations were started back in 2006. This system utilizes a vessel filled with activated carbon as the final major component to remove oil vapor from the compressed helium circuit prior to insertion into the system's cryogenic cold box. The need for a spare carbon bed at SNS due to the variability of carbon media lifetime calculation to adsorption efficiency will be discussed. The fabrication, installation and commissioning of this spare carbon vessel will be presented. The novel plan for connecting the spare carbon vessel piping to the existing infrastructure will be presented.

  1. [Valve-sparing Replacement in Patients with Aortic Root Dilatation].

    Yamazaki, Kazuhiro; Minatoya, Kenji; Ueda, Ryoma; Takehara, Masato; Sakamoto, Kazuhisa; Ide, Yujiro; Kanemitsu, Hideo; Ueyama, Koji; Ikeda, Tadashi

    2018-01-01

    Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.

  2. Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection.

    Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

    2018-04-01

     Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection.  This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017.  There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%).  Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement. Georg Thieme Verlag KG Stuttgart · New York.

  3. A spare-parts inventory program for TRIGA reactors

    Anderson, T V; Ringle, J C; Johnson, A G [Oregon State University (United States)

    1974-07-01

    As is fairly common with new reactor facilities, we had a few spare parts on hand as part of our original purchase when the OSU TRIGA first went critical in March of 1967. Within a year or so, however, it became apparent that we should critically examine our spare parts inventory in order to avoid unnecessary or prolonged outages due to lack of a crucial piece of equipment. Many critical components (those which must be present and operable according to our license or technical specifications) were considered, and a priority list of acquiring these was established. This first list was drawn up in March, 1969, two years after initial criticality, and some key components were ordered. The availability of funds was the overriding restriction then and now. This spare-parts list is reviewed and new components purchased annually; the average amount spent has been about $2,000 per year. This inventory has proved invaluable more than once; without it, we would have had lengthy shutdowns awaiting the arrival of the needed component. The sobering thought, however, is that our spare-parts inventory is still not complete-far from it, in fact, because this would be prohibitively expensive. It is very difficult to guess with 100% accuracy just which component might need replacing, and your $10,000 inventory of spare parts is useless in that instance if it doesn't include the needed part. An idea worth considering is to either (a) encourage General Atomic, through the collective voice of all TRIGA owners, to maintain a rather complete inventory of replacement parts, or (b) maintain an owner's spare-parts pool, financed by contributions from all the facilities. If either of these pools was established, the needed part could reach any facility within the U.S. within a few days, minimizing reactor outage time. (author)

  4. A spare-parts inventory program for TRIGA reactors

    Anderson, T.V.; Ringle, J.C.; Johnson, A.G.

    1974-01-01

    As is fairly common with new reactor facilities, we had a few spare parts on hand as part of our original purchase when the OSU TRIGA first went critical in March of 1967. Within a year or so, however, it became apparent that we should critically examine our spare parts inventory in order to avoid unnecessary or prolonged outages due to lack of a crucial piece of equipment. Many critical components (those which must be present and operable according to our license or technical specifications) were considered, and a priority list of acquiring these was established. This first list was drawn up in March, 1969, two years after initial criticality, and some key components were ordered. The availability of funds was the overriding restriction then and now. This spare-parts list is reviewed and new components purchased annually; the average amount spent has been about $2,000 per year. This inventory has proved invaluable more than once; without it, we would have had lengthy shutdowns awaiting the arrival of the needed component. The sobering thought, however, is that our spare-parts inventory is still not complete-far from it, in fact, because this would be prohibitively expensive. It is very difficult to guess with 100% accuracy just which component might need replacing, and your $10,000 inventory of spare parts is useless in that instance if it doesn't include the needed part. An idea worth considering is to either (a) encourage General Atomic, through the collective voice of all TRIGA owners, to maintain a rather complete inventory of replacement parts, or (b) maintain an owner's spare-parts pool, financed by contributions from all the facilities. If either of these pools was established, the needed part could reach any facility within the U.S. within a few days, minimizing reactor outage time. (author)

  5. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome.

    Volguina, Irina V; Miller, D Craig; LeMaire, Scott A; Palmero, Laura C; Wang, Xing Li; Connolly, Heidi M; Sundt, Thoralf M; Bavaria, Joseph E; Dietz, Harry C; Milewicz, Dianna M; Coselli, Joseph S

    2009-05-01

    A prospective, international registry study was initiated to provide contemporary comparative data on short-term clinical outcomes after aortic valve-sparing and aortic valve-replacing root operations in patients with Marfan syndrome. The purpose of this initial report is to describe the study design and to compare early outcomes in the first 151 enrolled patients. We assessed 30-day outcomes in 151 patients who met strict Ghent diagnostic criteria for Marfan syndrome and underwent aortic root replacement with either valve-replacing (n = 46) or valve-sparing techniques (n = 105) at one of 18 participating centers. In the valve replacement group, a mechanical composite valve graft was used in 39 (85%) patients and a bioprosthetic valve in 7 (15%). In the valve-sparing group, David V procedures were performed in 57 (54%) patients, David I in 38 (36%), David IV in 8 (8%), Florida sleeve in 1 (1%), and Yacoub remodeling in 1 (1%). No in-hospital or 30-day deaths occurred. Despite longer crossclamp and cardiopulmonary bypass times in the valve-sparing group, there were no significant between-group differences in postoperative complications. Thirty-day valve-related complications occurred in 2 (4%) patients undergoing valve replacement and in 3 (3%) undergoing valve-sparing procedures (P = .6). The analysis of early outcomes revealed that valve-sparing techniques were the most common approach to root replacement in patients with Marfan syndrome in these centers. The complexity of valve-sparing root replacement did not translate into any demonstrable adverse early outcomes. Subsequent analysis will compare the 3-year durability of these two surgical approaches.

  6. Clinical efficacy of FDG-PET scan as preoperative diagnostic tool in cervical cancer stage Ib and IIa: comparison between the results of FDG-PET scan and operative findings

    Kim, Jong Hoon

    1999-12-01

    This study was done to evaluate the clinical feasibility of FDG-PET scan for routine preoperative diagnostic methods in cervical carcinoma. PET-scans were performed from March, 1999 to November, 1999. There were 6 stage Ib and 7 IIa patients and all patients were performed radical hysterectomy and bilateral pelvic lymph node dissections and were evaluated by FDG-PET scan before operation. The mean age of the patients were 50.3 years old. Six cases had lymph node metastases by pelvis MRI, and three cases by FDG-PET scan. We could not find any lymph node metastases at surgery in 3 patients (50.0%) among 6 patients who were diagnosed by nodal metastases by pelvis MRI. And we found 1 patients with nodal metastases who had negative findings by pelvis MRI. By FDG-PET scan, we could find metastases in all positive patients. But we also found 2 additional metastatic cases in the patients with negative findings. In this study, the comparison was very difficult due to the individual differences in the comparison would be made by site-specific not person. The sensitivity of MRI and FDG-PET scan were 50.0% and 30.0%. The specificity were 94.1 % and 95.6%. The positive predictive value were 55.6 % and 50.0 %. In conclusion, we could find any superiority of FDG-PET scan in the diagnosis of lymph node metastases the pelvis MRI. So there are limitations to use the FDG-PET scan in the routine preoperative diagnostic tools in cervical cancer. But if we have more experiences to use the FDG-PET scan such as precise cut-off value of SUV and combination of other imaging technique, the FDG-PET scan are still promising diagnostic tools in cervical cancer.

  7. A review of the findings of the plasma diagnostic package and associated laboratory experiments: Implications of large body/plasma interactions for future space technology

    Murphy, Gerald B.; Lonngren, Karl E.

    1986-01-01

    The discoveries and experiments of the Plasma Diagnostic Package (PDP) on the OSS 1 and Spacelab 2 missions are reviewed, these results are compared with those of other space and laboratory experiments, and the implications for the understanding of large body interactions in a low Earth orbit (LEO) plasma environment are discussed. First a brief review of the PDP investigation, its instrumentation and experiments is presented. Next a summary of PDP results along with a comparison of those results with similar space or laboratory experiments is given. Last of all the implications of these results in terms of understanding fundamental physical processes that take place with large bodies in LEO is discussed and experiments to deal with these vital questions are suggested.

  8. Development of the spare parts program at Shearon Harris

    Roberts, A.J.

    1987-01-01

    Throughout construction, testing, and commercial operation of a nuclear power plant, utilities have a need for spare parts and consumables that must meet a wide range of technical and quality assurance (QA) requirements. The applications for which parts and consumables may be used need to be identified prior to procurement to ensure that the design basis of the plant is not compromised. The spare parts program at Shearon Harris nuclear power plant supported the maintenance department with the proper parts when needed for all but 5% of the maintenance work requests

  9. Cognitive Spare Capacity and Speech Communication: A Narrative Overview

    Mary Rudner

    2014-01-01

    Full Text Available Background noise can make speech communication tiring and cognitively taxing, especially for individuals with hearing impairment. It is now well established that better working memory capacity is associated with better ability to understand speech under adverse conditions as well as better ability to benefit from the advanced signal processing in modern hearing aids. Recent work has shown that although such processing cannot overcome hearing handicap, it can increase cognitive spare capacity, that is, the ability to engage in higher level processing of speech. This paper surveys recent work on cognitive spare capacity and suggests new avenues of investigation.

  10. The miRNA Mirage: How Close Are We to Finding a Non-Invasive Diagnostic Biomarker in Endometriosis? A Systematic Review

    Agrawal, Swati; Tapmeier, Thomas T.; Rahmioglu, Nilufer; Kirtley, Shona; Zondervan, Krina T.; Becker, Christian M.

    2018-01-01

    Background: Endometriosis is a common disorder of the reproductive age group, characterised by the presence of ectopic endometrial tissue. The disease not only causes enormous suffering to the affected women, but also brings a tremendous medical and economic burden to bear on society. There is a long lag phase between the onset and diagnosis of the disease, mainly due to its non-specific symptoms and the lack of a non-invasive test. Endometriosis can only be diagnosed invasively by laparoscopy. A specific, non-invasive test to diagnose endometriosis is an unmet clinical need. The recent discovery of microRNAs (miRNAs) as modulators of gene expression, and their stability and specificity, make them an attractive candidate biomarker. Various studies on miRNAs in endometriosis have identified their cardinal role in the pathogenesis of the disease, and have proposed them as potential biomarkers in endometriosis. Rationale/Objectives: The aims of this review were to study the role of circulatory miRNAs in endometriosis, and bring to light whether circulatory miRNAs could be potential non-invasive biomarkers to diagnose the disease. Search methods: Three databases, PubMed, EMBASE, and BIOSIS were searched, using a combination of Mesh or Emtree headings and free-text terms, to identify literature relating to circulating miRNAs in endometriosis published from 1996 to 31 December 2017. Only peer-reviewed, full-text original research articles in English were included in the current review. The studies meeting the inclusion criteria were critically assessed and checked using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. The dysregulated miRNAs were assessed regarding the concordance between the various studies and their role in the disease. Outcomes: Nine studies were critically analysed, and 42 different miRNAs were found to be dysregulated in them, with only one common miRNA (miR-20a) differentially expressed in more than one study. miR-17-5p/20a

  11. [The possibilities for diagnostics of prescription of death coming based on the changes in the lumbar intervertebral disks (the comparison of the morphological, immunohistochemical and topographical findings)].

    Byval'tsev, V A; Stepanov, I A; Semenov, A V; Perfil'ev, D V; Belykh, E G; Bardonova, L A; Nikiforov, S B; Sudakov, N P; Bespyatykh, I V; Antipina, S L

    The objective of the present study was the comprehensive analysis of the postmortem changes in the lumbar intervertebral disks within different periods after death. A total of seven vertebromotor segments were distinguished in the lumbosacral region of the vertebral column based on the examination of 7 corpses. All these segments were divided into three groups in accordance with the prescription of death coming as follows: up to 12 hours (group 1), between 12 and 24 hours (group 2), and between 24 and 36 hours (group 3) after death. The models of the segments thus obtained were subjected to the study by means of diffusion weighted MRI. The removed intervertebral disks were used for morphological and immunohistochemical investigations. The comparison of the diffusion coefficients (DI) revealed the significant difference between the intervertebral disks assigned to groups 1 and 2 (p<0.01). The number of the cells in the pulpal core, the vertebral end plate, and the fibrous ring in all the above groups of the intervertebral disks was significantly reduced (p<0.01). The analysis of the correlation dependence between cell density and diffusion coefficients has demonstrated the well apparent relationship between these characteristics of the intervertebral disks comprising groups 1 and 2. It is concluded that diffusion weighted MRI in the combination with the calculation of diffusion coefficients for the intervertebral disks provides a tool for diagnostics of prescription of death coming as confirmed by the results of the morphometric studies and immunohistochemical analysis.

  12. A distributed computational search strategy for the identification of diagnostics targets: application to finding aptamer targets for methicillin-resistant staphylococci.

    Flanagan, Keith; Cockell, Simon; Harwood, Colin; Hallinan, Jennifer; Nakjang, Sirintra; Lawry, Beth; Wipat, Anil

    2014-06-30

    The rapid and cost-effective identification of bacterial species is crucial, especially for clinical diagnosis and treatment. Peptide aptamers have been shown to be valuable for use as a component of novel, direct detection methods. These small peptides have a number of advantages over antibodies, including greater specificity and longer shelf life. These properties facilitate their use as the detector components of biosensor devices. However, the identification of suitable aptamer targets for particular groups of organisms is challenging. We present a semi-automated processing pipeline for the identification of candidate aptamer targets from whole bacterial genome sequences. The pipeline can be configured to search for protein sequence fragments that uniquely identify a set of strains of interest. The system is also capable of identifying additional organisms that may be of interest due to their possession of protein fragments in common with the initial set. Through the use of Cloud computing technology and distributed databases, our system is capable of scaling with the rapidly growing genome repositories, and consequently of keeping the resulting data sets up-to-date. The system described is also more generically applicable to the discovery of specific targets for other diagnostic approaches such as DNA probes, PCR primers and antibodies.

  13. A distributed computational search strategy for the identification of diagnostics targets: Application to finding aptamer targets for methicillin-resistant staphylococci

    Flanagan Keith

    2014-06-01

    Full Text Available The rapid and cost-effective identification of bacterial species is crucial, especially for clinical diagnosis and treatment. Peptide aptamers have been shown to be valuable for use as a component of novel, direct detection methods. These small peptides have a number of advantages over antibodies, including greater specificity and longer shelf life. These properties facilitate their use as the detector components of biosensor devices. However, the identification of suitable aptamer targets for particular groups of organisms is challenging. We present a semi-automated processing pipeline for the identification of candidate aptamer targets from whole bacterial genome sequences. The pipeline can be configured to search for protein sequence fragments that uniquely identify a set of strains of interest. The system is also capable of identifying additional organisms that may be of interest due to their possession of protein fragments in common with the initial set. Through the use of Cloud computing technology and distributed databases, our system is capable of scaling with the rapidly growing genome repositories, and consequently of keeping the resulting data sets up-to-date. The system described is also more generically applicable to the discovery of specific targets for other diagnostic approaches such as DNA probes, PCR primers and antibodies.

  14. Lifetime and 12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders among older African Americans: findings from the National Survey of American Life.

    Ford, Briggett C; Bullard, Kai McKeever; Taylor, Robert Joseph; Toler, Amanda K; Neighbors, Harold W; Jackson, James S

    2007-08-01

    The purpose of this study was to estimate lifetime and 12-month prevalence of 13 psychiatric disorders for older African Americans. Data are from the older African American subsample of the National Survey of American Life. Selected measures of lifetime and 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress disorder (PTSD), major depressive disorder, dysthymia, bipolar I and II disorders, alcohol abuse/dependence, and drug abuse/dependence). Twenty-three percent of older African Americans reported at least one lifetime disorder and 8.54% reported at least one 12-month disorder. Alcohol abuse, PTSD, and major depression were the most prevalent lifetime disorders. The most prevalent 12-month disorders were PTSD, major depression, and social phobia. Age, sex, education, and region were significantly associated with the odds of having a lifetime disorder. This is the first study of prevalence rates of serious mental disorders for older African Americans based on a national sample. Demographic correlates of the prevalence of disorders are discussed with an emphasis on age and regional differences.

  15. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  16. Spare parts inventory control under system availability constraints

    Houtum, van G.J.J.A.N.; Kranenburg, A.A.

    2015-01-01

    This book focuses on the tactical planning level for spare parts management. It describes a series of multi-item inventory models and presents exact and heuristic optimization methods, including greedy heuristics that work well for real, life-sized problems. The intended audience consists of

  17. Additive manufacturing technology in spare parts supply chain

    Li, Yao; Jia, Guozhu; Yang, Cheng

    2017-01-01

    Additive Manufacturing (AM) technology has the potential to significantly improve supply chain dynamics. The purpose of this paper is to investigate the impact of AM on spare parts supply chain. Three supply chain scenarios are investigated in this paper, namely conventional supply chain...

  18. Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse

    Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.

    2008-01-01

    Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the…

  19. A single - item replacement decision model for repairable spare ...

    In this paper, we present an analytical method for determining spare parts replacement over an infinite planning horizon. (The objective is to minimize the total system cost). We develop an exact and simple method for determining the time for equipment replacement or making decision about when to replace equipments, ...

  20. Initial Spare Parts of the A400M Aircraft

    2012-03-08

    inventory. Therefore, a balance has to be sought between inventory cost and customer service ( Heizer & Render , 2010:500-501). Nevertheless, spare part... Heizer , Jay H. and Barry Render . Principles of Operations Management. Boston: Pearson Education, 2011. Heuninckx, Baudouin. “Availability

  1. Muscle sparing lateral thoracotomy: the standard incision for thoracic procedures

    Mihai Dumitrescu

    2017-05-01

    Full Text Available Lateral thoracotomy is a versatile approach with many variations and is currently the most widely used incision in thoracic surgery. In the current article we are presenting the muscle-sparing lateral thoracotomy in the lateral decubitus position which we consider to be the “standard” for lateral thoracotomies. Indications, surgical technique and pitfalls are described alongside our experience with thoracic drainage. Although there is no consensus regarding the name of this incision, some authors call it “axillary thoracotomy” while others call it a “modified lateral thoracotomy”, they all agree on one aspect – the importance of muscle sparing – which makes it the go-to thoracotomy for both small and large procedures involving the lung. Lateral muscle sparing thoracotomy allows for good exposure of the pulmonary hilum, fissures, apex and diaphragm. The approach is easy and quick to perform while at the same time ensuring faster postoperative recovery by sparing the latissimus dorsi muscle, better cosmetics and lower postoperative pain score when compared to the posterolateral or classical lateral thoracotomies.

  2. Optimized lens-sparing treatment of retinoblastoma with electron beams

    Steenbakkers, RJHM; Altschuler, MD; DAngio, GJ; Goldwein, JW; Kassaee, A

    1997-01-01

    Purpose: The ideal lens-sparing radiotherapy technique for retinoblastoma calls for 100% dose to the entire retina including the ora serrata and zero dose to the lens, Published techniques, most of which use photons, have not accomplished this ideal treatment. We describe here a technique that

  3. Service differentiation in spare parts supply through dedicated stocks

    Alvarez, Elisa; van der Heijden, Matthijs C.; Zijm, Willem H.M.

    2012-01-01

    We investigate keeping dedicated stocks at customer sites in addition to stock kept at some central location as a tool for applying service differentiation in spare parts supply. We study the resulting two-echelon system in a multi-item setting, both under backordering and under emergency shipments

  4. Survival Following Kidney Sparing Management of Upper Urinary ...

    Survival Following Kidney Sparing Management of Upper Urinary Tract Transitional Cell Carcinoma is Adversely Affected By Prior History of Bladder Cancer. ... The tumor biology rather than the surgical approach dictates prognosis. Patients with higher stage and grade disease may be better served with a more aggressive ...

  5. Nephron-sparing surgery for bilateral Wilms' tumours: A single ...

    All three with unfavourable histology are alive. Four of the five metachronous presentations are alive, as are eight of 12 patients with synchronous bilateral tumours who presented since 2000. Conclusions: Appropriate chemotherapy and nephron-sparing surgery can achieve good results with preservation of adequate renal ...

  6. Quality of the spare triple-GEM detectors

    Lenci, Rosario; Paoletti, Emiliano; Pasquali, Luigi; Pinci, Davide; Piscitelli, Carmelo; Poli Lener, Marco; Sciubba, Adalberto; Tskhadadze, Edisher

    2017-01-01

    Triple-GEM chambers equip the inner region of the M1 muon station. In order to provide spare detectors in case of problems in the operating ones, new chambers have been assembled at the Frascati National Laboratories of the INFN. This note summarizes the results of the quality tests performed at the end of the production procedure.

  7. Prognostic factors in invasive bladder carcinoma treated by combined modality protocol (organ-sparing approach)

    Matos, Tadeja; Cufer, Tanja; Cervek, Jozica; Borstnar, Simona; Kragelj, Borut; Zumer-Pregelj, Mirjana

    2000-01-01

    Purpose: The results of bladder sparing approach for the treatment of muscle-invasive bladder cancer, using a combination of transurethral resection (TUR), chemotherapy, and radiotherapy, are encouraging. The survival of patients treated by this method is similar to the survival of patients treated by radical cystectomy. The aim of our study was to find out which pretreatment characteristics influence the survival of patients treated by organ sparing approach that would enable us to identify the patients most suitable for this type of treatment. Methods and Materials: The prognostic value of different factors, such as age, gender, performance status, hemoglobin level, clinical stage, histologic grade, presence of obstructive uropathy, and completeness of TUR, has been studied in 105 patients with invasive bladder cancer, who received a bladder sparing treatment in the period from 1988 to 1995. They were treated with a combination of TUR, followed by 2-4 cycles of methotrexate, cisplatinum, and vinblastine polychemotherapy. In complete responders the treatment was completed by radiotherapy (50 Gy to the bladder and 40 Gy to the regional lymph nodes), whereas nonresponders underwent cystectomy whenever feasible. Results: Our study has confirmed an independent prognostic value of performance status, histologic grade, and obstructive uropathy, for the disease-specific survival (DSS) of bladder cancer patients treated by a conservative approach. We believe that performance status best reflects the extent of disease and exerts significant influence on the extent and course of treatment, while obstructive uropathy is a good indicator of local spread of the disease, better than clinical T-stage. Our finding that histologic grade is one of the strongest prognostic factors shows that tumor biology also is a very important prognostic factor in patients treated by conservative approach. Conclusion: Patients with muscle-invasive bladder cancer who are most likely to benefit

  8. CWT and RWT Metrics Measure the Performance of the Army's Logistics Chain for Spare Parts

    2003-01-01

    .... Maintaining these weapon systems requires that spare parts be available where and when they are needed. Thus, the responsive functioning of the logistics chain for spare parts is critical to keeping equipment ready to operate...

  9. A COMPARATIVE STUDY OF CLINICAL EXAMINATION, ULTRASOUND FINDINGS, DIAGNOSTIC HYSTEROSCOPY WITH HISTOPATHOLOGICAL EXAMINATION REPORT OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

    Sathenahalli Devegowda Prathibha

    2016-08-01

    Full Text Available BACKGROUND AND OBJECTIVES Abnormal Uterine Bleeding (AUB is a very frequent gynaecological complaint and occurs across the entire age spectrum, approximately 75000 hysterectomies are carried out each year with 30% of these for menstrual problems alone. These menstrual aberrations occur more commonly at extremes of reproductive life. The introduction of hysteroscopy has opened a new dimension in evaluation of patient with AUB replacing the blind technique of Dilatation and Curettage. The present study was undertaken to know the accuracy of various tests with Histopathology. MATERIALS AND METHODS The present prospective study was carried out on 100 patients from reproductive, perimenopausal and postmenopausal age group with abnormal uterine bleeding in Dr. B. R. Ambedkar Medical College and Hospital. RESULTS In the present study, in relation to histopathological examination, clinical findings and hysteroscopy had better accuracy (72% as compared to ultrasound findings (41% in diagnosis of abnormal uterine bleeding. CONCLUSION Hysteroscopy guided biopsy and histopathology complements each other in the evaluation of patient with abnormal uterine bleeding for accurate diagnosis and further treatment.

  10. Diagnostic reasoning strategies and diagnostic success.

    Coderre, S; Mandin, H; Harasym, P H; Fick, G H

    2003-08-01

    Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

  11. Preventing Mitochondrial Diseases: Embryo-Sparing Donor-Independent Options.

    Adashi, Eli Y; Cohen, I Glenn

    2018-05-01

    Mutant mitochondrial DNA gives rise to a broad range of incurable inborn maladies. Prevention may now be possible by replacing the mutation-carrying mitochondria of zygotes or oocytes at risk with donated unaffected counterparts. However, mitochondrial replacement therapy is being held back by theological, ethical, and safety concerns over the loss of human zygotes and the involvement of a donor. These concerns make it plain that the identification, validation, and regulatory adjudication of novel embryo-sparing donor-independent technologies remains a pressing imperative. This Opinion highlights three emerging embryo-sparing donor-independent options that stand to markedly allay theological, ethical, and safety concerns raised by mitochondrial replacement therapy. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Erlotinib-induced rash spares previously irradiated skin

    Lips, Irene M.; Vonk, Ernest J.A.; Koster, Mariska E.Y.; Houwing, Ronald H.

    2011-01-01

    Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed. (orig.)

  13. UHV testing of spare straight section chambers of Indus-2

    Tiwari, S.K.; Ratnakala, K.C.; Sridhar, R.; Bhange, N.J.; Netram; Shukla, S.K.

    2015-01-01

    The vacuum system of Synchrotron Radiation Source, Indus-2, in RRCAT has been functioning up to the mark, continuously for last 10 years. To continue the same trouble-free functioning, it was planned to procure spares for all critical vacuum components, test for UHV performance and keep ready for installation, in case of requirement. As a part of this planning, fifteen chambers made of Aluminium alloy (6063 T6), procured as spare straight section chambers for Indus-2, and were tested for UHV performance. They were tested in batches of 2 or 3 chambers, depending upon their length, and the similar testing-procedure was followed. This paper narrates the tests carried out, and the results obtained. Ultimate vacuum in the range (2 to 9) x 10 -10 mbar was achieved. (author)

  14. Hippocampus sparing in whole-brain radiotherapy. A review

    Oskan, F.; Ganswindt, U.; Schwarz, S.B.; Manapov, F.; Belka, C.; Niyazi, M.

    2014-01-01

    Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing. (orig.) [de

  15. Transparent meta-analysis: does aging spare prospective memory with focal vs. non-focal cues?

    Bob Uttl

    Full Text Available BACKGROUND: Prospective memory (ProM is the ability to become aware of a previously-formed plan at the right time and place. For over twenty years, researchers have been debating whether prospective memory declines with aging or whether it is spared by aging and, most recently, whether aging spares prospective memory with focal vs. non-focal cues. Two recent meta-analyses examining these claims did not include all relevant studies and ignored prevalent ceiling effects, age confounds, and did not distinguish between prospective memory subdomains (e.g., ProM proper, vigilance, habitual ProM (see Uttl, 2008, PLoS ONE. The present meta-analysis focuses on the following questions: Does prospective memory decline with aging? Does prospective memory with focal vs. non-focal cues decline with aging? Does the size of age-related declines with focal vs. non-focal cues vary across ProM subdomains? And are age-related declines in ProM smaller than age-related declines in retrospective memory? METHODS AND FINDINGS: A meta-analysis of event-cued ProM using data visualization and modeling, robust count methods, and conventional meta-analysis techniques revealed that first, the size of age-related declines in ProM with both focal and non-focal cues are large. Second, age-related declines in ProM with focal cues are larger in ProM proper and smaller in vigilance. Third, age-related declines in ProM proper with focal cues are as large as age-related declines in recall measures of retrospective memory. CONCLUSIONS: The results are consistent with Craik's (1983 proposal that age-related declines on ProM tasks are generally large, support the distinction between ProM proper vs. vigilance, and directly contradict widespread claims that ProM, with or without focal cues, is spared by aging.

  16. [Long-term outcome of aortic valve sparing procedures in connective tissue disorders].

    Tanaka, Hiroshi; Ogino, H; Matsuda, H; Minatoya, K; Sasaki, N

    2009-10-01

    The aim of this study is to determine the long-term outcome of aortic valve sparing procedures for patients having connective tissue disorder. Between 1993 and 2008, the aortic valve sparing surgery was performed in 94 patients having aortic root dilatation. Eighty patients of them (37.2 +/- 13.4 years, 50 male) had cystic medial necrosis in the aortic wall, which was confirmed the pathological examination. We reviewed these patients. Sixty percent (48/80) had Marfan syndrome, 5% (4/80) had Loeyz-Dietz syndrome, 2% (2/80) had bicuspid aortic valve, and 11% (9/80) had aortic dissection. Our reimplantation procedure has been refined as followed: with a tube graft in 41, a tube graft with creation of neo-sinuses in 11, and a Valsalva graft in 14. Fourteen patients underwent the remodeling procedure. The follow-up rate was 100% with the duration of 3.7+/- 3.4 years. There were no operative death but six late deaths. Seventeen (21.3%) patients required aortic valve replacement, for recurrent aortic insufficiency in 13 and infection in 4. Freedom from reoperation was 80%, 43%, and freedom from moderate or severe aortic insufficiency was 80%, 54%, at 5 and 10 years, respectively. Pathological findings of the aortic valve obtained in the reoperations showed elongation and prolapse of the aortic valve due to myxomatous degeneration and fibrous thickening caused by aortic insufficiency. Even in connective tissue disorders, aortic valve sparing operation is associated with acceptable long-term durability, although cusp degeneration resulting in recurrent aortic insufficiency might be progressive.

  17. Skin sparing mastectomy: Technique and suggested methods of reconstruction

    Ahmed M. Farahat

    2014-09-01

    Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. Our patients can benefit from safe surgery and have good cosmetic outcomeby applying different reconstructive techniques.

  18. Governance, agricultural intensification, and land sparing in tropical South America

    CEDDIA Michele Graziano; BARDSLEY N. O.; GOMEZ Y PALOMA Sergio; SEDLACEK S

    2014-01-01

    In this paper we address two topical questions: How do the quality of governance and agricultural intensification impact on spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? Using data from the Food and Agriculture Organization, the World Bank, the World Database on Protected Areas, and the Yale Center for Environmental Law and Policy, we estimate a panel data model for six South A...

  19. ERVA - AREVAs Alternative Way for Spare Parts Management

    Hoppe, H.

    2014-07-01

    The availability of equipment and systems in power plants throughout the life of the plant is a key challenge for plant operators. Therefore, the management of spare parts during the entire life cycle of a plant is of particular importance. In order to maintain the functionality of the equipment without retrofit or re-design it is important to have original parts available for use or to ensure there is adequate stock available for the future. (Author)

  20. Aortic valve-sparing surgery in Marfan syndrome.

    Nachum, Eyal; Shinfeld, Amichay; Kogan, Alexander; Preisman, Sergey; Levin, Shany; Raanani, Ehud

    2013-08-01

    Patients with Marfan syndrome are referred for cardiac surgery due to root aneurysm with or without aortic valve regurgitation. Because these patients are young and frequently present with normal-appearing aortic cusps, valve sparing is often recommended. However, due to the genetic nature of the disease, the durability of such surgery remains uncertain. Between February 2004 and June 2012, 100 patients in our department suffering from aortic aneurysm with aortic valve regurgitation underwent elective aortic valve-sparing surgery. Of them, 30 had Marfan syndrome, were significantly younger (30 +/- 13 vs. 53 +/- 16 years), and had a higher percentage of root aneurysm, compared with ascending aorta aneurysm in their non-Marfan counterparts. We evaluated the safety, durability, clinical and echocardiographic mid-term results of these patients. While no early deaths were reported in either group, there were a few major early complications in both groups. At follow-up (reaching 8 years with a mean of 34 +/- 26 months) there were no late deaths, and few major late complications in the Marfan group. Altogether, 96% and 78% of the patients were in New York Heart Association functional class I-II in the Marfan and non-Marfan groups respectively. None of the Marfan patients needed reoperation on the aortic valve. Freedom from recurrent aortic valve regurgitation > 3+ was 94% in the Marfan patients. Aortic valve-sparing surgery in Marfan symdrome patients is safe and yields good mid-term clinical outcomes.

  1. Optimization Policy of Inventory Spare Parts Stocking and Provisioning

    Yun, Tae Sik; Park, Jong Hyuk; Hwang, Eui Youp; Yoo, Sung Soo; Kim, In Hwan

    2005-01-01

    Spare parts, especially safety related items, being used in Korea Nuclear Power Plants are largely from the United States, Canada, France and the like, meaning the inventory policy, stocking and provision, should be influenced by those countries' nuclear industry situation in a direct or indirect manner. As a result of nuclear industry downturn practices, lots of spare supply corporations have gone broke, which gave immediate signals we have to resolve inventory purchases in need. It is known for that nuclear maintenance spare items are particularly composed of many kinds with small quantities, which makes matters worse to Korea nuclear operation company (KHNP) to purchase them. Hence, Korea nuclear business is trying to change its exinventory purchasing paradigm into innovative schemes it did not have to consider in the past. In order to implement a new stocking policy, it should be kept in mind the factors such as not only how much to stock for a smooth operation but also economic point of view. Even though it has done a lot of studies to optimize the inventory stocking level in an academic curiosity, it is not easy to apply the researches in a real world. Since it is so tough job to anticipate when and how large scale even occurs. Hence, it would be thought that the nuclear inventory should be dealt in a different manner from the general manufacturing industry

  2. Aortic valve-sparing in 37 patients with Marfan syndrome: midterm results with David operation.

    Forteza, Alberto; De Diego, Javier; Centeno, Jorge; López, Maria Jesus; Pérez, Enrique; Martín, Carlos; Sánchez, Violeta; Rufilanchas, Juan J; Cortina, Jose

    2010-01-01

    We reviewed our experience with aortic valve-sparing operations in Marfan syndrome during last 5 years. Between March 2004 and June 2009, 94 patients with aortic root aneurysms underwent valve-sparing operations. Of these, 37 (68% male) were diagnosed with Marfan syndrome, according to the Ghent diagnostic criteria. Mean age was 30 +/- 10 years (range, 11 to 59 years). Moderate/severe aortic regurgitation was present in 13%, and the mean diameter of the Valsalva sinuses was 50 +/- 4 mm (range, 42 to 62 mm). The David V modification was performed in the last 28 patients. Additional procedures were mitral valve repair in 6, tricuspid valve repair in 3, closure of septal atrial defect in 2, and closure of a patent foramen ovale in 13. Mean follow-up was 27 +/- 16 months (range, 1 to 61 months). There were no in-hospital deaths and no major adverse outcomes. One patient required implantation of a mechanical prosthesis during the same procedure because of moderate aortic regurgitation. One late death occurred. No patients required reoperation. In the last follow-up, 23 patients did not have aortic regurgitation, 12 had grade I, and 1 had grade II. No thromboembolic complications have been documented, and 97% of the patients are free from anticoagulation. Short-term and midterm results with the reimplantation technique for aortic root aneurysms in Marfan patients are excellent. If long-term results are similar, this technique could be the treatment of choice for these patients. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Testing the Logistics Model of Supplying Military Vehicles with Spare Parts

    Robert Spudić

    2007-07-01

    Full Text Available The use of advanced transport means understands alsotheir supply by spare and consumable parts. In order to solvethe problem of the required quantities, costs of purchase andstorage of the parts, it is necessary to solve the problem of stocksmanagement. The wear of tyres for military vehicles in extremeexploitation conditions is of random character. How fast thetyres will wear on the all-ten·ain and heavy motor vehicle dependson the driver's skill and the external conditions (weather,terrain. All the conditions are of random character and in orderto determine as accurately as possible the wear of tyres it isnecessary to monitor the wear of tyres within a certain time period,and to find the approximate probability of tyre wear in thefuture period of time. When the probability of tyre wear is determined,stochastic supply management model is used to calculatethe value of the stocks which allows optimal planning ofstocks of spare parts at minimal costs. The stochastic model allowsoptimal calculation for the purchase of consumable partsof transport means whose consumption depends on the randomconditions and events.

  4. Diagnostic thoracoscopy

    Plavec Goran

    2002-01-01

    Full Text Available Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic diagnosis was confirmed histopathologically in 31 patient (81.12%. In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%. Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%. Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%. In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

  5. Whole-body low-dose computed tomography in multiple myeloma staging: Superior diagnostic performance in the detection of bone lesions, vertebral compression fractures, rib fractures and extraskeletal findings compared to radiography with similar radiation exposure.

    Lambert, Lukas; Ourednicek, Petr; Meckova, Zuzana; Gavelli, Giampaolo; Straub, Jan; Spicka, Ivan

    2017-04-01

    The primary objective of the present prospective study was to compare the diagnostic performance of conventional radiography (CR) and whole-body low-dose computed tomography (WBLDCT) with a comparable radiation dose reconstructed using hybrid iterative reconstruction technique, in terms of the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings. The secondary objective was to evaluate lesion attenuation in relation to its size. A total of 74 patients underwent same-day skeletal survey by CR and WBLDCT. In CR and WBLDCT, two readers assessed the number of osteolytic lesions at each region and stage according to the International Myeloma Working Group (IMWG) criteria. A single reader additionally assessed extraskeletal findings and their significance, the number of vertebral compressions and bone fractures. The radiation exposure was 2.7±0.9 mSv for WBLDCT and 2.5±0.9 mSv for CR (P=0.054). CR detected bone involvement in 127 out of 486 regions (26%; Prib fractures compared with CR (188 vs. 47; Pfractures, vertebral compressions and extraskeletal findings, which results in up- or downstaging in 24% patients according to the IMWG criteria. The attenuation of osteolytic lesions can be measured with the avoidance of the partial volume effect.

  6. Radical prostatectomy, sparing of the seminal vesicles, and painful orgasm.

    Mogorovich, Andrea; Nilsson, Andreas E; Tyritzis, Stavros I; Carlsson, Stefan; Jonsson, Martin; Haendler, Leif; Nyberg, Tommy; Steineck, Gunnar; Wiklund, N Peter

    2013-05-01

    Erectile dysfunction has been widely investigated as the major factor responsible for sexual bother in patients after radical prostatectomy (RP); painful orgasm (PO) is one element of this bother, but little is known about its prevalence and its effects on sexual health. This study aims to investigate the prevalence of PO and to identify potential risk factors. A total of 1,411 consecutive patients underwent open (radical retropubic prostatectomy) or robot-assisted laparoscopic RP between 2002 and 2006. The patients were asked to complete a study-specific questionnaire. Of a total of 145 questions, 5 dealt with the orgasmic characteristics. The questionnaire was also administered to a comparison group of 442 persons, matched for age and area of residency. The response rate was 91% (1,288 patients). A total of 143 (11%) patients reported PO. Among the 834 men being able to have an orgasm, the prevalence was 18% vs. 6% in the comparison group (relative risk [RR] 2.8, 95% confidence interval [CI] 1.7-4.5). When analyzed as independent variables, bilateral seminal vesicle (SV)-sparing approach (RR 2.33, 95% CI 1.0-5.3, P = 0.045) and age <60 years were significantly related to the presence of PO (95% CI 0.5-0.9, P = 0.019). After adjustment for age, bilateral SV-sparing still remained a significant predictor for occurrence of PO. We found that PO occurs significantly more often in patients undergoing bilateral SV-sparing RP when compared with age-matched comparison population. © 2013 International Society for Sexual Medicine.

  7. Outcomes of Aortic Valve-Sparing Operations in Marfan Syndrome.

    David, Tirone E; David, Carolyn M; Manlhiot, Cedric; Colman, Jack; Crean, Andrew M; Bradley, Timothy

    2015-09-29

    In many cardiac units, aortic valve-sparing operations have become the preferred surgical procedure to treat aortic root aneurysm in patients with Marfan syndrome, based on relatively short-term outcomes. This study examined the long-term outcomes of aortic valve-sparing operations in patients with Marfan syndrome. All patients with Marfan syndrome operated on for aortic root aneurysm from 1988 through 2012 were followed prospectively for a median of 10 years. Follow-up was 100% complete. Time-to-event analyses were calculated using the Kaplan-Meier method with log-rank test for comparisons. A total of 146 patients with Marfan syndrome had aortic valve-sparing operations. Reimplantation of the aortic valve was performed in 121 and remodeling of the aortic root was performed in 25 patients. Mean age was 35.7 ± 11.4 years and two-thirds were men. Nine patients had acute, 2 had chronic type A, and 3 had chronic type B aortic dissections before surgery. There were 1 operative and 6 late deaths, 5 caused by complications of dissections. Mortality rate at 15 years was 6.8 ± 2.9%, higher than the general population matched for age and sex. Five patients required reoperation on the aortic valve: 2 for endocarditis and 3 for aortic insufficiency. Three patients developed severe, 4 moderate, and 3 mild-to-moderate aortic insufficiency. Rate of aortic insufficiency at 15 years was 7.9 ± 3.3%, lower after reimplantation than remodeling. Nine patients developed new distal aortic dissections during follow-up. Rate of dissection at 15 years was 16.5 ± 3.4%. Aortic valve-sparing operations in patients with Marfan syndrome were associated with low rates of valve-related complications in long-term follow-up. Residual and new aortic dissections were the leading cause of death. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Qualified equipment for spare parts and modifications in Belgium

    Berthe, J.

    1993-01-01

    This paper describes the procedure followed for the procurement of components for spare parts and systems modifications, the legal and quality assurance environment and the specific measures taken to cope with various codes and standards. For pressure components, the regulation aspects of the American code used during the construction phase of plants had to be adapted to the Belgian context and to the actual industry situation. Obsolescence of products is treated either by qualification of a new product or by design modifications, or by replacement with an already qualified product. In these cases, the work is handled by the utility's engineering organization. 2 figs

  9. Detecting depression in patients with coronary heart disease: a diagnostic evaluation of the PHQ-9 and HADS-D in primary care, findings from the UPBEAT-UK study.

    Mark Haddad

    Full Text Available People with coronary heart disease (CHD are at heightened risk of depression, and this co-occurrence of conditions is associated with poorer outcomes including raised mortality. This study compares the diagnostic accuracy of two depression case finding instruments in CHD patients relative to a diagnostic standard, the revised Clinical Interview Schedule (CIS-R.The Patient Health Questionnaire (PHQ-9, the Hospital Anxiety and Depression Scale depression subscale (HADS-D and the CIS-R depression module were administered to 803 patients identified from the CHD registers of GP practices in Greater London.Of 730 recruited patients without previously identified depression, 32 (4.4% met ICD-10 depressive episode criteria according to the CIS-R. For the PHQ-9 and HADS-D lower cut-points than those routinely recommended were associated with improved case identifying properties. The PHQ-9 appeared the superior instrument using a cut-point of ≥8 (sensitivity=94%; specificity=84%. Using categorical scoring the PHQ-9 was 59% sensitive and 95% specific. For the HADS-D using cut-point ≥5, sensitivity was 81% and specificity was 77%. Areas under the curves (AUC (standard error were 0.95 (0.01 and 0.88 (0.02 for the PHQ-9 and HADS-D, and 0.91 (0.02 for PHQ-9 using the categorical algorithm. Statistically significant differences between AUCs of the PHQ-9 and the HADS-D favoured the former. Severity ratings compared across measures indicated inconsistency between recommended bandings: the PHQ-9 categorised a larger proportion of participants with mild and moderate depression.This is the first large-scale investigation of the accuracy of these commonly used measures within a primary care CHD population. Our results suggest that although both scales have acceptable abilities and can be used as case identification instruments for depression in patients with CHD, the PHQ-9 appeared diagnostically superior. Importantly, optimal cut-off points for depression

  10. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy

    Shah, Chirag; Badiyan, Shahed; Berry, Sameer; Khan, Atif J.; Goyal, Sharad; Schulte, Kevin; Nanavati, Anish; Lynch, Melanie; Vicini, Frank A.

    2014-01-01

    Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging

  11. Deterministic and heuristic models of forecasting spare parts demand

    Ivan S. Milojević

    2012-04-01

    Full Text Available Knowing the demand of spare parts is the basis for successful spare parts inventory management. Inventory management has two aspects. The first one is operational management: acting according to certain models and making decisions in specific situations which could not have been foreseen or have not been encompassed by models. The second aspect is optimization of the model parameters by means of inventory management. Supply items demand (asset demand is the expression of customers' needs in units in the desired time and it is one of the most important parameters in the inventory management. The basic task of the supply system is demand fulfillment. In practice, demand is expressed through requisition or request. Given the conditions in which inventory management is considered, demand can be: - deterministic or stochastic, - stationary or nonstationary, - continuous or discrete, - satisfied or unsatisfied. The application of the maintenance concept is determined by the technological level of development of the assets being maintained. For example, it is hard to imagine that the concept of self-maintenance can be applied to assets developed and put into use 50 or 60 years ago. Even less complex concepts cannot be applied to those vehicles that only have indicators of engine temperature - those that react only when the engine is overheated. This means that the maintenance concepts that can be applied are the traditional preventive maintenance and the corrective maintenance. In order to be applied in a real system, modeling and simulation methods require a completely regulated system and that is not the case with this spare parts supply system. Therefore, this method, which also enables the model development, cannot be applied. Deterministic models of forecasting are almost exclusively related to the concept of preventive maintenance. Maintenance procedures are planned in advance, in accordance with exploitation and time resources. Since the timing

  12. Relative sensory sparing in the diabetic foot implied through vibration testing

    Todd O'Brien

    2013-09-01

    Full Text Available Background: The dorsal aspect of the hallux is often cited as the anatomic location of choice for vibration testing in the feet of diabetic patients. To validate this preference, vibration tests were performed and compared at the hallux and 5th metatarsal head in diabetic patients with established neuropathy. Methods: Twenty-eight neuropathic, diabetic patients and 17 non-neuropathic, non-diabetic patients underwent timed vibration testing (TVT with a novel 128 Hz electronic tuning fork (ETF at the hallux and 5th metatarsal head. Results: TVT values in the feet of diabetic patients were found to be reduced at both locations compared to controls. Unexpectedly, these values were significantly lower at the hallux (P < 0.001 compared to the 5th metatarsal head. Conclusion: This study confirms the hallux as the most appropriate location for vibration testing and implies relative sensory sparing at the 5th metatarsal head, a finding not previously reported in diabetic patients.

  13. Impact of penile rehabilitation with low-dose vardenafil on recovery of erectile function in Japanese men following nerve-sparing radical prostatectomy

    Yuzo Nakano

    2014-12-01

    Full Text Available Erectile dysfunction (ED is a major complication after radical prostatectomy (RP; however, debate continues regarding the efficacy of penile rehabilitation in the recovery of the postoperative erectile function (EF. This study included a total of 103 consecutive sexually active Japanese men with localized prostate cancer undergoing nerve-sparing RP, and analyzed the postoperative EF, focusing on the significance of penile rehabilitation. In this series, 24 and 79 patients underwent bilateral and unilateral nerve-sparing RPs, respectively, and 10 or 20 mg of vardenafil was administered to 35 patients at least once weekly, who agreed to undergo penile rehabilitation. Twelve months after RP, 48 (46.6% of the 103 patients were judged to have recovered EF sufficient for sexual intercourse without any assistance. The proportion of patients who recovered EF in those undergoing penile rehabilitation (60.0% was significantly greater than that in those without penile rehabilitation (38.2%. Of several parameters examined, the preoperative International Index of Erectile Function-5 (IIEF-5 score and nerve-sparing procedure were significantly associated with the postoperative EF recovery rates in patients with and without management by penile rehabilitation, respectively. Furthermore, univariate analysis identified the preoperative IIEF-5 score, nerve-sparing procedure and penile rehabilitation as significant predictors of EF recovery, among which the preoperative IIEF-5 score and nerve-sparing procedure appeared to be independently associated with EF recovery. Considering these findings, despite the lack of independent significance, penile rehabilitation with low-dose vardenafil could exert a beneficial effect on EF recovery in Japanese men following nerve-sparing RP.

  14. Hair sparing does not compromise real-time magnetic resonance imaging guided stereotactic laser fiber placement for temporal lobe epilepsy.

    Singh, Shikha; Kumar, Kevin K; Rabon, Matthew J; Dolce, Dana; Halpern, Casey H

    2018-06-01

    Pre-operative scalp shaving is conventionally thought to simplify postoperative cranial wound care, lower the rate of wound infections, and ease optimal incision localization. Over the past few decades, some neurosurgeons have refrained from scalp shaving in order to improve patient satisfaction with brain surgery. However, this hair-sparing approach has not yet been explored in the growing field of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT). This study investigated the initial impact of a no-shave technique on post-operative wound infection rate as well as on entry and target accuracy in MRgLITT for mesial temporal epilepsy. Eighteen patients selected by the Stanford Comprehensive Epilepsy Program between November 2015 and August 2017 were included in the study. All patients underwent functional selective amygdalohippocampotomies using MRgLITT entirely within a diagnostic MRI suite. No hair was removed and no additional precautions were taken for hair or scalp care. Otherwise, routine protocols for surgical preparations and wound closure were followed. The study was performed under approval from Stanford University's Internal Review Board (IRB-37830). No post-operative wound infections or erosions occurred for any patient. The mean entry point error was 2.87 ± 1.3 mm and the mean target error was 1.0 ± 0.9 mm. There have been no other complications associated with this hair-sparing approach. The study's results suggest that hair sparing in MRgLITT surgery for temporal epilepsy does not increase the risk of wound complications or compromise accuracy. This preferred cosmetic approach may thus appeal to epilepsy patients considering such interventions. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Global survey of malaria rapid diagnostic test (RDT) sales, procurement and lot verification practices: assessing the use of the WHO-FIND Malaria RDT Evaluation Programme (2011-2014).

    Incardona, Sandra; Serra-Casas, Elisa; Champouillon, Nora; Nsanzabana, Christian; Cunningham, Jane; González, Iveth J

    2017-05-15

    Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, and assurance of quality is a key factor to promote good adherence to test results. Since 2007, the World Health Organization (WHO) and the Foundation for Innovative New Diagnostics (FIND) have coordinated a Malaria RDT Evaluation Programme, comprising a pre-purchase performance evaluation (product testing, PT) and a pre-distribution quality control of lots (lot testing, LT), the former being the basis of WHO recommendations for RDT procurement. Comprehensive information on malaria RDTs sold worldwide based on manufacturers' data and linked to independent performance data is currently not available, and detailed knowledge of procurement practices remains limited. The use of the PT/LT Programme results as well as procurement and lot verification practices were assessed through a large-scale survey, gathering product-specific RDT sales and procurement data (2011-14 period) from a total of 32 manufacturers, 12 procurers and 68 National Malaria Control Programmes (NMCPs). Manufacturers' reports showed that RDT sales had more than doubled over the four years, and confirmed a trend towards increased compliance with the WHO procurement criteria (from 83% in 2011 to 93% in 2014). Country-level reports indicated that 74% of NMCPs procured only 'WHO-compliant' RDT products, although procurers' transactions datasets revealed a surprisingly frequent overlap of different products and even product types (e.g., Plasmodium falciparum-only and Plasmodium-pan) in the same year and country (60 and 46% of countries, respectively). Importantly, the proportion of 'non-complying' (i.e., PT low scored or not evaluated) products was found to be higher in the private health care sector than in the public sector (32% vs 5%), and increasing over time (from 22% of private sector sales in 2011 to 39% in 2014). An estimated 70% of the RDT market was covered by the LT programme. The opinion about the PT

  16. Spare parts management for nuclear power generation facilities

    Scala, Natalie Michele

    With deregulation, utilities in the power sector face a much more urgent imperative to emphasize cost efficiencies as compared to the days of regulation. One major opportunity for cost savings is through reductions in spare parts inventories. Most utilities are accustomed to carrying large volumes of expensive, relatively slow-moving parts because of a high degree of risk-averseness. This attitude towards risk is rooted in the days of regulation. Under regulation, companies recovered capital inventory costs by incorporating them into the base rate charged to their customers. In a deregulated environment, cost recovery is no longer guaranteed. Companies must therefore reexamine their risk profile and develop policies for spare parts inventory that are appropriate for a competitive business environment. This research studies the spare parts inventory management problem in the context of electric utilities, with a focus on nuclear power. It addresses three issues related to this problem: criticality, risk, and policy. With respect to criticality and risk, a methodology is presented that incorporates the use of influence diagrams and the Analytic Hierarchy Process (AHP). A new method is developed for group aggregation in the AHP when Saaty and Vargas' (2007) dispersion test fails and decision makers are unwilling or unable to revise their judgments. With respect to policy, a quantitative model that ranks the importance of keeping a part in inventory and recommends a corresponding stocking policy through the use of numerical simulation is developed. This methodology and its corresponding models will enable utilities that have transitioned from a regulated to a deregulated environment become more competitive in their operations while maintaining safety and reliability standards. Furthermore, the methodology developed is general enough so that other utility plants, especially those in the nuclear sector, will be able to use this approach. In addition to regulated

  17. Active patient decision making regarding nerve sparing during radical prostatectomy: a novel approach.

    Lavery, Hugh J; Prall, David N; Abaza, Ronney

    2011-08-01

    The motivation to preserve sexual function can vary widely among patients before prostatectomy. Increasing patient involvement may allow a more personalized experience and may improve satisfaction. We assessed a strategy of surgeon deference to patient choice in regard to nerve sparing to determine to what degree patients are rational actors and capable of active decision making. A total of 150 patients treated with prostatectomy participated in a standardized preoperative discussion regarding the concept of nerve sparing, extracapsular extension and the potential need for adjuvant radiation in the event of local recurrence. Each patient was given his nomogram predicted risk of extracapsular extension and then elected nerve sparing or nonnerve sparing. The corresponding procedure was performed unless grossly invasive disease was encountered. Of the 150 patients 109 chose nerve sparing (73%) and 41 chose nonnerve sparing (27%). In patients with a nomogram predicted risk of extracapsular extension less than 20%, 20% to 50% and greater than 50%, nerve sparing was elected by 88%, 41% and 25%, respectively. Patients with lower risks of extracapsular extension electing nonnerve sparing were older and had higher rates of erectile dysfunction. Empowering patients to decide on their nerve sparing status is a reasonable strategy that did not lead to a high rate of patients with a high risk of extracapsular extension electing nerve sparing. With proper counseling informed patients made reasonable decisions, and appeared to be conservative, prioritizing cancer control in the majority of instances where extracapsular extension risk was high. In addition, they may have been overly conservative in electing nonnerve sparing when the risk was low. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. Design of inventory pools in spare part support operation systems

    Mo, Daniel Y.; Tseng, Mitchell M.; Cheung, Raymond K.

    2014-06-01

    The objective of a spare part support operation is to fulfill the part request order with different service contracts in the agreed response time. With this objective to achieve different service targets for multiple service contracts and the considerations of inventory investment, it is not only important to determine the inventory policy but also to design the structure of inventory pools and the order fulfilment strategies. In this research, we focused on two types of inventory pools: multiple inventory pool (MIP) and consolidated inventory pool (CIP). The idea of MIP is to maintain separated inventory pools based on the types of service contract, while CIP solely maintains a single inventory pool regardless of service contract. Our research aims to design the inventory pool analytically and propose reserve strategies to manage the order fulfilment risks in CIP. Mathematical models and simulation experiments would be applied for analysis and evaluation.

  19. Allotment of aircraft spare parts using genetic alorithms

    Batchoun Pascale

    2003-01-01

    Full Text Available In this paper we attempt to determine the optimal allocation of aircraft parts used as spares for replacement of defective parts on-board of a departing flight. In order to minimize the cost of delay caused by unexpected failure, Genetic algorithms (GAs are used to allocate the initial quantity of parts among the airports. GAs are a class of adaptive search procedures, that distinguish themselves from other optimization techniques by the use of concepts from population genetics to guide the search. Problem-specific knowledge is incorporated into the problem and efficient parameters are identified and tested for the task of optimizing the allocation of parts. The approach is illustrated by numerical results.

  20. Open Maximal Mucosa-Sparing Functional Total Laryngectomy

    Pavel Dulguerov

    2017-10-01

    Full Text Available BackgroundTotal laryngectomy after (chemoradiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.MethodsA retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemoradiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.ResultsThe cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%. All patients resumed oral diet and experienced a functional tracheo-esophageal voice.ConclusionMMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications.

  1. Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy.

    Stolzenburg, Jens-Uwe; Rabenalt, Robert; Do, Minh; Schwalenberg, Thilo; Winkler, Mathias; Dietel, Anja; Liatsikos, Evangelos

    2008-05-01

    Based on our recently published anatomic studies, we present the most recent refinement of the endoscopic extraperitoneal radical prostatectomy (EERPE), the intrafascial nerve-sparing EERPE (nsEERPE). As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule, freeing the prostate laterally from its thin surrounding fascia that contains small vessels and nerves. The technique enables puboprostatic ligament preservation, leaving intact endopelvic fascia, periprostatic fascia, and neurovascular bundles. The operation was performed in 150 patients with indications for nerve-sparing procedure. The mean operative time was 131 min (range: 50-210 min) and the mean catheterization time was 5.9 d (range: 4-20 d). Twelve months postoperatively, 94.3% of the patients were continent (no need for pads), 4.6% had minimal stress incontinence, and one patient required >2 pads/d. At the 12-mo follow-up, the potency rates (erections sufficient for intercourse with or without the use of phosphodiesterase 5 [PDE5] inhibitors) of the patients who underwent bilateral intrafascial nsEERPE were 89.7% (age: 44-55 yr), 81.1% (age: 56-65 yr), and 61.9% (age: >65 yr). Positive surgical margins in pT2 and pT3 tumors were 4.5% and 29.4%, respectively. The intrafascial nsEERPE enables the dissection of the prostate with limited trauma to the surrounding fascias and the enclosed neurovascular bundles. We propose that the preserved neurovascular bundles with intrafascial nsEERPE are more viable. The results advocate this proposition.

  2. Optimized lens-sparing treatment of retinoblastoma with electron beams

    Steenbakkers, Roel J.H.M.; Altschuler, Martin D.; D'Angio, Giulio J.; Goldwein, Joel W.; Kassaee, Alireza

    1997-01-01

    Purpose: The ideal lens-sparing radiotherapy technique for retinoblastoma calls for 100% dose to the entire retina including the ora serrata and zero dose to the lens. Published techniques, most of which use photons, have not accomplished this ideal treatment. We describe here a technique that approaches this ideal configuration using electron beam therapy. Methods and Materials: Dose-modeling calculations were made using a computer program built around a proprietary algorithm. This program calculates 3D dose distribution for electrons and photons and uses the Cimmino feasibility method for the inverse problem of beam weighting to achieve the prescribed dose. The algorithm has been verified in the ocular region by measurements in a RANDO phantom. To search for an ideal lens-sparing beam setup, a stylized phantom of an 8-month-old infant was generated with built-in inhomogeneities, and a phantom of a 5-year-old child was generated from a patient CT series. Results: Of more than 100 different beam setups tested, two 9 MeV electron beams at gantry angles plus and minus 26 degrees from the optic nerve axis achieved the best distribution. Both fields have a lens block and an isocenter between the globe and origin of the optic nerve. When equal doses are given to both fields, the entire extent of the retina (including ora serrata) received 100%, while the lens received 10% or less. Conclusion: The two-oblique-electron-beam technique here described appears to meet most of the stringent dosimetry needed to treat retinoblastoma. It is suitable for a range of ages, from infancy to early childhood years

  3. Hippocampus sparing in whole-brain radiotherapy. A review

    Oskan, F. [University of Munich, Department of Radiation Oncology and CCC Neuro-Oncology, Munich (Germany); Saarland University Medical Center, Department of Radiation Oncology, Homburg/Saar (Germany); Ganswindt, U.; Schwarz, S.B.; Manapov, F.; Belka, C.; Niyazi, M. [University of Munich, Department of Radiation Oncology and CCC Neuro-Oncology, Munich (Germany)

    2014-04-15

    Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing. (orig.) [German] Die Technik der Ganzhirnbestrahlung (''whole-brain radiation therapy'', WBRT) hat sich seit der Entwicklung nicht wesentlich veraendert. Allerdings stellten die Neuentwicklung von Techniken wie die intensitaetsmodulierte Strahlentherapie (IMRT), die volumenmodulierte Arc-Therapie (VMAT) oder die helikale Tomotherapie sowie immer groesseres Wissen ueber das neurale Stammzellkompartiment (NSCs) das herkoemmliche Ganzhirn-Paradigma in Frage. Die hippocampusschonende Ganzhirnbestrahlung ist eine neuartige Technik, welche die kritische Region des Hippocampus schont, ohne die Tumorkontrolle zu gefaehrden. Ueber diese Technik gibt es bisher nur eine begrenzte Datenlage im Sinne von Planungs- und Machbarkeitsstudien. Klinische Daten bzgl. der Behandlungsergebnisse fehlen nach wie vor, aber einige prospektive Studien sind im Gange, um nicht nur die Machbarkeit zu belegen, sondern auch das klinische Outcome im Sinne einer verringerten Neurotoxizitaet nachzuweisen. (orig.)

  4. Molecular Diagnostics

    Choe, Hyonmin; Deirmengian, Carl A.; Hickok, Noreen J.; Morrison, Tiffany N.; Tuan, Rocky S.

    2015-01-01

    Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Current molecular diagnostics are an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid...

  5. [Modern biomaterials as hemostatic dressings in kidney nephron sparing surgery (NSS)--murine model. A preliminary report].

    Nowacki, Maciej; Jundziłł, Arkadiusz; Bieniek, Miłosz; Kowalczyk, Tomasz; Kloskowski, Tomasz; Drewa, Tomasz

    2012-01-01

    Kidney cancer is now days, one of the main problems in oncological urology. More frequent cases detection of this type of cancer and the implementation of modern methods of treatment, involves the public and good diagnostic radiological imaging methods. Approximately 40% of renal tumors are detected clinically as a changes in T1N0M0 stage. This means that in these patients, surgery can be performed using the method of nephron sparing surgery (NSS), far from consisting the implementation of radical nephrectomy. Unfortunately, despite the saving nature of this type of treatment, NSS methods are associated with local recurrence of tumor formation. Another problem is intra operative bleeding, that's why in order to stop this negative process surgeons currently use hemostatic dressings. Potentially and clinically significant solution could be a combination of this two main problematics points of concern, through the use of modern biomaterials coated on oncostatic substances as a haemostatic dressings, to the prevention of tumor recurrence. The aim of this work, was to present preliminary report of the use of advanced biomaterials, as haemostatic dressings in an experimental technique of nephron sparing surgery on an murine model. In the experiment we use two types of biomaterials and the standard haemostatic dressing used in the nephron sparing surgery (NSS) as a control. We use a polycaprolactone biomaterial obtained by electrospinning. As a second type of biomaterial, we use a homogeneous material with a structure similar to wool, also obtained from medical polycaprolactone by electrospinning. As an murine (in vivo) model in the study, we use 10 C57BL/J mice (with the local ethical committee permission). 8 mice were used in the present study, 2 mice were constituted as a separate control for obtaining the bleeding data. Kidney melanoma cells were implanted under the C57B1/J B16 mouse kidney fibrous capsule, one week before NSS. After 3 weeks the animals were

  6. Cannabinoid 1 receptor knockout mice display cold allodynia, but enhanced recovery from spared-nerve injury-induced mechanical hypersensitivity.

    Sideris, Alexandra; Piskoun, Boris; Russo, Lori; Norcini, Monica; Blanck, Thomas; Recio-Pinto, Esperanza

    2016-01-01

    The function of the Cannabinoid 1 receptor (CB1R) in the development of neuropathic pain is not clear. Mounting evidence suggest that CB1R expression and activation may contribute to pain. Cannabinoid 1 receptor knockout mice (CB1R-/-) generated on a C57Bl/6 background exhibit hypoalgesia in the hotplate assay and formalin test. These findings suggest that Cannabinoid 1 receptor expression mediates the responses to at least some types of painful stimuli. By using this mouse line, we sought to determine if the lack of Cannabinoid 1 receptor unveils a general hypoalgesic phenotype, including protection against the development of neuropathic pain. The acetone test was used to measure cold sensitivity, the electronic von Frey was used to measure mechanical thresholds before and after spared-nerve injury, and analysis of footprint patterns was conducted to determine if motor function is differentially affected after nerve-injury in mice with varying levels of Cannabinoid 1 receptor. At baseline, CB1R-/- mice were hypersensitive in the acetone test, and this phenotype was maintained after spared-nerve injury. Using calcium imaging of lumbar dorsal root ganglion (DRG) cultures, a higher percentage of neurons isolated from CB1R-/- mice were menthol sensitive relative to DRG isolated from wild-type (CB1R+/+) mice. Baseline mechanical thresholds did not differ among genotypes, and mechanical hypersensitivity developed similarly in the first two weeks following spared-nerve injury (SNI). At two weeks post-SNI, CB1R-/- mice recovered significantly from mechanical hypersensitivity, while the CB1R+/+ mice did not. Heterozygous knockouts (CB1R+/-) transiently developed cold allodynia only after injury, but recovered mechanical thresholds to a similar extent as the CB1R-/- mice. Sciatic functional indices, which reflect overall nerve health, and alternation coefficients, which indicate uniformity of strides, were not significantly different among genotypes. Cold allodynia and

  7. Demarcation laser photocoagulation of selected macula-sparing rhegmatogenous retinal detachments.

    Vrabec, T R; Baumal, C R

    2000-06-01

    To report a series of macula-sparing rhegmatogenous retinal detachments (MSRRDs) treated with demarcation laser photocoagulation (DLP). Retrospective, noncomparative case series. Thirty-one patients (34 eyes) with primary or recurrent MSRRDs without associated visual field loss, necrotizing retinitis, or proliferative vitreoretinopathy (PVR), managed with DLP from November 1992 through May 1999. Demarcation laser photocoagulation consisting of a triple row of confluent laser burns. Best corrected postoperative visual acuity and MSRRD progression or recurrence. Thirty-four primary and recurrent MSRRDs were treated by DLP, which consisted of a triple row of confluent laser burns. Macula-sparing rhegmatogenous retinal detachments were located in all quadrants and affected 10% to 45% of the retina. Findings associated with MSRRDs included lattice degeneration (12 eyes), vitreous hemorrhage (4 eyes), and demarcation line (9 eyes). Symptoms (photopsias or floaters) were associated with 14 MSRRDs. Eight eyes were myopic and 11 were pseudophakic. Thirty-two MSRRDs were shallow, two were dome shaped, and all were smooth without corrugations. Follow-up ranged from 1.5 to 80 months (mean, 15.8 months; median, 17 months). Thirty-three of 34 detachments remained stable after DLP. Three flattened spontaneously. One eye was managed with scleral buckle 6 weeks after DLP. Progression was attributed to incomplete laser treatment. Best corrected postoperative visual acuity was the same or improved in all but one eye, in which a cataract developed. Demarcation laser photocoagulation is an effective method to manage acute or chronic, primary or recurrent MSRRDs without associated PVR that are shallow and smooth without corrugations. Demarcation laser photocoagulation is an alternative to both observation and surgical repair for these select MSRRDs.

  8. Transgressors, victims, and cry babies: is basic moral judgment spared in autism?

    Leslie, Alan M; Mallon, Ron; DiCorcia, Jennifer A

    2006-01-01

    Human social intelligence comprises a wide range of complex cognitive and affective processes that appear to be selectively impaired in autistic spectrum disorders. The study of these neuro-developmental disorders and the study of canonical social intelligence have advanced rapidly over the last twenty years by investigating the two together. Specifically, studies of autism have provided important insights into the nature of "theory of mind" abilities, their normal development and underlying neural systems. At the same time, the idea of impaired development of the neurocognitive mechanisms underlying "theory of mind" has shed new light on the nature of autistic disorders. This general approach is not restricted to the study of impairments but extends to mapping areas of social intelligence that are spared in autism. Here we investigate basic moral judgment and find that it appears to be substantially intact in children with autism who are severely impaired in "theory of mind". At the same time, we extend studies of moral reasoning in normal development by way of a new control task, the "cry baby" task. Cry baby scenarios, in which the distress of the victim is "unreasonable" or "unjustified," do not elicit moral condemnation from normally developing preschoolers or from children with autism. Judgments of moral transgressions in which the victim displays distress are therefore not likely the result of a simple automatic reaction to distress and more likely involve moral reasoning. Mapping the cognitive comorbidity patterns of disordered development must encompass both impairments and sparings because both are needed to make sense of the neural and genetic levels.

  9. Psoriasis sparing the polio-affected limb: Is it merely the koebner phenomenon?

    B C Ravikumar

    2014-01-01

    Full Text Available Psoriasis being a common skin condition, atypical forms and unusual localizations of this disease are quite frequently seen. However, psoriasis sparing a polio-affected limb is extremely rare. We report a case of an adult male, who presented with psoriasis distributed all over the body but with almost complete sparing of the polio-affected left lower limb.

  10. Sparing bilateral neck level IB in oropharyngeal carcinoma and xerostomia outcomes.

    Tam, Moses; Riaz, Nadeem; Kannarunimit, Danita; Peña, Angela P; Schupak, Karen D; Gelblum, Daphna Y; Wolden, Suzanne L; Rao, Shyam; Lee, Nancy Y

    2015-08-01

    To assess whether sparing neck-level IB in target delineation of node-positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia outcomes without compromising locoregional control (LRC). A total of 125 N+ OPC patients with a median age of 57 years underwent chemoradiation between May 2010 and December 2011. A total of 74% of patients had T1-T2 disease, 26% T3-T4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had target delineation sparing of bilateral level IB (the spared cohort) versus no sparing (the treated cohort). Sparing of contralateral high-level II nodes was also performed more consistently in the spared cohort. A prospective xerostomia questionnaire (patient reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer rated) at each patient follow-up visit was also recorded. The 2-year LRC for the spared and treated cohorts was 97.5% and 93.8%, respectively (median follow-up, 23.2 mo). No locoregional failures occurred outside of treatment fields. The spared cohort experienced significant benefits in patient-reported xerostomia summary scores (P=0.021) and observer-rated xerostomia scores (P=0.006). In addition, there were significant reductions in mean doses to the ipsilateral submandibular gland (63.9 vs. 70.5 Gy; Pxerostomia outcomes.

  11. An improved method for forecasting spare parts demand using extreme value theory

    Zhu, S.; Dekker, R.; van Jaarsveld, W.; Renjie, R.W.; Koning, A.J.

    2017-01-01

    Inventory control for spare parts is essential for many organizations due to the trade-off between preventing high holding cost and stockouts. The lead time demand distribution plays a central role in inventory control. The estimation of this distribution is problematic as the spare part demand is

  12. Configuration model of partial repairable spares under batch ordering policy based on inventory state

    Ruan Minzhi; Luo Yi; Li Hua

    2014-01-01

    Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost (LCC). With an analysis of various impacts on support system, the spares demand rate forecast model is constructed. According to systemic analysis method, spares support effectiveness evaluation indicators system is built, and then, initial spares configuration and optimization method is researched. To the issue of discarding and con-sumption for incomplete repairable items, its expected backorders function is approximated by Laplace demand distribution. Combining the (s-1, s) and (R, Q) inventory policy, the spares resup-ply model is established under the batch ordering policy based on inventory state, and the optimi-zation analysis flow for spares configuration is proposed. Through application on shipborne equipment spares configuration, the given scenarios are analyzed under two constraint targets:one is the support effectiveness, and the other is the spares cost. Analysis reveals that the result is consistent with practical regulation;therefore, the model’s correctness, method’s validity as well as optimization project’s rationality are proved to a certain extent.

  13. Connecting inventory control and repair shop control : a differentiated control structure for repairable spare parts

    Driessen, M.A.; Rustenburg, W.D.; Houtum, van G.J.J.A.N.; Wiers, V.C.S.

    2014-01-01

    This paper presents a control structure for integrating decisions on spare parts inventory control and the control of repair shops for maintenance spare parts. A dierentiated control structure is proposed for the various repair shop types recognized in practice. Decisions functions are mapped and

  14. Spare parts sharing with joint optimization of maintenance and inventory policies

    Larsen, Christian; Wong, Hartanto Wijaya; Nielsen, Lars Relund

    We consider a collaborative arrangement where a number of companies are willing to share expensive spare parts, required for both failure replacement and preventive maintenance purposes. We develop a discrete-time Markov decision model for the joint optimization of maintenance and spare parts...

  15. Optimal provisioning strategies for slow moving spare parts with small lead times

    Teunter, R.H.; Klein Haneveld, W.K.

    When an expensive piece of equipment is bought, spare parts can often be bought at a reduced price. A decision must be made about the initial provisioning of spare parts. Furthermore, if at a certain time the stock drops to zero, because a number of failures have occurred, a decision must be made

  16. Integrated service engineers and spare parts planning in the maintenance logistics

    Al Hanbali, Ahmad; Zijm, Willem H.M.

    2016-01-01

    We analyze the integrated tactical capacity planning of spare parts supply and workforce allocation in maintenance logistics of advanced equipment. The equipment time-to-failure, spare parts replenishment time, and equipment repair time are random and independent of each other.

  17. SOME SIMPLE APPROACHES TO PLANNING THE INVENTORY OF SPARE COMPONENTS OF AN INDUSTRIAL SYSTEM

    Alenka Brezavšek

    2016-02-01

    Full Text Available Two variants of a simple stochastic model for planning the inventory of spare components supporting maintenance of an industrial system are developed. In both variants, the aim is to determine how many spare components are needed at the beginning of a planning interval to fulfil demand for corrective replacements during this interval. Under the first variant, the acceptable probability of spare shortage during the planning interval is chosen as a decision variable while in the second variant, the adequate spare inventory level is assessed taking into account the expected number of component failures within the planning interval. Calculation of the number of spare components needed depends on the form of the probability density function of component failure times. Different statistical density functions that are useful to describe this function are presented. Advantages and disadvantages of using a particular density function in our model are discussed. The applicability of the model is given through illustrative numerical examples.

  18. Multiobjective spare part allocation by means of genetic algorithms and Monte Carlo simulation

    Marseguerra, Marzio; Zio, Enrico; Podofillini, Luca

    2005-01-01

    The management of spare parts is a major concern for several industrial organizations, due to the significant amount of resources invested every year for holding spares inventories. In this paper, we explore the possibility of using genetic algorithms for the task of optimizing the number of spare parts required by a multi-component system. To address the question of how many spares should be kept in inventory for each component kind, the analyst is required to define objective functions with respect to which the optimization is sought. In our work we will look at multiple objectives such as, for example, the maximization of system revenues and the minimization of the total spares volume. The modeling of the system failure, repair and replacement stochastic processes is done by means of Monte Carlo simulation, whose flexibility allows a closer adherence to reality

  19. MR findings in peliosis hepatis

    Saatci, I. [Dept. of Diagnostic Radiology, Hacettepe Univ. Hospital, Ankara (Turkey); Coskun, M. [Dept. of Diagnostic Radiology, Hacettepe Univ. Hospital, Ankara (Turkey); Boyvat, F. [Dept. of Diagnostic Radiology, Hacettepe Univ. Hospital, Ankara (Turkey); Cila, A. [Dept. of Diagnostic Radiology, Hacettepe Univ. Hospital, Ankara (Turkey); Guergey, A. [Dept. of Pediatric Hematology, Hacettepe Univ. Hospital, Ankara (Turkey)

    1995-02-01

    We report the MR findings of peliosis hepatis in a patient with Fanconi anemia who had been treated with anabolic androgenic steroids for 3 years. The MR examination of the upper abdomen was performed on a 0.5 T system. The signal intensity of the right lobe of the liver was diffusely increased in all sequences. Within the enlarged liver, multiple foci of brighter signal were seen involving both right and left lobes. The lesions showed contrast enhancement. A cystic cavity with an enhancing rim was seen representing a haematoma cavity. The spleen was spared the patient died of sepsis and the postmortem examination confirmed the diagnosis of peliosis hepatis. (orig.)

  20. MR findings in peliosis hepatis

    Saatci, I.; Coskun, M.; Boyvat, F.; Cila, A.; Guergey, A.

    1995-01-01

    We report the MR findings of peliosis hepatis in a patient with Fanconi anemia who had been treated with anabolic androgenic steroids for 3 years. The MR examination of the upper abdomen was performed on a 0.5 T system. The signal intensity of the right lobe of the liver was diffusely increased in all sequences. Within the enlarged liver, multiple foci of brighter signal were seen involving both right and left lobes. The lesions showed contrast enhancement. A cystic cavity with an enhancing rim was seen representing a haematoma cavity. The spleen was spared the patient died of sepsis and the postmortem examination confirmed the diagnosis of peliosis hepatis. (orig.)

  1. Companion diagnostics

    Jørgensen, Jan Trøst; Hersom, Maria

    2016-01-01

    of disease mechanisms, things are slowly changing. Within the last few years, we have seen an increasing number of predictive biomarker assays being developed to guide the use of targeted cancer drugs. This type of assay is called companion diagnostics and is developed in parallel to the drug using the drug-diagnostic...... co-development model. The development of companion diagnostics is a relatively new discipline and in this review, different aspects will be discussed including clinical and regulatory issues. Furthermore, examples of drugs, such as the ALK and PD-1/PD-L1 inhibitors, that have been approved recently....... Despite having discussed personalized medicine for more than a decade, we still see that most drug prescriptions for severe chronic diseases are largely based on 'trial and error' and not on solid biomarker data. However, with the advance of molecular diagnostics and a subsequent increased understanding...

  2. Skin sparing mastectomy: Technique and suggested methods of reconstruction

    Farahat, A.M.; Hashim, T.; Soliman, H.O.; Manie, T.M.; Soliman, O.M.

    2014-01-01

    To demonstrate the feasibility and accessibility of performing adequate mastectomy to extirpate the breast tissue, along with en-block formal axillary dissection performed from within the same incision. We also compared different methods of immediate breast reconstruction used to fill the skin envelope to achieve the best aesthetic results. Methods: 38 patients with breast cancer underwent skin-sparing mastectomy with formal axillary clearance, through a circum-areolar incision. Immediate breast reconstruction was performed using different techniques to fill in the skin envelope. Two reconstruction groups were assigned; group 1: Autologus tissue transfer only (n= 24), and group 2: implant augmentation (n= 14). Autologus tissue transfer: The techniques used included filling in the skin envelope using Extended Latissimus Dorsi flap (18 patients) and Pedicled TRAM flap (6 patients). Augmentation with implants: Subpectoral implants(4 patients), a rounded implant placed under the pectoralis major muscle to augment an LD reconstructed breast. LD pocket (10 patients), an anatomical implant placed over the pectoralis major muscle within a pocket created by the LD flap. No contra-lateral procedure was performed in any of the cases to achieve symmetry. Results: All cases underwent adequate excision of the breast tissue along with en-block complete axillary clearance (when indicated), without the need for an additional axillary incision. Eighteen patients underwent reconstruction using extended LD flaps only, six had TRAM flaps, four had augmentation using implants placed below the pectoralis muscle along with LD flaps, and ten had implants placed within the LD pocket. Breast shape, volume and contour were successfully restored in all patients. Adequate degree of ptosis was achieved, to ensure maximal symmetry. Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian

  3. Robust optimization methods for cardiac sparing in tangential breast IMRT

    Mahmoudzadeh, Houra, E-mail: houra@mie.utoronto.ca [Mechanical and Industrial Engineering Department, University of Toronto, Toronto, Ontario M5S 3G8 (Canada); Lee, Jenny [Radiation Medicine Program, UHN Princess Margaret Cancer Centre, Toronto, Ontario M5G 2M9 (Canada); Chan, Timothy C. Y. [Mechanical and Industrial Engineering Department, University of Toronto, Toronto, Ontario M5S 3G8, Canada and Techna Institute for the Advancement of Technology for Health, Toronto, Ontario M5G 1P5 (Canada); Purdie, Thomas G. [Radiation Medicine Program, UHN Princess Margaret Cancer Centre, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5S 3S2 (Canada); Techna Institute for the Advancement of Technology for Health, Toronto, Ontario M5G 1P5 (Canada)

    2015-05-15

    Purpose: In left-sided tangential breast intensity modulated radiation therapy (IMRT), the heart may enter the radiation field and receive excessive radiation while the patient is breathing. The patient’s breathing pattern is often irregular and unpredictable. We verify the clinical applicability of a heart-sparing robust optimization approach for breast IMRT. We compare robust optimized plans with clinical plans at free-breathing and clinical plans at deep inspiration breath-hold (DIBH) using active breathing control (ABC). Methods: Eight patients were included in the study with each patient simulated using 4D-CT. The 4D-CT image acquisition generated ten breathing phase datasets. An average scan was constructed using all the phase datasets. Two of the eight patients were also imaged at breath-hold using ABC. The 4D-CT datasets were used to calculate the accumulated dose for robust optimized and clinical plans based on deformable registration. We generated a set of simulated breathing probability mass functions, which represent the fraction of time patients spend in different breathing phases. The robust optimization method was applied to each patient using a set of dose-influence matrices extracted from the 4D-CT data and a model of the breathing motion uncertainty. The goal of the optimization models was to minimize the dose to the heart while ensuring dose constraints on the target were achieved under breathing motion uncertainty. Results: Robust optimized plans were improved or equivalent to the clinical plans in terms of heart sparing for all patients studied. The robust method reduced the accumulated heart dose (D10cc) by up to 801 cGy compared to the clinical method while also improving the coverage of the accumulated whole breast target volume. On average, the robust method reduced the heart dose (D10cc) by 364 cGy and improved the optBreast dose (D99%) by 477 cGy. In addition, the robust method had smaller deviations from the planned dose to the

  4. [Cytology in uropathological diagnostics].

    Gaisa, N T; Lindemann-Docter, K

    2015-11-01

    Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

  5. Model of delivery consolidation of critical spare part : case study of an oil and gas company

    Hartanto, D.; Agustinita, A.

    2018-04-01

    The availability of spare parts in oil and gas industry is very important to prevent the occurrence of very high opportunity cost, that is the loss caused by exploitation equipment which must stop because of unavailability of the spare part. This is done by providing safety stock with a very high service level that leads to high inventory costs. If the company wants to lower inventory costs, the choices are not to lower the service level but to lower the ordering cost. One of the components of ordering cost is the delivery cost. Exploitation facilities are usually located in remote areas so that the cost of delivery is high. In addition, many spare parts are supplied by the same supplier. Therefore, there is an opportunity to lower the cost of delivery of spare parts by consolidation. In this paper,mixed integer linear programming (MILP) model is developed to plan the procurement of spare parts so that inventory costs which include holding and ordering cost for spare parts can be minimized. The model has been verified and validated. Using this model the company can lower inventory costs of the spare part by 32%.

  6. Critical spare parts ordering decisions using conditional reliability and stochastic lead time

    Godoy, David R.; Pascual, Rodrigo; Knights, Peter

    2013-01-01

    Asset-intensive companies face great pressure to reduce operation costs and increase utilization. This scenario often leads to over-stress on critical equipment and its spare parts associated, affecting availability, reliability, and system performance. As these resources impact considerably on financial and operational structures, the opportunity is given by demand for decision-making methods for the management of spare parts processes. We proposed an ordering decision-aid technique which uses a measurement of spare performance, based on the stress–strength interference theory; which we have called Condition-Based Service Level (CBSL). We focus on Condition Managed Critical Spares (CMS), namely, spares which are expensive, highly reliable, with higher lead times, and are not available in store. As a mitigation measure, CMS are under condition monitoring. The aim of the paper is orienting the decision time for CMS ordering or just continuing the operation. The paper presents a graphic technique which considers a rule for decision based on both condition-based reliability function and a stochastic/fixed lead time. For the stochastic lead time case, results show that technique is effective to determine the time when the system operation is reliable and can withstand the lead time variability, satisfying a desired service level. Additionally, for the constant lead time case, the technique helps to define insurance spares. In conclusion, presented ordering decision rule is useful to asset managers for enhancing the operational continuity affected by spare parts

  7. Governance, agricultural intensification, and land sparing in tropical South America

    Ceddia, Michele Graziano; Bardsley, Nicholas Oliver; Gomez-y-Paloma, Sergio; Sedlacek, Sabine

    2014-01-01

    In this paper we address two topical questions: How do the quality of governance and agricultural intensification impact on spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? Using data from the Food and Agriculture Organization, the World Bank, the World Database on Protected Areas, and the Yale Center for Environmental Law and Policy, we estimate a panel data model for six South American countries and quantify the effects of major determinants of agricultural land expansion, including various dimensions of governance, over the period 1970–2006. The results indicate that the effect of agricultural intensification on agricultural expansion is conditional on the quality and type of governance. When considering conventional aspects of governance, agricultural intensification leads to an expansion of agricultural area when governance scores are high. When looking specifically at environmental aspects of governance, intensification leads to a spatial contraction of agriculture when governance scores are high, signaling a sustainable intensification process. PMID:24799696

  8. Memory sparing, fast scattering formalism for rigorous diffraction modeling

    Iff, W.; Kämpfe, T.; Jourlin, Y.; Tishchenko, A. V.

    2017-07-01

    The basics and algorithmic steps of a novel scattering formalism suited for memory sparing and fast electromagnetic calculations are presented. The formalism, called ‘S-vector algorithm’ (by analogy with the known scattering-matrix algorithm), allows the calculation of the collective scattering spectra of individual layered micro-structured scattering objects. A rigorous method of linear complexity is applied to model the scattering at individual layers; here the generalized source method (GSM) resorting to Fourier harmonics as basis functions is used as one possible method of linear complexity. The concatenation of the individual scattering events can be achieved sequentially or in parallel, both having pros and cons. The present development will largely concentrate on a consecutive approach based on the multiple reflection series. The latter will be reformulated into an implicit formalism which will be associated with an iterative solver, resulting in improved convergence. The examples will first refer to 1D grating diffraction for the sake of simplicity and intelligibility, with a final 2D application example.

  9. Replenishment of system spares for improved economic performance

    McVay, J.L.; Gray, G.

    1990-01-01

    The nuclear industry continues to be faced with increasing external pressures that contribute to escalating production costs. In the past, regulatory and political pressures have been the chief sources for the authors concern. Today, however, the economic aspects for power generation may present an equal or an even greater challenge to the industry's stability. For nuclear utilities to survive and prosper, they must become more cost conscious and competitive. This challenge becomes even more important when one considers the growing number of cogeneration facilities, new independent power producers, and neighboring utilities all competing for the customer on a cost basis. This paper addresses opportunities created by the development of recent industry guidelines addressing engineering analysis techniques to be used during replenishment of system spares and components. This activity, while it has not been traditionally thought of as an engineering activity, can contribute significantly to the reduction of operation and maintenance (O and M) costs for plant systems and will help nuclear utilities to aggressively battle the rising issue of cost control

  10. Using Spare Logic Resources To Create Dynamic Test Points

    Katz, Richard; Kleyner, Igor

    2011-01-01

    A technique has been devised to enable creation of a dynamic set of test points in an embedded digital electronic system. As a result, electronics contained in an application specific circuit [e.g., gate array, field programmable gate array (FPGA)] can be internally probed, even when contained in a closed housing during all phases of test. In the present technique, the test points are not fixed and limited to a small number; the number of test points can vastly exceed the number of buffers or pins, resulting in a compact footprint. Test points are selected by means of spare logic resources within the ASIC(s) and/or FPGA(s). A register is programmed with a command, which is used to select the signals that are sent off-chip and out of the housing for monitoring by test engineers and external test equipment. The register can be commanded by any suitable means: for example, it could be commanded through a command port that would normally be used in the operation of the system. In the original application of the technique, commanding of the register is performed via a MIL-STD-1553B communication subsystem.

  11. Valve-sparing aortic root replacement in Marfan syndrome.

    Cameron, Duke E; Vricella, Luca A

    2005-01-01

    Marfan syndrome is the most common inherited connective tissue disorder, affecting approximately 1 in 10,000 live births. The cardinal features of Marfan syndrome are the abnormalities of the skeleton (tall stature, arachnodactyly, and joint hyperelasticity), eye (lens subluxation), and aorta (root aneurysm with proclivity toward rupture and dissection). Aortic catastrophe accounts for most of the premature mortality among Marfan patients, a risk that climbs steeply during adolescence and results in death of half of Marfan patients by the age of 40 years. Most of the improvement in life expectancy that has been achieved in Marfan syndrome is attributable to early recognition of aortic root aneurysms and prophylactic replacement with composite grafts (mechanical valve prostheses within Dacron conduits) before rupture or dissection occurs. Despite the excellent early and late results with composite grafts, there has been growing interest in operative procedures that replace the sinuses but preserve the aortic valve leaflets, to avoid anticoagulation and minimize the risk of prosthesis-related endocarditis. These procedures are still in evolution and late results are not yet known, but as with mitral repair in the setting of myxomatous disease, valve-sparing procedures in Marfan syndrome have weathered a storm of initial criticism and skepticism and are steadily gaining acceptance.

  12. Aortic valve sparing root surgery for Marfan syndrome.

    Matalanis, George; Perera, Nisal K

    2017-11-01

    Aortic valve sparing root surgery (AVSRS) is a safe and durable alternative for patients with dilated roots or pure aortic regurgitation (AR), which avoids the risks of anticoagulation or valvular degeneration with prosthetic valves. Notwithstanding the theoretical challenges of greater tissue fragility in Marfan syndrome (MFS), AVSRS has been demonstrated to have equal outcomes in this condition as it does in those without MFS. The benefits of retaining the native aortic valve in this generally younger age group extend beyond those of avoiding the inconvenience and complications of prolonged exposure to anticoagulants and include ease of management for future aortic, cardiac and non-cardiac procedures which are the norm for these patients. The essential principles of AVSRS in MFS do not differ from those for the rest of the population. Successful repair and durable valve function depend on a sound understanding of the close interaction between the structure and function of this exquisitely designed piece of engineering. We are fortunate to have numerous tools in our surgical armamentarium to preserve these valves. It is the purpose of this paper to demystify the complex structure-function interactions of the aortic valve, thereby gaining an intuition for AVSRS. We will also elaborate on specific technical details of established techniques that we have found successful in preserving the normal function of these valves in the long term.

  13. Transportation of a Spare Stator to Trillo I NPP

    Nova, J.R. de; Sanchez Miro, J.L.; Alvaro, C. de

    1998-01-01

    The shutdown of Trillo NPP due to an irreparable in situ fault in the stator of the electric generator, has resulted in the need to transport a spare stator from Mulheim (Germany) to Trillo I NPP (Spain). The problem occasioned by this type of transport have been exacerbated by the very short period of time available to plan and carry out this operation. Owing to this pressing need, the logistics of the transport were tackled from all possible alternative approaches. Within each one of these alternatives, all available modes were considered, so as to minimise the possibility of an insurmountable difficulty arising and thus making it impossible to continue with trans transportation. The two basic alternatives considered were road and rail. This paper describes the different aspects which intervened in this special transport, especially the following: - The very short time period available for planning and execution - The railway transport mode used - The large number of organisations participating in the operation - The solution to the technical problems caused by the use of different types of transportation equipment - The studies, adaptations and improvements carried out on the different routes - The coordination of the resources used in the operation. (Author)

  14. Ovarian transposition in young women and fertility sparing.

    Mossa, B; Schimberni, M; Di Benedetto, L; Mossa, S

    2015-09-01

    Ovarian transposition is a highly effective surgical procedure used to preserve ovarian function in premenopausal patients with cancers requiring postoperative or primary pelvic radiotherapy. Pelvic irradiation determines severe damage of ovarian DNA and iatrogenic ovarian failure with premature menopause, necessity of long-term hormone replacement therapy and infertility. We conducted an extensive research of the literature in Medline between January 2000 and April 2015 using the key-words "ovarian transposition radiotherapy", "radiotherapy gonadal function", radiotherapy fertility sparing". The population included young women with normal ovarian function affected by cancers that required pelvic radiotherapy. We have examined 32 articles reporting on 1189 women undergoing ovarian transposition. Median age was 32.5 years, follow up was median 48 months. The procedure has been performed in patients less than 40 years of age. Surgery has been achieved by laparotomy or laparoscoy. We have analyzed effects of radiotherapy on ovarian function. The proportion of women treated by ovarian transposition preserved ovarian function was 70%. About 86% of patients did not develop ovarian cysts and in 98-99% of cases did not occur any metastatic disease. Ovarian transposition is associated with significant preservation of ovarian function and a low frequency of complications as cysts and metastasis. In 31% of cases the procedure can fail. Further studies are needed to evaluate the efficacy of ovarian transposition and the follow up. Ovarian transposition should be discussed at the time of cancer diagnosis in every premenopausal woman requiring pelvic radiotherapy.

  15. Nitrogen sparing by 2-ketoisocaproate in parenterally fed rats

    Yagi, M.; Matthews, D.E.; Walser, M.

    1990-01-01

    In rats receiving total parenteral nutrition with or without sodium 2-ketoisocaproate (KIC; 2.48 g.kg-1.day-1), L-[1- 13 C]leucine and [1- 14 C]KIC were constantly infused for 6 h. CO 2 production, 14 CO 2 production, 13 CO 2 enrichment, urinary urea nitrogen (N) plus ammonia N and total urinary N were measured. Whole body protein synthesis (S) was calculated in non-KIC-infused rats and also in unfed rats infused with [1- 14 C]leucine from fractional oxidation of labeled leucine (1-F), where F is fractional utilization for protein synthesis, and urea N plus ammonia N excretion (C) as S = C x F/(1-F). Addition of KIC caused a significant reduction in N excretion and a significant improvement in N balance. Fractional oxidation of labeled KIC increased, whereas fractional utilization of labeled KIC for protein synthesis decreased, but the extent of incorporation of infused KIC into newly synthesized protein (as leucine) amounted to at least 40% of the total rate of leucine incorporation into newly synthesized whole body protein. We conclude that addition of KIC spares N in parenterally fed rats and becomes a major source of leucine for protein synthesis

  16. Governance, agricultural intensification, and land sparing in tropical South America.

    Ceddia, Michele Graziano; Bardsley, Nicholas Oliver; Gomez-y-Paloma, Sergio; Sedlacek, Sabine

    2014-05-20

    In this paper we address two topical questions: How do the quality of governance and agricultural intensification impact on spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? Using data from the Food and Agriculture Organization, the World Bank, the World Database on Protected Areas, and the Yale Center for Environmental Law and Policy, we estimate a panel data model for six South American countries and quantify the effects of major determinants of agricultural land expansion, including various dimensions of governance, over the period 1970-2006. The results indicate that the effect of agricultural intensification on agricultural expansion is conditional on the quality and type of governance. When considering conventional aspects of governance, agricultural intensification leads to an expansion of agricultural area when governance scores are high. When looking specifically at environmental aspects of governance, intensification leads to a spatial contraction of agriculture when governance scores are high, signaling a sustainable intensification process.

  17. Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism.

    Oscar-Berman, Marlene; Valmas, Mary M; Sawyer, Kayle S; Ruiz, Susan Mosher; Luhar, Riya B; Gravitz, Zoe R

    2014-01-01

    Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome. © 2014 Elsevier B.V. All rights reserved.

  18. Profiles of Impaired, Spared, and Recovered Neuropsychological Processes in Alcoholism

    Oscar-Berman, Marlene; Valmas, Mary M.; Sawyer, Kayle S.; Ruiz, Susan Mosher; Luhar, Riya B.; Gravitz, Zoe R.

    2015-01-01

    Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychological profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among participants is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory, (2) executive functions, (3) emotion and psychosocial skills, (4) visuospatial cognition, and (5) psychomotor abilities. The brain systems that are most vulnerable to alcoholism are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome. PMID:25307576

  19. Plasma Diagnostics

    Zaveryaev, V [Kurchatov Institute, Moscow (Russian Federation); others, and

    2012-09-15

    The success in achieving peaceful fusion power depends on the ability to control a high temperature plasma, which is an object with unique properties, possibly the most complicated object created by humans. Over years of fusion research a new branch of science has been created, namely plasma diagnostics, which involves knowledge of almost all fields of physics, from electromagnetism to nuclear physics, and up-to-date progress in engineering and technology (materials, electronics, mathematical methods of data treatment). Historically, work on controlled fusion started with pulsed systems and accordingly the methods of plasma parameter measurement were first developed for short lived and dense plasmas. Magnetically confined hot plasmas require the creation of special experimental techniques for diagnostics. The diagnostic set is the most scientifically intensive part of a plasma device. During many years of research operation some scientific tasks have been solved while new ones arose. New tasks often require significant changes in the diagnostic system, which is thus a very flexible part of plasma machines. Diagnostic systems are designed to solve several tasks. As an example here are the diagnostic tasks for the International Thermonuclear Experimental Reactor - ITER: (1) Measurements for machine protection and basic control; (2) Measurements for advanced control; (3) Additional measurements for performance evaluation and physics. Every new plasma machine is a further step along the path to the main goal - controlled fusion - and nobody knows in advance what new phenomena will be met on the way. So in the planning of diagnostic construction we should keep in mind further system upgrading to meet possible new scientific and technical challenges. (author)

  20. ADAPTIVE OPTICS IMAGING OF FOVEAL SPARING IN GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

    Querques, Giuseppe; Kamami-Levy, Cynthia; Georges, Anouk; Pedinielli, Alexandre; Capuano, Vittorio; Blanco-Garavito, Rocio; Poulon, Fanny; Souied, Eric H

    2016-02-01

    To describe adaptive optics (AO) imaging of foveal sparing in geographic atrophy (GA) secondary to age-related macular degeneration. Flood-illumination AO infrared (IR) fundus images were obtained in four consecutive patients with GA using an AO retinal camera (rtx1; Imagine Eyes). Adaptive optics IR images were overlaid with confocal scanning laser ophthalmoscope near-IR autofluorescence images to allow direct correlation of en face AO features with areas of foveal sparing. Adaptive optics appearance of GA and foveal sparing, preservation of functional photoreceptors, and cone densities in areas of foveal sparing were investigated. In 5 eyes of 4 patients (all female; mean age 74.2 ± 11.9 years), a total of 5 images, sized 4° × 4°, of foveal sparing visualized on confocal scanning laser ophthalmoscope near-IR autofluorescence were investigated by AO imaging. En face AO images revealed GA as regions of inhomogeneous hyperreflectivity with irregularly dispersed hyporeflective clumps. By direct comparison with adjacent regions of GA, foveal sparing appeared as well-demarcated areas of reduced reflectivity with less hyporeflective clumps (mean 14.2 vs. 3.2; P = 0.03). Of note, in these areas, en face AO IR images revealed cone photoreceptors as hyperreflective dots over the background reflectivity (mean cone density 3,271 ± 1,109 cones per square millimeter). Microperimetry demonstrated residual function in areas of foveal sparing detected by confocal scanning laser ophthalmoscope near-IR autofluorescence. Adaptive optics allows the appreciation of differences in reflectivity between regions of GA and foveal sparing. Preservation of functional cone photoreceptors was demonstrated on en face AO IR images in areas of foveal sparing detected by confocal scanning laser ophthalmoscope near-IR autofluorescence.

  1. Diagnostic imaging of craniopharyngioma

    Gradzki, J.; Nowak, S.; Paprzycki, W.

    1993-01-01

    40 patients have been examined with operational and histological confirmation of craniopharyngioma. CT image and X-ray plane of skull were performed in case all of these patients. TMR was conformed to examine 4 patients. X-ray planes was compared to CT. CT permits tumor cyst detection. The efficacy of mentioned above diagnostic techniques was compared with surgical findings. (author)

  2. Diagnostic and interventional radiology

    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie

    2016-08-01

    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  3. Algorithm of Functional Musculoskeletal Disorders Diagnostics

    Alexandra P. Eroshenko

    2012-01-01

    The article scientifically justifies the algorithm of complex diagnostics of functional musculoskeletal disorders during resort treatment, aimed at the optimal application of modern methods of physical rehabilitation (correction programs formation), based on diagnostic methodologies findings

  4. Algorithm of Functional Musculoskeletal Disorders Diagnostics

    Alexandra P. Eroshenko

    2012-04-01

    Full Text Available The article scientifically justifies the algorithm of complex diagnostics of functional musculoskeletal disorders during resort treatment, aimed at the optimal application of modern methods of physical rehabilitation (correction programs formation, based on diagnostic methodologies findings

  5. Diagnostic development

    Barnett, C.F.; Brisson, D.A.; Greco, S.E.

    1978-01-01

    During the past year the far-infrared or submillimeter diagnostic research program resulted in three major developments: (1) an optically pumped 0.385-μm D 2 O-laser oscillator-amplifier system was operated at a power level of 1 MW with a line width of less than 50 MHz; (2) a conical Pyrex submillimeter laser beam dump with a retention efficiency greater than 10 4 was developed for the ion temperature Thompson scattering experiment; and (3) a new diagnostic technique was developed that makes use of the Faraday rotation of a modulated submillimeter laser beam to determine plasma current profile. Measurements of the asymmetric distortion of the H/sub α/ (6563 A) spectral line profile show that the effective toroidal drift velocity, dv/sub two vertical bars i/dT/sub i/, may be used as an indicator of plasma quality and as a complement to other ion temperature diagnostics

  6. Nephron sparing surgery as the treatment of choice in renal cell carcinoma

    Wyczolkowski, M.; Drewniak, T.; Klima, W.; Rzepecki, M.; Prajsner, A.; Kajetan Juszczak, K.

    2010-01-01

    Advances in imaging diagnostics have contributed to the frequent detection of small kidney tumours both at an early stage and of low grade. Although radical nephrectomy is still the gold standard in Renal Cell Carcinoma (RCC) treatment, yet it slowly ceases to be the standard approach and open or laparoscopic Nephron Sparing Surgery (NSS) is becoming more and more common. Ai m. The purpose of the study was to determine the functional and oncological outcomes of NSS for RCC basing on an analysis of 108 patients. Material and methods. The patients were divided into two groups: T1a (≤ 4 cm) and T1b (≥ 4 ≤ 7 cm). We performed an analysis of all patients with a minimal follow-up time of 24 months. In the majority of patients the diagnosis was clear cell carcinoma(83.9%). Results. G2 tumours were the most common (51.7%). The cumulative proportion of survivors without local relapse within the operated kidney and/or in the local lymph nodes and without distant metastases after 2 and 3 years was 99% and 93%, respectively. Our results support the fact that in pT1a and pT1b patients NSS is a safe and effective procedure. The size of pT1 tumours has no bearing on 2-year and 3-year recurrence-free survivals. Conclusion. Intraoperative ultrasound allows for further identification of additional neo plasmatic foci and for the use of the best surgical approach. Intraoperative ultrasound is useful in NSS, and especially in those cases, where the tumor lies in the central part of the kidney. (authors)

  7. Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

    Tran, De Q H; Elgueta, Maria Francisca; Aliste, Julian; Finlayson, Roderick J

    Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

  8. Uterine-sparing Laparoscopic Resection of Accessory Cavitated Uterine Masses.

    Peters, Ann; Rindos, Noah B; Guido, Richard S; Donnellan, Nicole M

    2018-01-01

    To demonstrate surgical techniques utilized during uterine-sparing laparoscopic resections of accessory cavitated uterine masses (ACUMs). ACUMs represent a rare uterine entity observed in premenopausal women suffering from dysmenorrhea and recurrent pelvic pain. The diagnosis is made when an isolated extra-cavitated uterine mass is resected from an otherwise normal appearing uterus with unremarkable endometrial lumen and adnexal structures. Pathologic confirmation requires an accessory cavity lined with endometrial epithelium (and corresponding glands and stroma) filled with chocolate-brown fluid. Adenomyosis must be absent. Although the origin of ACUMs is currently unknown, the most common presentation is a 2-4 cm lateral uterine wall mass at the level of the insertion of the round ligament. Hence it has been hypothesized that gubernaculum dysfunction may be responsible for duplication or persistence of paramesonephric tissue leading to ACUM formation as a new Müllerian anomaly. A stepwise surgical tutorial describing 2 laparoscopic ACUM resections using a narrated video (Canadian Task Force classification III). An academic tertiary care hospital. In this video, we present 2 patients who underwent uterine-sparing laparoscopic resections of their ACUM in order to preserve fertility (Case 1) or avoid the complications and surgical recovery time of a total laparoscopic hysterectomy (Case 2). Case 1 is a 19-year-old, gravida 0, para 0 woman with dysmenorrhea and recurrent pelvic pain who presented for multiple emergency room and outpatient evaluations. Transvaginal ultrasonography was unremarkable except for a 28×30×26mm left lateral uterine mass with peripheral vascular flow that was initially felt to be a leiomyoma or rudimentary uterine horn. MRI imaging, however, demonstrated this mass to be more consistent with an ACUM. This was based on the lack of communication between the lesion and the main uterine cavity exhibited by high T2 signal (compatible with

  9. Experienced and less-experienced nurses' diagnostic reasoning: implications for fostering students' critical thinking.

    Ferrario, Catherine G

    2003-01-01

    To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (> or = 5 years' experience) and novice (thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote student's cognitive development through strategies that promote active, reflective, and integrative learning.

  10. Optimal selection of Orbital Replacement Unit on-orbit spares - A Space Station system availability model

    Schwaab, Douglas G.

    1991-01-01

    A mathematical programing model is presented to optimize the selection of Orbital Replacement Unit on-orbit spares for the Space Station. The model maximizes system availability under the constraints of logistics resupply-cargo weight and volume allocations.

  11. Land Sparing and Land Sharing Policies in Developing Countries - Drivers and Linkages to Scientific Debates

    Mertz, Ole; Mertens, Charlotte Filt

    2017-01-01

    The need for developing land sparing or land sharing policies for protecting the environment has been a polarized debate in the scientific literature. Some studies show that "spared" landscapes with clearly separated intensive agriculture and pristine forest are better for biodiversity and other...... ecosystem services, whereas others demonstrate the benefits of "shared" mosaic landscapes composed of a mix of forest types, agricultural fields, grassland, and plantations. Increasingly, these scientific views have been depolarized, recognizing that both shared and spared landscapes have a role to play......, depending on the context. However, it is less clear from the literature what drives actual policy-making related to land sparing and land sharing in developing countries and what the outcomes of these policies are. We therefore reviewed the international peer-reviewed literature for evidence of policies...

  12. CWT and RWT Metrics Measure the Performance of the Army's Logistics Chain for Spare Parts

    2003-01-01

    .... A responsive logistics chain for spare parts is also critical in deployments. When Army personnel know that parts can be quickly and dependably supplied through the logistics chain, units can deploy with fewer "just in case" supplies...

  13. Computer system design description for the spare pump mini-dacs data acquisition and control system

    Vargo, G.F. Jr.

    1994-01-01

    The attached document outlines the computer software design for the mini data acquisition and control system (DACS), that supports the testing of the spare pump for Tank 241-SY-101, at the maintenance and storage facility (MASF)

  14. Diagnostic dilemma

    Feldt-Rasmussen, Ulla; Dobrovolny, Robert; Nazarenko, Irina

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from the deficient activity of a-galactosidase A (a-Gal A). In affected males, the clinical diagnosis is confirmed by the markedly decreased a-Gal A activity. However, in female heterozygotes, the a-Gal A activity can range from low t...... on enzyme replacement therapy. Thus, gene dosage analyses can detect large deletions (>50bp) in suspect heterozygotes for X-linked and autosomal dominant diseases that are "sequencing cryptic," resolving molecular diagnostic dilemmas....... to normal due to random X-chromosomal inactivation, and diagnostic confirmation requires identification of the family's a-Gal A gene mutation. In a young female who had occasional acroparesthesias, corneal opacities, and 15 to 50% of the lower limit of normal leukocyte a-Gal A activity, a-Gal A sequencing...... in two expert laboratories did not identify a confirmatory mutation, presenting a diagnostic dilemma. A renal biopsy proved diagnostic and renewed efforts to detect an a-Gal A mutation. Subsequent gene dosage analyses identified a large a-Gal A deletion confirming her heterozygosity, and she was started...

  15. Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours.

    Venkatramani, Vivek; Swain, Sanjaya; Satyanarayana, Ramgopal; Parekh, Dipen J

    2017-06-01

    Nephron-sparing surgery has emerged as the surgical treatment of choice for small renal masses over the past two decades, replacing the traditional teaching of radical nephrectomy for renal cell carcinoma. With time, there has been an evolution in the techniques and indications for partial nephrectomy. This review summarizes the current status of nephron-sparing surgery for renal carcinoma and also deals with the future of this procedure.

  16. Pancreas-sparing duodenectomy for an obstructive adenocarcinoma of the duodenum

    Lam, D; Croome, KP; Hernandez-Alejandro, R

    2012-01-01

    A duodenal adenocarcinoma arising from the junction of the second and third portion of the duodenum, which was resected by pancreas-sparing duodenectomy, is reported. The completely obstructing tumour was circumferential and measured 6.5cm x 3.5cm x 1.0 cm. There was no evidence of pancreas invasion, nor any lymph node metastasis. Pancreas-sparing duodenectomy was performed, with dissection of the pancreaticoduodenal lymph nodes. The proximal duodenum was transected just distal to the ampula ...

  17. Geometric factors influencing dosimetric sparing of the parotid glands using IMRT

    Hunt, Margie A.; Jackson, Andrew; Narayana, Ashwatha; Lee, Nancy

    2006-01-01

    Purpose/Objective: To determine the relationship between the parotid volume, parotid-planning target volume (PTV) overlap, and dosimetric sparing of the parotid with intensity-modulated radiation therapy (IMRT). Methods and Materials: Parotid data were collected retrospectively for 51 patients treated with simultaneous boost IMRT. Unresectable patients received 54 or 59.4 Gy to subclinical disease, 70 Gy to gross disease. Patients treated postoperatively received 54, 60, and 66 Gy to low-risk, high-risk, and tumor bed regions. Volume and mean dose of each gland and gland segments outside of and overlapping the PTV were collected. Proximity of each gland to each PTV was recorded. Results: Dosimetric sparing (mean dose ≤26.5 Gy) was achieved in 66 of 71 glands with ≤21% parotid-PTV overlap and 8 of 23 glands with >21% overlap (p = 21%. Median mean dose was 25.9 Gy to glands overlapping PTV 54 or PTV 59 alone and 30.0 Gy to those abutting PTV 7 (p 7 was associated with higher parotid dose, satisfactory sparing was achieved in 24 of 43 ipsilateral glands. Conclusions: Dosimetric sparing of the parotid is feasible when the parotid-PTV overlap is less than approximately 20%. With more overlap, sparing may result in low doses within the overlap region, possibly leading to inadequate PTV coverage. Gland proximity to the high-dose PTV is associated with higher mean dose but does not always preclude dosimetric sparing

  18. Intensity-modulated radiation therapy for nasopharyngeal carcinoma parotid sparing with euivalent uiform dose optimization

    Yue Weiyou; Dai Jianrong; Gao Li

    2006-01-01

    Objective: The aim of this study was to evaluate the role of an euivalent uiform dose (EUD) based optimization algorithm in sparing the parotids of patients with nasopharyngeal carcinoma (NPC) when they are treated with intensity-modulated radiation therapy (IMRT). Methods: 12 patients were randomly selected from the NPC patients who received IMRT treatments. For these patients, the treatment plans were designed with physical optimization constraints (dose/dose-volume constraints). Based on these plans, new plans were designed through replacing the physical constraints with maximum EUD for parotids, while keeping the physical objectives for targets and other organs at risk(OARs) unchanged. Comparison was then made between the new plan, which had EUD constraints to parotids, and the former for each individual patient. Results: While maintaining the dose to the targets and the other OARs un- changed, optimization with EUD constraints to parotids decreased the mean dose and V 30 of parotids significantly, simultaneously, the dose of target volume and other organs at risk keep stable, the values of probability were less than 0.05 by T-test. Conclusions: The doses to parotids can be reduced through optimization with EUD constraints. This finding is quite helpful to reduce the occurrence rate of parotid complications, and to provide spaces for escalating target dose. (authors)

  19. Fertility-sparing treatment of endometrial cancer precursors among young women: a reproductive point of view.

    Ricciardi, E; Maniglio, P; Frega, A; Marci, R; Caserta, D; Moscarini, M

    2012-12-01

    Early-stage endometrial cancer and complex atypical hyperplasia are treated with hysterectomy and bilateral salpingo-oophorectomy. An emerging issue among younger women affected is the possibility of a fertility-sparing treatment with progestative therapy and close follow-up. To assess the possibility of conceiving after a diagnosis of atypical endometrial hyperplasia among women younger than 40 years old, in term of delaying definitive treatment and achieving pregnancy. 15 women younger than 40 years old with complex CAH or early carcinoma of the endometrium and a wish to preserve fertility. Progestins were administered orally for at least a 12 weeks period. Endometrial biopsies were used at follow-up. In 11 women, a complete pathological remission of the disease was observed. 4 pregnancies were attained in 4 women. 3 showed progression and underwent definitive surgery at 18 months. 1 showed no response at 24 months and 3 cycles and was counseled to receive a hysterectomy. A conservative approach in patients younger than 40 years appears a valid option, and a progestative therapy trial should be attempted whether a valid consensus is attained. Considering the risk to find AEH at biopsies and eventually a carcinoma at hysterectomy (25% of cases) a careful management is strictly required.

  20. Pitfalls in diagnostic radiology

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology

    2015-04-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  1. Pitfalls in diagnostic radiology

    Peh, Wilfred C.G.

    2015-01-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  2. Precipitation of sparingly soluble salts in packed sandbeds

    Pavlakou, Efstathia I.; Sygouni, Varvara; Paraskeva, Christakis A.

    2015-04-01

    One of the main problems encountered by the oil extraction industry, is the reduction of the local permeability of the rock formation near the extraction wells because of salt deposition in the pores of the rocks during the injection of brine water to displace the trapped oil ganglia within the oil formations. This phenomenon makes the oil recovery less efficient and under extreme cases the well is abandoned with a large amount of oil entrapped. Several detailed studies have been conducted in the past concerning sand bed consolidation using sparingly soluble salts for varying conditions (e.g. temperature, grain size, sand type, salt concentrations etc) and various salts [1]. Nevertheless, salt precipitation in the rock formation pores under the presence of other miscible or immiscible substances with water has not been investigated in details yet. In the present study, salt (CaCO3) precipitation experiments were performed in small beds packed with sea sand mixed with a low amount of CaCO3 seed grains. The experiments were performed using pure solutions (NaHCO3, CaCl2.2H2O) and solutions mixed with Ethylene Glycol in sand beds. Additionally, precipitation experiments were performed using pure solutions in sand beds saturated with oil phase (n-dodecane) for a wide range of solution supersaturation. During the experiments the ionic strength was kept constant. pH and concentration values of calcium ion of the effluent were measured and the precipitated salt crystals were identified using X-ray Diffraction (XRD) method. At the end of each experiment Scanning Electron Microscope (SEM) was conducted using a sample of the precipitated sand to identify the morphology of the precipitated crystals and their cohesion with sand grains. Acknowledgments This research was partially funded by the European Union (European Social Fund-ESF) and Greek National Funds through the Operational program "Education and Lifelong Learning" under the action Aristeia II (Code No 4420). References

  3. All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer.

    Melamed, Alexander; Rizzo, Anthony E; Nitecki, Roni; Gockley, Allison A; Bregar, Amy J; Schorge, John O; Del Carmen, Marcela G; Rauh-Hain, J Alejandro

    2017-07-01

    To compare all-cause mortality between women who underwent fertility-sparing surgery with those who underwent conventional surgery for stage I ovarian cancer. In a cohort study using the National Cancer Database, we identified women younger than 40 years diagnosed with stage IA and unilateral IC epithelial ovarian cancer between 2004 and 2012. Fertility-sparing surgery was defined as conservation of one ovary and the uterus. The primary outcome was time from diagnosis to death. We used propensity score methods to assemble a cohort of women who underwent fertility-sparing or conventional surgery but were otherwise similar on observed covariates and conducted survival analyses using the Kaplan-Meier method and Cox proportional hazard models. We identified 1,726 women with stage IA and unilateral IC epithelial ovarian cancer of whom 825 (47.8%) underwent fertility-sparing surgery. Fertility-sparing surgery was associated with younger age, residence in the northeastern and western United States, and serous or mucinous histology (Pfertility-sparing surgery and 37 deaths among propensity-matched women who underwent conventional surgery after a median follow-up of 63 months. Fertility-sparing surgery was not associated with hazard of death (hazard ratio 0.80, 95% confidence interval [CI] 0.49-1.29, P=.36). The probability of survival 10 years after diagnosis was 88.5% (95% CI 82.4-92.6) in the fertility-sparing group and 88.9% (95% CI 84.9-92.0) in the conventional surgery group. In patients with high-risk features such as clear cell histology, grade 3, or stage IC, 10-year survival was 80.5% (95% CI 68.5-88.3) among women who underwent fertility-sparing surgery and 83.4% (95% 76.0-88.7) among those who had conventional surgery (hazard ratio 0.86, 95% CI 0.49-1.53, P=.61). Compared with conventional surgery, fertility-sparing surgery was not associated with increased risk of death in young women with stage I epithelial ovarian cancer.

  4. MR findings of ulegyria

    Momoshima, Suketaka; Shiga, Hayao; Yuasa, Yuji; Imai, Yutaka; Higuchi, Nobuya; Maezawa, Mariko.

    1991-01-01

    Magnetic resonance (MR) findings of the brains diagnosed to have ulegyria were reviewed. The reviewed subjects comprised six epileptic children, ranged from 2 to 16 years of age. All patients had convulsion of tonic-clonic type of various severity and had histories of ischemic-hypoxic or hypoglycemic episode in the perinatal or postnatal period. T 1 -weighted images demonstrated the findings precisely reflecting the salient macroscopic features of ulegyria; localized atrophy of the brain with mushroom-shaped cortical gyri with narrow roots and relatively spared wider crowns. T 2 -weighted images showed the areas of hyperintensity in the subcortical and deep white matter subjacent to the atrophic cortex, suggestive of cicatrical gliosis as well as cystic degeneration. The atrophic gyri were seen in the anterior and/or posterior parasagittal arterial border zones bilaterally with minimal asymmetry. Although these findings were nearly pathognomonic to ulegyria, polymicrogyria could mimic it since both are characterized by abnormally diminutive cortical gyri seen in epileptic children. In polymicrogyria, however, affected gyri are uniformly diminutive and not mushroom-shaped, the cortex is rather thickened than atrophic, the underlying white matter shows no focal hyperintensity, subcortical cystic changes are not present, and affected cortex is not restricted to arterial border zones. Even in one of our cases with extensive ulegyria, it was easy to differentiate it from polymicrogyria since parasagittal regions were most severely affected. Although the previous reports on ulegyria have been exclusively based on postmortem pathological examinations or experimental models, its easy recognition on MRI would contribute to further understanding of its clinical significance and mechanisms. (author)

  5. Nipple-Sparing Mastectomy Improves Long-Term Nipple But Not Skin Sensation After Breast Reconstruction: Quantification of Long-Term Sensation in Nipple Sparing Versus Non-nipple Sparing Mastectomy.

    Rodriguez-Unda, Nelson A; Bello, Ricardo J; Clarke-Pearson, Emily M; Sanyal, Abanti; Cooney, Carisa M; Manahan, Michele A; Rosson, Gedge D

    2017-06-01

    Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non-nipple-sparing mastectomy. Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included. Breast measurements were taken in 4 quadrants (upper/lower lateral, upper/lower medial) and nipple. Averaged skin cutaneous thresholds [(UL+LL+UM+LM)/4] and nipple sensation between NSM and NNSM were compared as the primary outcome measure. A generalized estimating equations model was used; univariate and multivariate variable analyses were done when appropriate. Forty-four patients (74 breasts) were examined (53 NNSM vs 21 NSM). The groups were further subdivided into autologous versus implant-based reconstruction. Averaged cutaneous skin thresholds for quadrants were better for the NSM, 51.8(±24.5) g/mm versus NNSM, 56.5(±25.7) g/mm, although this difference was not statistically significant. However, NSM breasts measured higher nipple or nipple area sensitivity, 44.5(±30.8) g/mm versus NNSM, 83.8(±27.4) g/mm (P sensation was the number of revision surgeries, especially after third revision. Breast sensation is decreased after reconstruction in both NSM and NNSM, but nipple sensation or nipple area is better preserved in NSM breasts. Number of revision surgeries (>3) was a predictor of decreased sensation.

  6. Idiopathic chondrolysis - diagnostic difficulties

    Kozlowski, K.; Scougall, J.; Royal Alexandra Hospital for Children, Sydney

    1984-01-01

    Four cases of idiopathic chondrolysis of the hip in three white girls and one Maori girl are reported. The authors stress the causes why a disease with characteristic clinical and radiographic appearances and normal biochemical findings presents diagnostic difficulties. It is suspected that idiopathic chondrolysis is a metabolic disorder of chondrocytes, triggered by environment circumstances in susceptible individuals. Idiopathic chondrolysis is probably one of the most common causes of coxarthrosis in women. (orig.)

  7. Impact of shelf life on measured prompt fraction of spare Inconel in-core flux detectors

    Mohindra, VK; Sadeghi, S. [Atomic Energy of Canada Limited, Mississauga, Ontario (Canada); Crouse, B. [Darlington Nuclear Generating Station, Bowmanville, Ontario (Canada)

    2008-07-01

    Prompt fraction measurements associated with spare self-powered Inconel In-Core Flux Detectors (ICFDs) carried out a few years after installation on Shut Down System number 1 (SDS1) and Reactor Regulating System (RRS) at Darlington Nuclear Generating Station (DNGS), were found to be lower than those of the original detectors. These detectors, spares and originals, were manufactured in the late 80s, however, the former were kept at manufacturer's warehouse and latter were installed in the reactor core within a few years after manufacturing. Although the prompt fractions of the spare detectors were relatively low, the electronic/electrical behavior of the spare detectors was intact. The first batch of the original detectors performed as per the design requirements. Therefore, it is suspected that during shelf life, spare Inconel in-core flux detectors underwent changes that lowered their measured values of prompt fraction, which were taken within a few years after installation in the reactor. Detailed study of detectors' material composition and impurity concentrations revealed no association with the lower prompt fraction measurements. The evaluation of the limited data of the original and spare Inconel ICFDs installed at Darlington showed: 1. The reduction in prompt fraction was roughly proportional to the shelf life of the detectors; and 2. The rate of reduction in prompt fraction during storage was about double the rate of reduction during operation in the reactor. Above observations were based on the data provided by DNGS for a few detectors. The purpose of this paper is two fold, firstly to present the results of the complete study carried out to investigate the cause of relatively low prompt fractions measured on spare SDS1 and RRS Inconel ICFDs at DNGS, and secondly to generate interest/awareness within other CANDU utilities to add to the database of prompt fractions of spare Inconel ICFDs measured after installation. The data will help to improve

  8. Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction.

    Dias, Ricardo Ribeiro; Mejia, Omar Asdrubal Vilca; Fiorelli, Alfredo Inácio; Pomerantzeff, Pablo Maria Alberto; Dias, Altamiro Ribeiro; Mady, Charles; Stolf, Noedir Antonio Groppo

    2010-01-01

    Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months. The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001), (95% CI = 82% - 95% P = 0.03) and (95% CI = 81% - 95%, P = 0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% CI = 1.8 - 19.5, P = 0.003), 12 (95% CI = 3 - 49.7, P = 0.0004) and 16 (95% CI = 3.6 - 71.3, P = 0.0002). The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.

  9. Posterior Pole Sparing Laser Photocoagulation Combined with Intravitreal Bevacizumab Injection in Posterior Retinopathy of Prematurity

    Rebecca Kim

    2014-01-01

    Full Text Available Purpose. To report the results of the posterior pole sparing laser photocoagulation combined with intravitreal bevacizumab injection (IVB in retinopathy of prematurity (ROP. Methods. A retrospective chart review of premature babies with ROP, all of whom received laser photocoagulation with IVB. Eleven eyes of 6 infants with advanced zone I ROP underwent laser ablation sparing posterior pole with concurrent IVB. The results were compared with those of full-laser treatment combined with IVB to 8 eyes of 5 infants with advanced ROP without involvement of the posterior pole. Results. The posterior pole sparing laser with IVB was performed with zone I, stage 3+ ROP at the mean postmenstrual age of 36 weeks and 5 days. The plus sign decreased significantly at postoperative day 1, the neovascular proliferation regressed by postoperative week 1, and the normal vascularization started at postoperative day 32 on the average. Two months after treatment, vascularization of the spared avascular area was completed. There was no macular dragging, tractional retinal detachment, foveal destruction by laser scars, or any other adverse event. No significant anatomical differences were identified from those of full-laser ablation combined with IVB. Conclusions. Posterior pole sparing laser with IVB can give favorable results without destruction of posterior pole retina.

  10. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma.

    Hu, Jun; Zhu, Li-rong; Liang, Zhi-qing; Meng, Yuan-guang; Guo, Hong-yan; Qu, Peng-peng; Ma, Cai-ling; Xu, Cong-jian; Yuan, Bi-bo

    2011-10-01

    To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC). A retrospective study of young EOC inpatients (≤40 years old) was performed during January 1994 and December 2010 in eight institutions. Data were analyzed from 94 patients treated with fertility-sparing surgery with a median follow-up time of 58.7 months. As histologic grade increased, overall survival (OS) and disease-free survival (DFS) of patients receiving fertility-sparing surgery declined. Neither staging surgery nor laparoscopy of early stage EOC with conservative surgery had a significant effect on OS or DFS. Normal menstruation recommenced after chemotherapy in 89% of the fertility-sparing group. Seventeen pregnancies among twelve patients were achieved by the end of the follow-ups. Fertility-sparing treatment for patients with EOC Stage I Grade 1 could be cautiously considered for young patients. The surgical procedure and surgical route might not significantly influence the prognosis. Standard chemotherapy is not likely to have an evident impact on ovarian function or fertility in young patients.

  11. Management of spare parts in the obsolescence of equipment. Experiences of TECNATOM

    Martin Frances, Antonio [Spares Engineering, TECNATOM, Ave. Montes de Oca 1, 28709, Madrid (Spain)

    2010-07-01

    Since 1957, Tecnatom is giving engineering specialized services to the Electric Power Generation Plants. These activities also extend to other industrial areas like aerospace sector. TECNATOM it's made up of highly qualified specialists with an extensive experience and dedicated spirit and a pool of young people who interact with them to ensure the continuity of the company as a great team. As an important part of our activities, the 'Spares Engineering', complements the reliability and guarantee of a committed company. Nowadays, because of different reasons, there is a growing problematic in the collection of safety equipment and its spares in the NPPs. Tecnatom has set several actions in motion directed to improve the availability of these equipment and spares, by means of life extension of equipment installed, by means of the development of equipment and spares alternatives to the originals, or by means of services in relation with the spare parts. The actions developed until now have provided satisfactory results in technical and economical terms for the Plants. We have developments at present in course, that we hope they will increase this contribution to solve the problems of obsolescence in NPP's. (authors)

  12. Ambient diagnostics

    Cai, Yang

    2014-01-01

    Part I. FundamentalsIntroductionWhat is Ambient Diagnostics?Diagnostic ModelsMultimedia IntelligenceCrowd SourcingSoft SensorsScience of SimplicityPersonal DiagnosesBasic AlgorithmsBasic ToolsSummaryProblemsTransformationEarly Discoveries of Heartbeat PatternsTransforms, Features, and AttributesSequential FeaturesSpatiotemporal FeaturesShape FeaturesImagery FeaturesFrequency Domain FeaturesMulti-Resolution FeaturesSummaryProblemsPattern RecognitionSimilarities and DistancesClustering MethodsClassification MethodsClassifier Accuracy MeasuresSummaryProblemsPart II. Multimedia IntelligenceSound RecognitionMicrophone AppsModern Acoustic Transducers (Microphones)Frequency Response CharacteristicsDigital Audio File FormatsHeart Sound SensingLung Sound SensingSnore MeterSpectrogram (STFT)Ambient Sound AnalysisSound RecognitionRecognizing Asthma SoundPeak ShiftFeature CompressionRegroupingNoise IssuesFuture ApplicationsSummaryProblemsColor SensorsColor SensingHuman Color VisionColor SensorsColor Matching ExperimentsC...

  13. Structure, longitudinal invariance, and stability of the Child Behavior Checklist 1½-5's Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Disorder scale: Findings from Generation R (Rotterdam).

    Rescorla, Leslie A; Ghassabian, Akhgar; Ivanova, Masha Y; Jaddoe, Vincent Wv; Verhulst, Frank C; Tiemeier, Henning

    2017-11-01

    Although the Child Behavior Checklist 1½-5's 12-item Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Problems Scale (formerly called Pervasive Developmental Problems scale) has been used in several studies as an autism spectrum disorder screener, the base rate and stability of its items and its measurement model have not been previously studied. We therefore examined the structure, longitudinal invariance, and stability of the Child Behavior Checklist 1½-5's Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Problems Scale in the diverse Generation R (Rotterdam) sample based on mothers' ratings at 18 months ( n = 4695), 3 years ( n = 4571), and 5 years ( n = 5752). Five items that seemed especially characteristic of autism spectrum disorder had low base rates at all three ages. The rank order of base rates for the 12 items was highly correlated over time ( Qs ⩾ 0.86), but the longitudinal stability of individual items was modest (phi coefficients = 0.15-0.34). Confirmatory factor analyses indicated that the autism spectrum disorder scale model manifested configural, metric, and scalar longitudinal invariance over the time period from 18 months to 5 years, with large factor loadings. Correlations over time for observed autism spectrum disorder scale scores (0.25-0.50) were generally lower than the correlations across time of the latent factors (0.45-0.68). Results indicated significant associations of the autism spectrum disorder scale with later autism spectrum disorder diagnoses.

  14. Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials

    Preet Mohinder Singh

    2018-01-01

    Conclusions: Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization.

  15. A new model for Assessment and Optimization of Number of Spare Transformers and their Locations in Distribution Systems

    M Sedaghati

    2015-12-01

    Full Text Available In this paper, a new model has been presented to determine the number of spare transformers and their locations for distribution stations. The number of spare transformers must be so that they need minimum investment. Furthermore, they must be sufficient for replacing with transformers that have been damaged. For this reason, in this paper a new purpose function has been presented to maximize profit in distribution company’s budgeting and planning. For determining the number of spares that must be available in a stock room, this paper considers the number of spares and transformer’s fault at the same time. The number of spare transformers is determined so that at least one spare transformer will be available for replacing with the failed transformers. This paper considers time required for purchasing or repairing a failed transformer to determine the number of required spare transformers. Furthermore, whatever the number of spare equipment are increased, cost of maintenance will be increased, so an economic comparison must be done between reduced costs from reducing of outage time and increased costs from spare transformers existence.

  16. A critical spare part inventory control based on hazard function approach: A case study in a garment company

    Melinda, Intan Dewi; Jauhari, Wakhid Ahmad

    2018-02-01

    Spare part procurement is a complex issue and requires an accurate analysis. Stock outs of spare part can leads a great impact on production. Therefore, it is necessary to design the inventory control of spare parts that guarantee the availability of spare parts needed for supporting the maintenance activity. This paper studies the inventory policy for sewing machine spare part using hazard function to approximate the demand. Hazard function is the indicator of the effect of ageing on the reliability of the system. It quantifies the risk of failure as the age of the system increases. We use a continuous review policy based on Hadley Within Approach to calculate the optimum inventory level for critical spare parts. There are four spare parts categorized as critical spare parts, which are needle plate, feed dog, rotary and binder attachment. The optimal ordering quantity for needle plate, feed, rotary and binder attachment are 5 units, 17 units, 5 units, and 9 units, respectively and the reorder point are 2 units, 1 unit, 2 units and 1 unit, respectively. Finally, the service level achieved by the proposed policy is in a range of 95.91%-97.93%, which indicates that the inventory level of spare parts can be used to support the required parts in the maintenance activity.

  17. Pancreas-sparing duodenectomy for an obstructive adenocarcinoma of the duodenum.

    Lam, D; Croome, Kp; Hernandez-Alejandro, R

    2012-08-01

    A duodenal adenocarcinoma arising from the junction of the second and third portion of the duodenum, which was resected by pancreas-sparing duodenectomy, is reported. The completely obstructing tumour was circumferential and measured 6.5cm x 3.5cm x 1.0 cm. There was no evidence of pancreas invasion, nor any lymph node metastasis. Pancreas-sparing duodenectomy was performed, with dissection of the pancreaticoduodenal lymph nodes. The proximal duodenum was transected just distal to the ampula of Vater and jejunum was transected just distal to the ligament of Treitz. A hand-sewn side-to-side anastomosis for the duodenojejunostomy was performed. There were no postoperative complications. Pathology reported a duodenal adenocarcinoma resected with negative margins. Pancreaticoduodenectomy is the treatment of choice for a duodenal adenocarcinoma, however, pancreas-sparing duodenectomy may be a safe alternative for duodenal tumours not involving the 2(nd) portion, especially in elderly patients with multiple medical comorbidities. © JSCR.

  18. Comparing organic farming and land sparing: optimizing yield and butterfly populations at a landscape scale.

    Hodgson, Jenny A; Kunin, William E; Thomas, Chris D; Benton, Tim G; Gabriel, Doreen

    2010-11-01

    Organic farming aims to be wildlife-friendly, but it may not benefit wildlife overall if much greater areas are needed to produce a given quantity of food. We measured the density and species richness of butterflies on organic farms, conventional farms and grassland nature reserves in 16 landscapes. Organic farms supported a higher density of butterflies than conventional farms, but a lower density than reserves. Using our data, we predict the optimal land-use strategy to maintain yield whilst maximizing butterfly abundance under different scenarios. Farming conventionally and sparing land as nature reserves is better for butterflies when the organic yield per hectare falls below 87% of conventional yield. However, if the spared land is simply extra field margins, organic farming is optimal whenever organic yields are over 35% of conventional yields. The optimal balance of land sparing and wildlife-friendly farming to maintain production and biodiversity will differ between landscapes. © 2010 Blackwell Publishing Ltd/CNRS.

  19. Diagnostic accuracy of organ electrodermal diagnostics | Szopinski ...

    Objective. To estimate the diagnostic accuracy as well as the scope of utilisation of a new bio-electronic method of organ diagnostics. Design. Double-blind comparative study of the diagnostic results obtained by means of organ electrodermal diagnostics (OED) and clinical diagnoses, as a criterion standard. Setting.

  20. Comparison of electrophysiological findings in axonal and demyelinating Guillain-Barre syndrome

    Yadegari, Samira; Nafissi, Shahriar; Kazemi, Neda

    2014-01-01

    Background: Incidence and predominant subtype of Guillain-Barre syndrome (GBS) differs geographically. Electrophysiology has an important role in early diagnosis and prediction of prognosis. This study is conducted to determine the frequent subtype of GBS in a large group of patients in Iran and compare nerve conduction studies in axonal and demyelinating forms of GBS. Methods: We retrospectively evaluated the medical records and electrodiagnostic study (EDS) of 121 GBS patients who were managed in our hospital during 11 years. After regarding the exclusion criteria, patients classified as three groups: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). The most frequent subtype and then electrophysiological characteristic based on the time of EDS and their cerebrospinal fluid (CSF) profile were assessed. Results: Among 70 patients finally included in the study, 67% were men. About 63%, 23%, and 14% had AIDP, AMAN, and AMSAN, respectively. AIDP patients represented a wider range of ages compared with other groups. Higher levels of CSF protein, abnormal late responses and sural sparing were more frequent in AIDP subtype. Five AMSAN patients also revealed sural sparing. Conduction block (CB) was observed in one AMAN patient. Prolonged F-wave latency was observed only in AIDP cases. CB and inexcitable sensory nerves were more frequent after 2 weeks, but reduced F-wave persistency was more prominent in the early phase. Conclusion: AIDP was the most frequent subtype. Although the electrophysiology and CSF are important diagnostic tools, classification should not be made based on a distinct finding. PMID:25422732

  1. SNS Diagnostics

    Shea, T.J.; Cameron, P.; Doolittle, L.; Power, J.

    2000-01-01

    The Spallation Neutron Source (SNS) Project is a collaborative effort to build the next generation neutron science facility at Oak Ridge, TN. The facility will deliver a 2 MW proton beam to a liquid mercury target. Neutrons from this target will be moderated and sent to several state-of-the-art instruments. Six national laboratories are involved in SNS construction. Berkeley (LBNL) will build the front end that produces a 2.5 MeV, 52 mA H-beam. Los Alamos (LANL) is responsible for the 1 GeV linac with a superconducting section provided by Thomas Jefferson (JLab). Brookhaven (BNL) is building the transfer lines and accumulator ring. Oak Ridge (ORNL) and Argonne (ANL) have responsibility for the target and instruments. All activities are coordinated by the SNS project office at Oak Ridge. The high beam power, a desired availability of 95%, and an aggressive commissioning schedule lead to some interesting challenges in beam diagnostics

  2. Conserving the birds of Uganda's banana-coffee arc: land sparing and land sharing compared.

    Mark F Hulme

    Full Text Available Reconciling the aims of feeding an ever more demanding human population and conserving biodiversity is a difficult challenge. Here, we explore potential solutions by assessing whether land sparing (farming for high yield, potentially enabling the protection of non-farmland habitat, land sharing (lower yielding farming with more biodiversity within farmland or a mixed strategy would result in better bird conservation outcomes for a specified level of agricultural production. We surveyed forest and farmland study areas in southern Uganda, measuring the population density of 256 bird species and agricultural yield: food energy and gross income. Parametric non-linear functions relating density to yield were fitted. Species were identified as "winners" (total population size always at least as great with agriculture present as without it or "losers" (total population sometimes or always reduced with agriculture present for a range of targets for total agricultural production. For each target we determined whether each species would be predicted to have a higher total population with land sparing, land sharing or with any intermediate level of sparing at an intermediate yield. We found that most species were expected to have their highest total populations with land sparing, particularly loser species and species with small global range sizes. Hence, more species would benefit from high-yield farming if used as part of a strategy to reduce forest loss than from low-yield farming and land sharing, as has been found in Ghana and India in a previous study. We caution against advocacy for high-yield farming alone as a means to deliver land sparing if it is done without strong protection for natural habitats, other ecosystem services and social welfare. Instead, we suggest that conservationists explore how conservation and agricultural policies can be better integrated to deliver land sparing by, for example, combining land-use planning and agronomic

  3. REPLACEMENT SPARE PART INVENTORY MONITORING USING ADAPTIVE NEURO FUZZY INFERENCE SYSTEM

    Hartono Hartono

    2016-01-01

    Full Text Available Abstract   The amount of inventory is determined on the basis of the demand. So that users can know the demand forecasts need to be done on the request. This study uses the data to implement a replacement parts on the electronic module production equipment in the telecommunications transmission systems, switching, access and power, ie by replacing the electronic module in the system is trouble  or damaged parts of a good electronic module spare parts inventory, while the faulty electronic modules shipped to the Repair Center for repaired again, so that the results of these improvements can replenish spare part  inventory. Parameters speed on improvement process of electronic module broken (repaired, in the form of an average repair time at the repair centers, in order to get back into the electronic module that is ready for used as spare parts in compliance with the safe supply inventory  warehouse.  This research using the method  of  Adaptive Neuro Fuzzy Inference System (ANFIS in developing a decision support system for inventory control of spare parts available in Warehouse Inventory taking into account several parameters supporters, namely demand, improvement and fulfillment of spare parts and repair time. This study uses a recycling input parameter repair faulty electronic module of the customer to immediately replace the module in inventory warehouse,  do improvements in the Repair Center. So the acceleration restoration factor is very influential as the input spare parts inventory supply in the warehouse and using the Adaptive Neuro-Fuzzy Inference System (ANFIS method.   Keywords: ANFIS, inventory control, replacement

  4. Primary Buttonhole Mastopexy and Nipple-Sparing Mastectomy: A Preliminary Report.

    Salibian, Arthur H; Harness, Jay K; Mowlds, Donald S

    2016-10-01

    Patients undergoing nipple-sparing mastectomy and immediate-implant based reconstruction occasionally require a mastopexy based on their breast size and degree of ptosis. Previous reports have shown the feasibility of mastopexy-nipple-sparing mastectomy in selected patients to raise the nipple up to 5 cm. Major mastopexy with nipple transposition more than 6 cm in conjunction with nipple-sparing mastectomy for therapeutic indications has not been described. The authors review their experience with primary buttonhole mastopexy performed in conjunction with nipple-sparing mastectomy. Between 2008 and 2014, 16 patients (32 breasts) underwent bilateral primary mastopexy and nipple-sparing mastectomy with immediate staged implant-based reconstruction. The Passot buttonhole technique was used for the mastopexy in all patients, raising the nipple from 7 to 12 cm. Tumor-related data, risk factors, breast size, degree of ptosis, expander size, fill volume, selection criteria, and complications are discussed. The average follow-up period was 33 months (range, 14 to 80 months). There were no tumor recurrences, and all patients completed their reconstruction. Two patients required removal of the expander and delayed reconstruction because of infection and implant exposure due to nipple-areola loss. The reasons for nipple-areola loss and technical modifications to enhance skin viability by retaining a thin layer of subareolar breast tissue for removal during the second-stage implant exchange are discussed. Primary mastopexy using the buttonhole technique performed together with nipple-sparing mastectomy is a safe procedure with predictable results in patients with very large or ptotic breasts requiring lifts greater than 6 cm. The success of the combined procedure depends on preserving a thin layer of subareolar breast tissue and removing it at the time of implant exchange.

  5. Reframing the land-sparing/land-sharing debate for biodiversity conservation.

    Kremen, Claire

    2015-10-01

    Conservation biologists are devoting an increasing amount of energy to debating whether land sparing (high-yielding agriculture on a small land footprint) or land sharing (low-yielding, wildlife-friendly agriculture on a larger land footprint) will promote better outcomes for local and global biodiversity. In turn, concerns are mounting about how to feed the world, given increasing demands for food. In this review, I evaluate the land-sparing/land-sharing framework--does the framework stimulate research and policy that can reconcile agricultural land use with biodiversity conservation, or is a revised framing needed? I review (1) the ecological evidence in favor of sparing versus sharing; (2) the evidence from land-use change studies that assesses whether a relationship exists between agricultural intensification and land sparing; and (3) how that relationship may be affected by socioeconomic and political factors. To address the trade-off between biodiversity conservation and food production, I then ask which forms of agricultural intensification can best feed the world now and in the future. On the basis of my review, I suggest that the dichotomy of the land-sparing/land-sharing framework limits the realm of future possibilities to two, largely undesirable, options for conservation. Both large, protected regions and favorable surrounding matrices are needed to promote biodiversity conservation; they work synergistically and are not mutually exclusive. A "both-and" framing of large protected areas surrounded by a wildlife-friendly matrix suggests different research priorities from the "either-or" framing of sparing versus sharing. Furthermore, wildlife-friendly farming methods such as agroecology may be best adapted to provide food for the world's hungry people. © 2015 New York Academy of Sciences.

  6. Imaging systems for medical diagnostics

    Krestel, E.

    1990-01-01

    This book provides physicians and clinical physicists with detailed information on today's imaging modalities and assists them in selecting the optimal system for each clinical application. Physicists, engineers and computer specialists engaged in research and development and sales departments will also find this book to be of considerable use. It may also be employed at universities, training centers and in technical seminars. The physiological and physical fundamentals are explained in part 1. The technical solutions contained in part 2 illustrate the numerous possibilities available in X-ray diagnostics, computed tomography, nuclear medical diagnostics, magnetic resonance imaging, sonography and biomagnetic diagnostics. (orig.)

  7. Mammary carcinoma diagnostics and therapy

    Fischer, Uwe; Baum, Friedemann

    2014-01-01

    The book on mammary carcinoma diagnostics and therapy covers the following issues: development, anatomy and physiology of the mammary glands, pathology of benign and malign mammary gland changes, non-imaging diagnostics; mammography; ultrasonic mammography; magnetic resonance tomography of the mammary glands; imaging diagnostics findings; mammary interventions; examination concepts; operative therapy of the mammary carcinoma; chemotherapy of the mammary carcinoma; radio-oncological therapy of the mammary carcinoma; logistics in a medical center for mammary gland diseases; logistics in an interdisciplinary center for mammary diseases; dialogue conduction and psycho-social attendance.

  8. Spare-parts and perpetuity of equipment in French PWR plants

    Briolat, R.

    1993-01-01

    Supply of plants with new or repaired parts in strict quality conditions aids maintaining safety in operation and energy availability. Taking into account their expected life-time, a process of perpetuity in partnership with suppliers is necessary to ensure operation for the medium and long term. At EDF, the method involves a classification of mechanical and electrical spare parts in two levels of quality, responding to safety and availability imperatives and current available industrial practices. A diagram is presented to define optimal strategy for each equipment component, which gives choice between spare part storage, longevity agreement with the supplier, or a technology transfer agreement. 1 tab

  9. Spare parts management for nuclear research reactors [Paper No.: I-14

    Kini, M.P.

    1981-01-01

    Most of the equipment installed at CIRUS and other reactors are imported units. CIRUS reactor is 20 years old and with present problems for obtaining spare parts for this equipment, indigenous effort in procurement has become imperative. In the absence of specifications and drawings for most of the components, the task of indigenous procurement has become quite demanding. The efforts put by Reactor Operations Division of the Bhabha Atomic Research Centre, Bombay in locating local manufacturers who are willing to fabricate in small quantities of spare parts to specifications and the difficulties involved is the theme of this paper. The paper also covers the efforts on equipment replacement, its success and failures. (author)

  10. Neural stem cell sparing by linac based intensity modulated stereotactic radiotherapy in intracranial tumors

    Oehler, Julia; Brachwitz, Tim; Wendt, Thomas G; Banz, Nico; Walther, Mario; Wiezorek, Tilo

    2013-01-01

    Neurocognitive decline observed after radiotherapy (RT) for brain tumors in long time survivors is attributed to radiation exposure of the hippocampus and the subventricular zone (SVZ). The potential of sparing capabilities for both structures by optimized intensity modulated stereotactic radiotherapy (IMSRT) is investigated. Brain tumors were irradiated by stereotactic 3D conformal RT or IMSRT using m3 collimator optimized for PTV and for sparing of the conventional OARs (lens, retina, optic nerve, chiasm, cochlea, brain stem and the medulla oblongata). Retrospectively both hippocampi and SVZ were added to the list of OAR and their dose volume histograms were compared to those from two newly generated IMSRT plans using 7 or 14 beamlets (IMSRT-7, IMSRT-14) dedicated for optimized additional sparing of these structures. Conventional OAR constraints were kept constant. Impact of plan complexity and planning target volume (PTV) topography on sparing of both hippocampi and SVZ, conformity index (CI), the homogeneity index (HI) and quality of coverage (QoC) were analyzed. Limits of agreement were used to compare sparing of stem cell niches with either IMSRT-7 or IMSRT-14. The influence of treatment technique related to the topography ratio between PTV and OARs, realized in group A-D, was assessed by a mixed model. In 47 patients CI (p ≤ 0.003) and HI (p < 0.001) improved by IMSRT-7, IMSRT-14, QoC remained stable (p ≥ 0.50) indicating no compromise in radiotherapy. 90% of normal brain was exposed to a significantly higher dose using IMSRT. IMSRT-7 plans resulted in significantly lower biologically effective doses at all four neural stem cell structures, while contralateral neural stem cells are better spared compared to ipsilateral. A further increase of the number of beamlets (IMSRT-14) did not improve sparing significantly, so IMSRT-7 and IMSRT-14 can be used interchangeable. Patients with tumors contacting neither the subventricular zone nor the cortex benefit

  11. Inventory-transportation integrated optimization for maintenance spare parts of high-speed trains

    Wang, Jiaxi; Wang, Huasheng; Wang, Zhongkai; Li, Jian; Lin, Ruixi; Xiao, Jie; Wu, Jianping

    2017-01-01

    This paper presents a 0–1 programming model aimed at obtaining the optimal inventory policy and transportation mode for maintenance spare parts of high-speed trains. To obtain the model parameters for occasionally-replaced spare parts, a demand estimation method based on the maintenance strategies of China’s high-speed railway system is proposed. In addition, we analyse the shortage time using PERT, and then calculate the unit time shortage cost from the viewpoint of train operation revenue. Finally, a real-world case study from Shanghai Depot is conducted to demonstrate our method. Computational results offer an effective and efficient decision support for inventory managers. PMID:28472097

  12. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas

    Chang, A.E.; Steinberg, S.M.; Culnane, M.

    1989-01-01

    We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone

  13. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas

    Chang, A.E.; Steinberg, S.M.; Culnane, M.; Lampert, M.H.; Reggia, A.J.; Simpson, C.G.; Hicks, J.E.; White, D.E.; Yang, J.J.; Glatstein, E. (National Cancer Institute, Bethesda, MD (USA))

    1989-09-01

    We have documented functional and psychosocial changes in patients with extremity soft tissue sarcomas who have undergone multimodality limb-sparing treatments. In 88 patients, parameters related to economic status, sexual activity, pain, limb function, and global quality of life (QOL) were recorded prior to surgery and every 6 months postoperatively. Changes from the preoperative assessment for every parameter were analyzed in each patient. Six months after surgery, there was a decrease in employment status, sexual activity, and in limb function in a significant number of patients. At 12 months, these decreases were still evident. Despite these changes, global QOL measured by a standardized test showed at least some improvement in a significant proportion of patients at 12 months. These findings highlight the difficulty in defining QOL. It could not be ascertained if radiation therapy and/or chemotherapy were causative factors in specific changes because of the small numbers of patients in each subgroup. However, among 60 patients with high-grade sarcomas, significant wound problems developed in 10 of 33 who received postoperative radiation therapy in combination with adjuvant doxorubicin and cyclophosphamide chemotherapy compared with one of 27 patients who received adjuvant chemotherapy alone (P = .016). Also, among high-grade sarcoma patients with 12-month follow-up, six of 19 patients who received radiation therapy and chemotherapy developed joint contractures compared with zero of 15 patients who received chemotherapy alone (P less than .04). The combination of postoperative radiation therapy and chemotherapy appeared to be associated with significantly more tissue-related injury in patients with high-grade sarcomas compared with chemotherapy alone.

  14. Mitigation diagnostics

    Hall, S.T.

    1990-01-01

    This paper reports that experience in the remediation of schools and other large buildings has shown the importance of the effects of both the location of geologic sources and HVAC-induced distribution of indoor radon. In general, elevated radon in areas of schools with evenly distributed HVAC pressures are correlated with maximum soil radon emanations. However, strong or unequal HVAC effects can redistribute indoor radon to areas away from the direct source. Effective remediation required a complete understanding of both contributions. In some schools, highest indoor radon levels were located near large return ducts and were attributed to proximity to negative HVAC pressure. Successful sub-slab depressurization systems were installed, however, in rooms with lower indoor but greatest sub-slab radon levels, closest to the source. This shows the inadequacy of using indoor radon levels alone as a basis for remediation. Wings of two other schools with radon problems have equivalent window fan coil units in rooms of equal size and no central HVAC system. Highest indoor radon levels correlated well with highest sub-slab radon levels due to the equivalent effects of the window units. Diagnostic tests in other schools have revealed: blockwall radon transport to upper floors; high blockwall radon adjacent to sub-slab sources; and elevated indoor radon over crawlspace being drawn upward by HVAC-induced negative pressure, determined from indoor to outdoor micromanometer measurements

  15. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: A 2-year follow-up study

    Hongsen Chiang

    2012-12-01

    Conclusions: Patients undergoing quadriceps-sparing and standard medial parapatellar TKA had comparable outcomes for quadriceps muscle strength, hamstring–quadriceps balance, and knee function; however, the quadriceps-sparing TKA was more time consuming surgically and resulted in a less accurate prosthesis position.

  16. Joint optimisation of spare part inventory, maintenance frequency and repair capacity for k-out-of-N systems

    de Smidt-Destombes, Karin S.; van der Heijden, Matthijs C.; van Harten, Aart

    2009-01-01

    To achieve a high system availability at minimal costs, relevant decisions include the choice of preventive maintenance frequency, spare part inventory levels and spare part repair capacity. We develop heuristics for the joint optimisation of these variables for (a) a single k-out-of-N system under

  17. Defecography - analysis of qualitative findings

    Schott, U.; Braunschweig, R.; Claussen, C.D.

    1994-01-01

    The defectography is an examination of the anorectal function in defecatory disorder. The defecography has a diagnostic impact on disease, which only emerge during defecation as intussusception, enterocele, prolapse or sphincter dysfunction. Other findings as rectocele or descending pelvic floor are ambiguous concerning clinical relevance. The interpretation of defecography should include patient's history and clinical findings and - if available -endoscopic and manometric findings. (orig.) [de

  18. Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis.

    Moore, Jason

    2009-02-27

    Limiting the exposure of kidney transplant recipients to calcineurin inhibitors (CNIs) has potential merit, but there is no clear consensus on the utility of current strategies. In an attempt to aid clarification, we conducted a systematic review and meta-analysis of randomized trials that assessed CNI sparing (minimization or elimination) with mycophenolate as sole adjunctive immunosuppression.

  19. An approximate approach for the joint problem of level of repair analysis and spare parts stocking

    Basten, R.J.I.; Heijden, van der M.C.; Schutten, J.M.J.

    2011-01-01

    For the spare parts stocking problem, generally metric type methods are used in the context of capital goods. Implicitly, a decision is assumed on which components to discard and which to repair upon failure, and where to perform repairs. In the military world, this decision is taken explicitly

  20. Locating spare part warehouses using the concept of gradual coverage - A case study

    Hansen, Klaus Reinholdt Nyhuus; Grunow, Martin

    2009-01-01

    for MAN Diesel SE is presented, where gradual coverage has been used for locating warehouses for spare parts. In particular it is described, how coverage decay functions are found, which identifies customers’ reaction to the offered ’speed of delivery’ and ’total order cost’. With these functions, demand...

  1. A joint spare part and maintenance inspection optimisation model using the Delay-Time concept

    Wang Wenbin

    2011-01-01

    Spare parts and maintenance are closely related logistics activities where maintenance generates the need for spare parts. When preventive maintenance is present, it may need more spare parts at one time because of the planned preventive maintenance activities. This paper considers the joint optimisation of three decision variables, e.g., the ordering quantity, ordering interval and inspection interval. The model is constructed using the well-known Delay-Time concept where the failure process is divided into a two-stage process. The objective function is the long run expected cost per unit time in terms of the three decision variables to be optimised. Here we use a block-based inspection policy where all components are inspected at the same time regardless of the ages of the components. This creates a situation that the time to failure since the immediate previous inspection is random and has to be modelled by a distribution. This time is called the forward time and a limiting but closed form of such distribution is obtained. We develop an algorithm for the optimal solution of the decision process using a combination of analytical and enumeration approaches. The model is demonstrated by a numerical example. - Highlights: → Joint optimisation of maintenance and spare part inventory. → The use of the Delay-Time concept. → Block-based inspection. → Fixed order interval but variable order quantity.

  2. Nephron sparing surgery (NSS) for unilateral wilms tumor (UWT): the SIOP 2001 experience

    Wilde, Jim C. H.; Aronson, Daniel C.; Sznajder, Beata; van Tinteren, Harm; Powis, Mark; Okoye, Bruce; Cecchetto, Giovanni; Audry, Georges; Fuchs, Jörg; Schweinitz, Dietrich Von; Heij, Hugo; Graf, Norbert; Bergeron, Christophe; Pritchard-Jones, Kathy; van den Heuvel-Eibrink, Marry; Carli, Modesto; Oldenburger, Foppe; Sandstedt, Bengt; de Kraker, Jan; Godzinski, Jan

    2014-01-01

    Total nephrectomy (TN) remains the standard treatment of unilateral Wilms tumors (uWT). The SIOP WT-2001 protocol allowed Nephron Sparing Surgery (NSS) for polar or peripherally non-infiltrating tumors. Inventory of the current SIOP NSS-experience. 2,800 patients with a unilateral, localized or

  3. Fetal Growth Restriction with Brain Sparing: Neurocognitive and Behavioral Outcomes at 12 Years of Age

    Beukers, Fenny; Aarnoudse-Moens, Cornelieke S. H.; van Weissenbruch, Mirjam M.; Ganzevoort, Wessel; van Goudoever, Johannes B.; van Wassenaer-Leemhuis, Aleid G.

    2017-01-01

    Objective To study neurocognitive functions and behavior in children with a history of fetal growth restriction (FGR) with brain sparing. We hypothesized that children with FGR would have poorer outcomes on these domains. Study design Subjects were 12-year-old children with a history of FGR born to

  4. Modified Sleeve Technique in Aortic Valve-Sparing Operation for Marfan Syndrome.

    Wu, Yung-Szu; Hsieh, Shih-Rong; Wang, Chung-Chi; Tsai, Chung-Lin

    2018-03-22

    We devised a simple modification of the Florida Sleeve procedure to perform aortic valve-sparing surgery. This technique is simple, quick, effective, and safe. We used this technique in operations performed on two young patients with Marfan syndrome. The initial and short-term results were satisfactory.

  5. Information system design of inventory control spare parts maintenance (valuation class 5000) (case study: plant kw)

    Fitriana, Rina; Moengin, Parwadi; Riana, Mega

    2016-02-01

    Plat KW hadn't using optimal inventory level planning yet and hadn't have an information system that well computerized. The research objective is to be able to design an information system related inventory control of spare parts maintenance. The study focused on five types of spare parts with the highest application rate during February 2013- March 2015 and included in the classification of fast on FSN analysis Grinding stones Cut 4". Cable Tie 15". Welding RB 26-32MM. Ring Plat ½" and Ring Plate 5/8 ". Inventory calculation used Economic Order Quantity (EOQ). Safety Stock (SS) and Reorder Point (ROP) methods. System analysis conducted using the framework PIECES with the proposed inventory control system. the performance of the plant KW relating to the supply of spare parts maintenance needs can be more efficient as well as problems at the company can be answered and can perform inventory cost savings amounting Rp.267.066. A computerized information system of inventory control spare parts maintenance provides a menu that can be accessed by each departments as the user needed.

  6. Applying of neural networks in determination of replacement cycle of spare parts

    Saric, Tomislav; Majdandzic; Niko; Lujic, Roberto

    2003-01-01

    The article shows neural networks applicability to determine expected working time of equipment components before the damage. The results based on measure - simulated values of suggested model have been presented. Advantages of suggested model have been analyzed compared to traditional way of replacement of spare parts and components. Implementation possibility of suggested model in Management Information Maintenance System has been described. (author)

  7. Non-potassium sparing diuretics and sudden cardiac death in hypertensive patients : a pharmacoepidemiologic approach

    A.W. Hoes (Arno)

    1992-01-01

    textabstractThe studies described in this thesis focus on the possible relationship between the use of non-potassium sparing diuretics and the occurrence of sudden cardiac death in hypertensive patients. To study this potential adverse drug reaction several methods were applied, including

  8. Successful pregnancy outcome after fertility-sparing surgery and chemotherapy for dysgerminoma.

    Shamim, Muhammad

    2010-09-01

    Ovarian dysgerminoma is a rare malignancy of the ovary. This is a case report of a 30-year-old female, presenting with a huge ovarian mass along with multiple gallstones; she was treated by fertility-sparing excision of the mass and cholecystectomy, followed by chemotherapy. She later had an uneventful pregnancy and delivered a healthy baby.

  9. Spare parts management at complex technology-based organizations: an agenda for research

    Rustenburg, W.D.; Houtum, van G.J.J.A.N.; Zijm, W.H.M.

    2001-01-01

    This paper explores the applicability of sophisticated models and techniques for spare parts inventory management within a highly technology-driven environment, viz. the Royal Netherlands Navy. In particular, we discuss the structure of the so-called VARI-METRIC models, a set of tools that has been

  10. A decision-making framework to integrate maintenance contract conditions with critical spares management

    Godoy, David R.; Pascual, Rodrigo; Knights, Peter

    2014-01-01

    Maintenance outsourcing is a strategic driver for asset intensive industries pursuing to enhance supply chain performance. Spare parts management plays a relevant role in this premise since its significant impact on equipment availability, and hence on business success. Designing critical spares policies might therefore seriously affect maintenance contracts profitability, yet service receivers and external providers traditionally attempt to benefit separately. To coordinate both chain parties, we investigated whether the spare components pool should be managed in-house or contracted out. This paper provides a decision-making framework to efficiently integrate contractual conditions with critical spares stockholding. Using an imperfect maintenance strategy over a finite horizon, the scheme maximizes chain returns whilst evaluating the impact of an additional part to stock. As result, an original joint value – preventive interval and stock level – sets the optimal agreement to profitably allocate the components pool within the service contract. Subsidization bonuses on preventive interventions and pooling costs are also estimated to induce the service provider to adjust its policy when needed. The proposed contractual conditions motivate stakeholders to continuously improve maintenance performance and supply practices, thus obtaining higher joint benefits

  11. Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique

    Brodin, N. Patrik; af Rosenschold, Per Munck; Blomstrand, Malin

    2014-01-01

    BackgroundWe investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy.MethodsWe included 17 pediatric medulloblastoma...

  12. Joint Optimization of Preventive Maintenance and Spare Parts Inventory with Appointment Policy

    Jing Cai

    2017-01-01

    Full Text Available Under the background of the wide application of condition-based maintenance (CBM in maintenance practice, the joint optimization of maintenance and spare parts inventory is becoming a hot research to take full advantage of CBM and reduce the operational cost. In order to avoid both the high inventory level and the shortage of spare parts, an appointment policy of spare parts is first proposed based on the prediction of remaining useful lifetime, and then a corresponding joint optimization model of preventive maintenance and spare parts inventory is established. Due to the complexity of the model, the combination method of genetic algorithm and Monte Carlo is presented to get the optimal maximum inventory level, safety inventory level, potential failure threshold, and appointment threshold to minimize the cost rate. Finally, the proposed model is studied through a case study and compared with both the separate optimization and the joint optimization without appointment policy, and the results show that the proposed model is more effective. In addition, the sensitivity analysis shows that the proposed model is consistent with the actual situation of maintenance practices and inventory management.

  13. An approximate approach for the joint problem of level of repair analysis and spare parts stocking.

    Basten, Robertus Johannes Ida; van der Heijden, Matthijs C.; Schutten, Johannes M.J.

    2011-01-01

    For the spare parts stocking problem, generally metric type methods are used in the context of capital goods. Implicitly, a decision is assumed on which components to discard and which to repair upon failure, and where to perform repairs. In the military world, this decision is taken explicitly

  14. MANAGEMENT OF ENDOCRINE DISEASE: Outcome of adrenal sparing surgery in heritable pheochromocytoma.

    Castinetti, F; Taieb, D; Henry, J F; Walz, M; Guerin, C; Brue, T; Conte-Devolx, B; Neumann, H P H; Sebag, F

    2016-01-01

    The management of hereditary pheochromocytoma has drastically evolved in the last 20 years. Bilateral pheochromocytoma does not increase mortality in MEN2 or von Hippel-Lindau (VHL) mutation carriers who are followed regularly, but these mutations induce major morbidities if total bilateral adrenalectomy is performed. Cortical sparing adrenal surgery may be proposed to avoid definitive adrenal insufficiency. The surgical goal is to leave sufficient cortical tissue to avoid glucocorticoid replacement therapy. This approach was achieved by the progressive experience of minimally invasive surgery via the transperitoneal or retroperitoneal route. Cortical sparing adrenal surgery exhibits management of all patients with MEN2 or VHL hereditary pheochromocytoma. Hereditary pheochromocytoma is a rare disease, and a randomized trial comparing cortical sparing vs classical adrenalectomy is probably not possible. This lack of data most likely explains why cortical sparing surgery has not been adopted in most expert centers that perform at least 20 procedures per year for the treatment of this disease. This review examined recent data to provide insight into the technique, its indications, and the results and subsequent follow-up in the management of patients with hereditary pheochromocytoma with a special emphasis on MEN2. © 2016 European Society of Endocrinology.

  15. Assessing End-Of-Supply Risk of Spare Parts Using the Proportional Hazard Model

    X. Li (Xishu); R. Dekker (Rommert); C. Heij (Christiaan); M. Hekimoğlu (Mustafa)

    2016-01-01

    textabstractOperators of long field-life systems like airplanes are faced with hazards in the supply of spare parts. If the original manufacturers or suppliers of parts end their supply, this may have large impacts on operating costs of firms needing these parts. Existing end-of-supply evaluation

  16. Radical Radiation Therapy After Lung-Sparing Surgery for Malignant Pleural Mesothelioma: Survival, Pattern of Failure, and Prognostic Factors

    Minatel, Emilio [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Bearz, Alessandra [Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Di Maso, Matteo [Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Baresic, Tania [Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Drigo, Annalisa; Barresi, Loredana [Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Furlan, Carlo [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Del Conte, Alessandro [Department of Medical Oncology, Pordenone General Hospital, Pordenone (Italy); Bruschi, Gioia [Department of Pneumology, Pordenone General Hospital, Pordenone (Italy); Fontana, Paolo [Department of Thoracic Surgery, Mestre General Hospital, Mestre (Italy); Pagan, Vittore [Department of Surgery, Centro di Riferimento Oncologico of Aviano, Aviano (Italy); Franchin, Giovanni [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Aviano (Italy)

    2015-11-01

    Purpose: To prospectively assess the survival, patterns of failure, and prognostic factors in a large cohort of patients with malignant pleural mesothelioma who had undergone a novel trimodal therapeutic approach, including lung-sparing surgery, chemotherapy, and subsequent treatment with high doses of intensity modulated radiation therapy (IMRT) to the whole hemithorax. Methods and Materials: The analysis was conducted on the data from 69 patients. Of the 69 patients, 35 underwent extended pleurectomy/decortication (P/D), with resection of the entire pleura, along with portions of the pericardium and diaphragm and 34, partial pleurectomy, defined as partial removal of parietal or visceral pleura for diagnostic purposes, leaving gross tumor behind in all cases. All patients received cisplatin/pemetrexed chemotherapy. Postoperative IMRT was delivered to the entire hemithorax, excluding the intact lung. The IMRT dose was 50 Gy in 25 fractions. Any fluorodeoxyglucose-avid areas or regions of particular concern for residual disease were given a simultaneous boost to 60 Gy. Results: The median follow-up duration was 19 months. No difference was seen in overall survival and locoregional control between the extended P/D group and the partial pleurectomy group. The 2-year overall survival was 65% and 58% in the extended P/D and partial pleurectomy groups, respectively (P=.94). Locoregional control at 2 years was 65% and 64% in the extended P/D and partial pleurectomy groups, respectively (P=.75). The predominant pattern of failure was distant: 19 patients (27.5%) developed distant metastases as the first site of relapse. Gross residual disease after surgery was significantly associated with overall survival (hazard ratio 3.45). One fatal pneumonitis was reported; 14 cases (20%) of grade 2 to 3 pneumonitis were documented. Conclusions: Radical IMRT after lung-sparing surgery and chemotherapy for malignant pleural mesothelioma leads to promising survival results and

  17. Muscle MRI findings in patients with limb girdle muscular dystrophy with calpain 3 deficiency (LGMD2A) and early contractures.

    Mercuri, Eugenio; Bushby, Kate; Ricci, Enzo; Birchall, Daniel; Pane, Marika; Kinali, Maria; Allsop, Joanna; Nigro, Vincenzo; Sáenz, Amets; Nascimbeni, Annachiara; Fulizio, Luigi; Angelini, Corrado; Muntoni, Francesco

    2005-02-01

    Limb girdle muscular dystrophy 2A is a common variant secondary to mutations in the calpain 3 gene. A proportion of patients has early and severe contractures, which can cause diagnostic difficulties with other conditions. We report clinical and muscle magnetic resonance imaging findings in seven limb girdle muscular dystrophy 2A patients (four sporadic and three familial) who had prominent and early contractures. All patients showed a striking involvement of the posterior thigh muscles. The involvement of the other thigh muscles was variable and was related to clinical severity. Young patients with minimal functional motor impairment showed a predominant involvement of the adductors and semimembranosus muscles while patients with restricted ambulation had a more diffuse involvement of the posterolateral muscles of the thigh and of the vastus intermedius with relative sparing of the vastus lateralis, sartorius and gracilis. At calf level all patients showed involvement of the soleus muscle and of the medial head of the gastrocnemius with relative sparing of the lateral head. MRI findings were correlated to those found in two patients with the phenotype of limb girdle muscular dystrophy 2A without early contractures and the pattern observed was quite similar. However, the pattern observed in limb girdle muscular dystrophy 2A is different from that reported in other muscle diseases such as Emery-Dreifuss muscular dystrophy and Bethlem myopathy which have a significant clinical overlap with limb girdle muscular dystrophy 2A once early contractures are present. Our results suggest that muscle MRI may help in recognising patients with limb girdle muscular dystrophy 2A even when the clinical presentation overlaps with other conditions, and may therefore, be used as an additional investigation to target the appropriate biochemical and genetic tests.

  18. Effect of Nerve-Sparing Radical Prostatectomy on Urinary Continence in Patients With Preoperative Erectile Dysfunction

    Yong Hyun Park

    2016-03-01

    Full Text Available Purpose: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP is associated with improved recovery of urinary continence compared to non–nerve-sparing radical prostatectomy (nnsRP in patients with localized prostate cancer and preoperative erectile dysfunction. Methods: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary’s Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. Results: Urinary continence recovered in 279 patients (77.5% within the mean follow-up period of 22.5 months (range, 6–123 months. Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022. All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002–1.478; P=0.026 and nerve-sparing status (HR, 0.713; 95% CI, 0.548–0.929; P=0.012 were independently associated with recovery of urinary continence. Conclusions: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes.

  19. Radiation therapy for retinoblastoma: comparison of results with lens-sparing versus lateral beam techniques

    McCormick, B.; Ellsworth, R.; Abramson, D.; Haik, B.; Tome, M.; Grabowski, E.; LoSasso, T.

    1988-01-01

    From 1979 through 1986, 170 children were seen at our institution diagnosed with retinoblastoma. Sixty-six of the children with involvement of 121 eyes, were referred for definitive external beam radiation to one or both eyes. During the study period, two distinct radiation techniques were used. From 1980 through mid-1984, a lens-sparing technique included an anterior electron beam with a contact lens mounted lead shield, combined with a lateral field, was used. Since mid-1984, a modified lateral beam technique has been used, mixing lateral electrons and superior and inferior lateral oblique split beam wedged photons. Doses prescribed were similar for both techniques, ranging from 3,850 to 5,000 cGy in 4 to 5 weeks. The lens-sparing and the modified lateral techniques are compared for local control. For eyes with Group I through III disease, the lens-sparing technique resulted in local control in 33% of the eyes treated, where the modified lateral technique controlled 83% of the eyes treated (p = .006). Mean time to relapse was identical in both groups, that is 24 and 26 months respectively. Most relapses were successfully treated with further local therapy, including laser or cryosurgery, or 60Co plaques. Five eyes required enucleation following initial treatment with the lens-sparing technique, but none thus far with the lateral beam technique. For eyes with Group IV and V disease, no significant differences were found between the two techniques in terms of local control or eventual need for enucleation. With a mean follow-up time of 33 months for the entire group, the 4-year survival is 93%. Two of the 4 deaths are due to second primary tumor, and all 4 have occurred in the lens-sparing group. Because follow-up time is more limited in the lateral beam group, this is not statistically significant and direct survival comparisons are premature

  20. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy.

    Bellangino, Mariangela; Verrill, Clare; Leslie, Tom; Bell, Richard W; Hamdy, Freddie C; Lamb, Alastair D

    2017-11-07

    Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could

  1. Submandibular gland-sparing radiation therapy for locally advanced oropharyngeal squamous cell carcinoma: patterns of failure and xerostomia outcomes

    Gensheimer, Michael F; Liao, Jay J; Garden, Adam S; Laramore, George E; Parvathaneni, Upendra

    2014-01-01

    Saliva from submandibular glands (SMG) is necessary to minimize xerostomia. It is unclear whether SMG can be safely spared in patients undergoing bilateral neck radiotherapy for locally advanced oropharyngeal cancer without increasing the risk of marginal recurrence. We evaluated the outcomes of contralateral submandibular gland (cSMG) sparing intensity-modulated radiation therapy (IMRT). All patients with stage III/IV oropharyngeal squamous cell carcinoma treated with bilateral neck IMRT from 2006–2012 at our institution were included. Appropriately selected patients with favorable primary tumor characteristics and no definite contralateral neck disease were treated with cSMG-sparing IMRT. Patterns of failure and xerostomia outcomes were retrospectively analyzed. 114 patients were treated. 89% had stage IV disease and 89% received definitive radiation therapy. 76 patients (67%) received cSMG sparing IMRT. With a median follow-up of 30 months, there were 10 local, 9 regional, and 10 distant recurrences. 2-year overall survival was 86% and 2-year loco-regional control was 87%. In cSMG spared patients, the mean cSMG dose was 30.7 Gy. Late grade 2+ xerostomia was significantly reduced in the cSMG spared group compared to those without SMG sparing (6 months: 23% vs. 72%, 12 months: 6% vs. 41%, 24 months: 3% vs. 36%, all p < 0.0007). There were no peri-SMG marginal recurrences in the cSMG-spared cohort. cSMG sparing IMRT did not increase marginal failures in this series of locally advanced oropharyngeal SCC patients. Xerostomia was significantly reduced in cSMG spared patients

  2. Can sparing of the superficial contralateral parotid lobe reduce xerostomia following radiotherapy for head and neck cancer?

    Nevens, Daan; Nuyts, Sandra

    2017-12-01

    The purpose of this study is to see whether sparing the superficial contralateral parotid lobe can help limiting xerostomia following radiotherapy for head and neck cancer. 88 patients that were included in two prospective randomized studies were analysed in the current study. Using the dosimetry of both the parotid glands, we divided our patients in four groups. Group 1 includes patients where we were able to reduce the radiation dose below the threshold in order to spare both the ipsilateral and contralateral parotid glands, Group 2 consists of patients where only the contralateral parotid gland could be spared. Group 3 consists of patients where only the contralateral superficial parotid lobe could be spared, while in Group 4 not even the contralateral superficial lobe could be spared. When we compared Group 1 and Group 2, we did not observe a significant difference between both groups in terms of xerostomia scores at 6 or 12 months. When we compared these groups with Group 3, we observed significant differences with more xerostomia in Group 3 where only the contralateral superficial lobe was spared. A significant difference was also observed between Group 3 and Group 4 with more xerostomia in Group 4. Sparing of just one superficial parotid lobe results in less xerostomia when compared to not sparing any lobe of both parotid glands. Advances in knowledge: When sparing of the whole contralateral parotid gland is not possible, delineating both the superficial parotid glands and trying to spare at least one of them can mean a way forward in limiting xerostomia in head and neck cancer patients treated with radiotherapy.

  3. Bouveret's Syndrome: diagnostic considerations

    Cooper, S.G.; Sherman, S.B.; Steinhardt, J.E.; Wilson, J.M. Jr.; Richman, A.H.

    1987-01-01

    Bouveret's syndrome is a rare disease entity manifested by the formation of a cholecystoduodenal or choledochoduodenal fistula with passage of a gallstone into the duodenal bulb and subsequent obstruction of the gastric outlet. To date, no report of this entity using computed tomographic (CT) imaging is available. This article presents a case of Bouveret's syndrome with the classic findings on upper gastrointestinal (GI) tract series and a description of the CT manifestations. The literature is reviewed with discussion of the diagnostic approach to patients with Bouveret's syndrome

  4. Finding Sliesthorp?

    Dobat, Andres S.

    2016-01-01

    In 2003, a hitherto unknown Viking age settlement was discovered at Füsing in Northern Germany close to Hedeby/Schleswig, the largest of the early Scandinavian towns. Finds and building features suggest a high status residence and a seat of some chiefly elite that flourished from around 700 to th...... and the transformation of socio‐political structures in Northern Europe as it transitioned from prehistory into the middle Ages....

  5. Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

    М. Л. Гордеев

    2016-08-01

    Full Text Available Aim: The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.Methods: From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11, combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12, and Bentall procedure (group 3, n = 26. We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.Results: The hospital mortality rate was 8.2% (4/49 patients. The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.Conclusions: Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long

  6. Tissue sparing, behavioral recovery, supraspinal axonal sparing/regeneration following sub-acute glial transplantation in a model of spinal cord contusion.

    Barbour, Helen R; Plant, Christine D; Harvey, Alan R; Plant, Giles W

    2013-09-27

    It has been shown that olfactory ensheathing glia (OEG) and Schwann cell (SCs) transplantation are beneficial as cellular treatments for spinal cord injury (SCI), especially acute and sub-acute time points. In this study, we transplanted DsRED transduced adult OEG and SCs sub-acutely (14 days) following a T10 moderate spinal cord contusion injury in the rat. Behaviour was measured by open field (BBB) and horizontal ladder walking tests to ascertain improvements in locomotor function. Fluorogold staining was injected into the distal spinal cord to determine the extent of supraspinal and propriospinal axonal sparing/regeneration at 4 months post injection time point. The purpose of this study was to investigate if OEG and SCs cells injected sub acutely (14 days after injury) could: (i) improve behavioral outcomes, (ii) induce sparing/regeneration of propriospinal and supraspinal projections, and (iii) reduce tissue loss. OEG and SCs transplanted rats showed significant increased locomotion when compared to control injury only in the open field tests (BBB). However, the ladder walk test did not show statistically significant differences between treatment and control groups. Fluorogold retrograde tracing showed a statistically significant increase in the number of supraspinal nuclei projecting into the distal spinal cord in both OEG and SCs transplanted rats. These included the raphe, reticular and vestibular systems. Further pairwise multiple comparison tests also showed a statistically significant increase in raphe projecting neurons in OEG transplanted rats when compared to SCs transplanted animals. Immunohistochemistry of spinal cord sections short term (2 weeks) and long term (4 months) showed differences in host glial activity, migration and proteoglycan deposits between the two cell types. Histochemical staining revealed that the volume of tissue remaining at the lesion site had increased in all OEG and SCs treated groups. Significant tissue sparing was

  7. Dual p16 and Ki-67 Expression in Liquid-Based Cervical Cytological Samples Compared to Pap Cytology Findings, Biopsies, and HPV Testing in Cervical Cancer Screening: A Diagnostic Accuracy Study.

    Prigenzi, Karla Calaça Kabbach; Heinke, Thaís; Salim, Rafael Calil; Focchi, Gustavo Rubino de Azevedo

    2018-01-01

    Our objective was to verify the sensitivity and specificity of dual immunocytochemistry staining for p16 and Ki-67 in liquid-based samples (the "dual" assay) for cervical lesion screening, compared to biopsy findings and human papillomavirus (HPV) DNA molecular detection. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for the "dual immunocytochemistry assay" were calculated and compared to histopathological results and to high-risk HPV DNA detection in adult women or teenagers submitted to cervical cancer screening. A total of 151 women were included. The majority (96.2%) of those with negative dual assay results had lower biopsy grades (p cytology results suggestive of cervical cancer had positive dual immunocytochemistry assay results more frequently (p < 0.001), and these positive results were also significantly associated with biopsy findings (p < 0.001) and with high-risk genotype HPV infection (p = 0.007). Specificity and PPV for the dual assay were 0.972 (0.855-0.999) and 0.800 (0.284-0.995), respectively, and 1.000 (0.590-1.000) and 1.000 (0.631-1.000) for HPV detection. The dual immunocytochemistry assay had high specificity and PPV. It reveals a persistent HPV infection, avoiding the need for new tissue collections for biopsies or hybrid capture. © 2018 S. Karger AG, Basel.

  8. Lectures in plasma diagnostics

    Hutchinson, I.H.

    1990-06-01

    This paper discusses the following topics on plasma diagnostics: Electric probes in flowing and magnetized plasmas; Electron cyclotron emission absorption; Magnetic diagnostics; Spectroscopy; and Thomson Scattering

  9. Diagnostic Criteria

    Narender P. Van Orshoven

    2010-01-01

    Full Text Available The aims of this study were to find out whether Postprandial hypotension (PPH occurs more frequently in patients admitted to a geriatric ward than in healthy elderly individuals, what the optimal interval between blood pressure measurements is in order to diagnose PPH and how often it is associated with symptoms.The result of this study indicates that PPH is present in a high number of frail elderly, but also in a few healthy older persons. Measuring blood pressure at least every 10 minutes for 60 minutes after breakfast will adequately diagnose PPH, defined as >20 mmHg systolic fall, in most patients. However with definition of PPH as >30 mmHg systolic fall, measuring blood pressure every 10 minutes will miss PPH in one of three patients. With the latter definition of PPH the presence of postprandial complaints is not associated with the existence of PPH.

  10. Neuroimaging findings in movement disorders

    Topalov, N.

    2015-01-01

    Full text: Neuroimaging methods are of great importance for the differential diagnostic delimitation of movement disorders associated with structural damage (neoplasms, ischemic lesions, neuroinfections) from those associated with specific pathophysiological mechanisms (dysmetabolic disorders, neurotransmitter disorders). Learning objective: Presentation of typical imaging findings contributing to nosological differentiation in groups of movement disorders with similar clinical signs. In this presentation are discussed neuroimaging findings in Parkinson‘s disease, atypical parkinsonian syndromes (multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration), parkinsonism in genetically mediated diseases (Wilson’s disease, pantothenate kinase-associated neurodegeneration – PKAN), vascular parkinsonism, hyperkinetic movement disorders (palatal tremor, Huntington‘s chorea, symptomatic chorea in ischemic stroke and diabetes, rubral tremor, ballismus, hemifacial spasm). Contemporary neuroimaging methods enable support for diagnostic and differential diagnostic precision of a number of hypo- and hyperkinetic movement disorders, which is essential for neurological clinical practice

  11. Immediate Breast Reconstruction with Expander Assisted Latissimus Dorsi Flap after Skin Sparing Mastectomy

    Abdalla, H.M.; Shallan, M.A.; Fouad, F.A.; Elsayed, A.A.

    2006-01-01

    Background and Purpose: The latissimus dorsi my-ocutaneous flap (LDMF) used to. be the standard practice far breast reconstruction; haw ever, with the increased use of tissue expanders and the development of the transverse rectus-abdomen's myocutaneaus flap for autologous tissue breast reconstruction, its use has decreased. To. reassess the role of the LDMF in breast reconstruction, a prospective study was performed to. evaluate women who. had a skin sparing mastectomy followed by immediate reconstruction with a latissimus dorsi flap and tissue expander implant. Patients and Methods: Twenty-five women with early breast cancer underwent immediate latissimus dorsi my-ocutaneaus flaps with tissue expander after skin sparing mastectamy. The ancalagic safety at skin sparing mastectamy, the pastaperative aesthetic results and camplicatians were evaluated. Results: Between May 2003 and April 2005, 25 can-secutive wamen diagnased with breast cancer underwent skin sparing mas tecta my and expander assisted immediate latissimus darsi breast recanstructian. Their median age was 42 years, ranging fram 34 to 48 years. The pracedure duratian ranged fram 2.5 to. 6 haurs, with a median at 3.9 haurs, hawever, expansian was campleted by 4 manths (range I to. 8 manths). Patients were discharged 7 days after surgery with a range af 5 to. 15 days. The camplicatian rate was law, manifesting with skin flap necrosis in 12%, waund infectian in 4%, and part site extrusian in 4%. There was no. flap lass. With the exceptian af serama farmatian, the danar site marbidity was law (seroma 40%, hematama 4%, back pain 8%, and limited arm mavement 4%). No. lacal recurrence was recorded. The aesthetic result af surgery was rated as excellent in 20%, gaad in 60%, fair in 24%, and paar in 4% af cases. The duratian af past-aperative fallaw up was 14.7 manths, ranging fram 6 to 24 manths. Conclusions: Skin sparing mastectamy and immediate breast recanstructian is an ancalagically safe technique. The use

  12. Joint optimization of preventive maintenance and spare parts inventory for an optimal production plan with consideration of CO_2 emission

    Ba, Kader; Dellagi, Sofiene; Rezg, Nidhal; Erray, Walid

    2016-01-01

    This article presents a joint optimization of spare parts inventory and preventive maintenance. While minimizing CO_2 emissions, this approach is based on an optimal production plan achieved thanks to the HMMS model. The process which is studied in this paper only manufactures one type of product. The purpose of the paper is to determine for a random demand over a given period, a cost-effective production plan and a maintenance policy which integrates a spare parts strategy in accordance with environmental requirements and regulations. Our green spare parts management can be defined as a set of actions that are applied in order to decrease the spare parts footprint in its lifetime (Ba et al., 2015) [1]. Indeed, we take into account the spare parts characteristics (new or used) which will be used during maintenance actions (preventive or corrective) to preserve the environment. Consequently, we set up analytical models based on the effect of the production rate on the system deterioration so as to substantially cut the maintenance costs, production costs and CO_2 emissions. To evaluate the performance of our models, we give some illustrative examples. - Highlights: • Establishment of an optimal production plan for a manufacturing process. • Cost-effective maintenance strategy with a green spare parts strategy. • Possibility to choose between used and new spare parts to execute maintenance action.

  13. Diagnostics of movement predispositions in fitnness centre

    Vojtíšek, Petr

    2011-01-01

    Title: Diagnostics of movement predispositions in fitness Objectives: The objective of bachelor thesis is to summarize the findings of the initial diagnostics od movement predispositions in fitness and then serve as a resource for those interested in education in this field. The aim of the practical part of this work is to obtain information about the diagnostic methods used to assess physical assumptions in the fitness centers. Methods: In this thesis was used the method of analysis of scien...

  14. Diagnostic imaging of exotic pets

    Silverman, S.

    1993-01-01

    Radiographic, ultrasonographic, and computed tomographic (CT) imaging are important diagnostic modalities in exotic pets. The use of appropriate radiographic equipment, film-screen combinations, and radiographic projections enhances the information obtained from radiographs. Both normal findings and common radiographic abnormalities are discussed. The use of ultrasonography and CT scanning for exotic small mammals and reptiles is described

  15. Conserving the birds of Uganda's Banana-Coffee Arc: Land Sparing and Land Sharing Compared

    Hulme, Mark F.; Vickery, Juliet A.; Green, Rhys E.

    2013-01-01

    Reconciling the aims of feeding an ever more demanding human population and conserving biodiversity is a difficult challenge. Here, we explore potential solutions by assessing whether land sparing (farming for high yield, potentially enabling the protection of non-farmland habitat), land sharing...... (lower yielding farming with more biodiversity within farmland) or a mixed strategy would result in better bird conservation outcomes for a specified level of agricultural production. We surveyed forest and farmland study areas in southern Uganda, measuring the population density of 256 bird species...... explore how conservation and agricultural policies can be better integrated to deliver land sparing by, for example, combining land-use planning and agronomic support for small farmers....

  16. [Valve-sparing aortic root replacement for young female patients with Marfan syndrome].

    Nawata, Kan; Morota, T

    2009-10-01

    Annuloaortic ectasia is frequently related with Marfan syndrome, and Bentall procedure or aortic root replacement with valved conduit has been the conventional standard operation for this disease. Recently, some institutes have adopted valve-sparing aortic root replacement (VSARR) instead of Bentall procedure. Young female patients with Marfan syndrome who wishes for childbearing seem to be a group of good candidates of this type of operation, because it let them free from morbidities after artificial valve implantation. Valve-sparing operation should be taken into consideration when the size of Valsalva sinus reaches 45 mm for patients with Marfan syndrome and when it reaches 40 mm for patients with past histories or family histories of aortic dissection or aortic rupture. Since pregnancy is one of the most serious risk factors for aortic events, Valsalva sinus of 40 mm or larger could be the new standard for surgical indication if VSARR is applicable.

  17. Rare presentation of a testicular angiofibroma treated with testis sparing surgery.

    Leone, Luca; Fulvi, Paola; Sbrollini, Giulia; Filosa, Alessandra; Caraceni, Enrico; Marronaro, Angelo; Galosi, Andrea B

    2016-12-30

    Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

  18. Probability and Confidence Trade-space (PACT) Evaluation: Accounting for Uncertainty in Sparing Assessments

    Anderson, Leif; Box, Neil; Carter, Katrina; DiFilippo, Denise; Harrington, Sean; Jackson, David; Lutomski, Michael

    2012-01-01

    There are two general shortcomings to the current annual sparing assessment: 1. The vehicle functions are currently assessed according to confidence targets, which can be misleading- overly conservative or optimistic. 2. The current confidence levels are arbitrarily determined and do not account for epistemic uncertainty (lack of knowledge) in the ORU failure rate. There are two major categories of uncertainty that impact Sparing Assessment: (a) Aleatory Uncertainty: Natural variability in distribution of actual failures around an Mean Time Between Failure (MTBF) (b) Epistemic Uncertainty : Lack of knowledge about the true value of an Orbital Replacement Unit's (ORU) MTBF We propose an approach to revise confidence targets and account for both categories of uncertainty, an approach we call Probability and Confidence Trade-space (PACT) evaluation.

  19. Sparingly Solvating Electrolytes for High Energy Density Lithium-Sulfur Batteries

    Cheng, Lei; Curtiss, Larry A.; Zavadil, Kevin R.; Gewirth, Andrew A.; Shao, Yuyan; Gallagher, Kevin

    2016-07-11

    Moving to lighter and less expensive battery chemistries compared to lithium-ion requires the control of energy storage mechanisms based on chemical transformations rather than intercalation. Lithium sulfur (Li/S) has tremendous theoretical specific energy, but contemporary approaches to control this solution-mediated, precipitation-dissolution chemistry requires using large excesses of electrolyte to fully solubilize the polysulfide intermediate. Achieving reversible electrochemistry under lean electrolyte operation is the only path for Li/S to move beyond niche applications to potentially transformational performance. An emerging topic for Li/S research is the use of sparingly solvating electrolytes and the creation of design rules for discovering new electrolyte systems that fundamentally decouple electrolyte volume from reaction mechanism. This perspective presents an outlook for sparingly solvating electrolytes as the key path forward for longer-lived, high-energy density Li/S batteries including an overview of this promising new concept and some strategies for accomplishing it.

  20. Latissimus-sparing thoracotomy in the pediatric patient: a valuable asset for thoracic reconstruction.

    Malczewski, M C; Colony, L; Cobb, L M

    1994-03-01

    The traditional posterolateral thoracotomy involves division of the latissimus dorsi muscle (LD). While the division results in no functional disability, it does negate the potential for possible future thoracic reconstruction if required in individual cases (eg, bronchopleural fistula, empyema, etc). A latissimus-sparing thoracotomy (LST) mobilizes the muscle dorsad and does not compromise the operation. Thus, the ipsilateral LD can be used when chest wall reconstruction is required. This option has been used frequently for adults; however, its use in children has not been extensively documented. Microvascular anastomoses for a contralateral LD free-flap may be tenuous in the small vessels of the child; thus, reconstruction using the ipsilateral LD could be beneficial and safer. The feasibility of LST has not been established with regard to the chest of the child. The authors present three pediatric thoracic cases that illustrate the value of this procedure, and discuss different situations in which latissimus-sparing thoracotomy is advantageous.

  1. DBMS Development of Irradiated Materials and Spare parts on master-slave manipulator in IMEF

    Choo, Y. S.; Kim, D. S.; Jung, Y. H.; Kim, H. M.; Yoo, B. O.; Baik, S. J.; Hong, K. P.; Ahn, S. B.; Ryu, W. S. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2008-12-15

    The data of irradiated specimens(include nuclear fuel) which are transported from research reactor and commercial power reactor and the spare parts of the master-slave manipulator for the IMEF facility, which is operated since 1996, were controlled and managed through the Hangul and Excel software. But it is recommended to use a special program, which is developed for DBMS, for the beneficial control and systematic management of all irradiated specimens, especially assuming the increase of specimen's kind and amount by increasing customers in the near future. This report summarized the whole logical and physical processes and results about following items : - Management System of Irradiated Materials including nuclear fuel - Management System of spare parts for the master-slave manipulator.

  2. CT findings in abdominal actinomycosis

    Lee, In Jae; Ha, Hyun Kwon; Lee, Moon Gyu; Kim, Pyo Nyun; Auh, Yong Ho

    1999-01-01

    Abdominal actinomycosis is a chronic, progressive, suppurative disease with a favorable response to intravenous treatment with penicillin. In many instances, however, its clinical and radiological findings may overlap with those of other inflammatory and neoplastic conditions, and the familiarity with the various radiological features can thus avoid diagnostic delays. The purpose of this paper is to describe and discuss the CT findings of abdominal actinomycosis

  3. Painful orgasm in an adolescent after seminal-sparing cystoprostatectomy: a puzzling symptom.

    Angelini, Lorenzo; Castagnetti, Marco; Rigamonti, Waifro

    2015-01-01

    An 18-year-old boy, followed up after seminal-sparing cystectomy for bladder rhabdomyosarcoma, presented complaining of recurrent episodes of left scrotal/inguinal pain arising after orgasms. Full work-up ruled out disease recurrence, but showed enlarged seminal vesicles. Ligation of the vas deferens was unsuccessful. The patient was started on α-blockers to reduce vas contractions with improvement of symptoms. The possible pathophysiology and treatments of this symptom are discussed. 2014 S. Karger AG, Basel

  4. Optimal repairable spare-parts procurement policy under total business volume discount environment

    Pascual, Rodrigo; Santelices, Gabriel; Lüer-Villagra, Armin; Vera, Jorge; Cawley, Alejandro Mac

    2017-01-01

    In asset intensive fields, where components are expensive and high system availability is required, spare parts procurement is often a critical issue. To gain competitiveness and market share is common for vendors to offer Total Business Volume Discounts (TBVD). Accordingly, companies must define the procurement and stocking policy of their spare parts in order to reduce procurement costs and increase asset availability. In response to those needs, this work presents an optimization model that maximizes the availability of the equipment under a TBVD environment, subject to a budget constraint. The model uses a single-echelon structure where parts can be repaired. It determines the optimal number of repairable spare parts to be stocked, giving emphasis on asset availability, procurement costs and service levels as the main decision criteria. A heuristic procedure that achieves high quality solutions in a fast and time-consistent way was implemented to improve the time required to obtain the model solution. Results show that using an optimal procurement policy of spare parts and accounting for TBVD produces better overall results and yields a better availability performance. - Highlights: • We propose a model for procurement of repairable components in single-echelon and business volume discount environments. • We used a mathematical model to develop a competitive heuristic that provides high quality solutions in very short times. • Our model places emphasis on using system availability, procurement costs and service levels as leading decision criteria. • The model can be used as an engine for a multi-criteria Decision Support System.

  5. Army Contracting Officials Could Have Purchased Husky Mounted Detection System Spare Parts at Lower Prices (Redacted)

    2016-03-31

    system mounted on an armored vehicle . It detects and marks landmines and other buried explosive hazards, and serves an important role in keeping...countries. Figure 1. HMDS Shown on a Husky Vehicle Source: Project Manager Close Combat Systems FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY Introduction...Reasonable Prices From Meggitt Aircraft Braking Systems for Sole-Source Commercial Spare Parts,” May 8, 2015 Report No. DODIG-2015-103, “Summary of

  6. Spare Parts Inventory Management for the Next Generation Finnish Defense Force Fighter Fleet

    2017-12-01

    might benefit the end user most in high criticality or high cost classification classes: CrA, CrB, EA and EB. H. LEAD TIME EFFECTS Lead time is...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. SPARE PARTS INVENTORY MANAGEMENT...Eddine Dahel THIS PAGE INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704–0188 Public reporting burden for this collection

  7. Development of Availability and Sustainability Spares Optimization Models for Aircraft Reparables

    2013-09-01

    the integrated SAP ® Enterprise Resource Planning ( ERP ) information system of the RSAF. A more in-depth review of OPUS10 capabilities will be provided...Dynamic Multi-Echelon Technique for Recoverable Item Control EBO: Expected Backorder EOQ: Economic Order Quantity ERP : Enterprise Resource...particular, the propulsion sub-system was expanded to include SSRUs. Spares information are extracted from the RSAF ERP system and include: 22

  8. Carotid sparing intensity modulated radiotherapy on early glottic cancer: Preliminary study

    Choi, Hoon Sik; Jeong, Bae Kwon; Jeong, Ho Jin; Song, Jin Ho; Kim, Jin Pyeong; Park, Jung Je; Woo, Seung Hoon; Kang, Ki Mun [Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of)

    2016-03-15

    To compare the dose distribution between carotid sparing intensity modulated radiotherapy (IMRT) and opposed lateral field technique (LAFT), and to determine the effects of carotid sparing IMRT in early glottic cancer patients who have risk factors for atherosclerosis. Ten early glottic cancer patients were treated with carotid sparing IMRT. For each patient, the conventional LAFT plan was developed for comparison. IMRT and LAFT plans were compared in terms of planning target volume (PTV) coverage, conformity index, homogeneity index, and the doses to planning organ at risk volume (PRV) for carotid arteries, spinal cord and pharyngeal constrictor muscle. Recurrence was not observed in any patients during the follow-up period. V95% for PTV showed no significant difference between IMRT and LAFT plans, while V100% was significantly higher in the IMRT plan (95.5% vs. 94.6%, p = 0.005). The homogeneity index (11.6%) and conformity index (1.4) in the IMRT plan were significantly better than those in the LAFT plans (8.5% and 5.1, respectively) (p = 0.005). The median V5Gy (90.0%), V25Gy (13.5%), and V50Gy (0%) for carotid artery PRV in the IMRT plan were significantly lower than those in the LAFT plan (99.1%, 89.0%, and 77.3%, respectively) (p = 0.005). Our study suggests that carotid sparing IMRT can significantly decrease the dose to carotid arteries compared to LAFT, and it would be considered for early glottic cancer patient with high risk of atherosclerosis.

  9. Preventative Valve-Sparing Aortic Root Replacement and Pregnancy Outcome in Marfan Syndrome

    Sokol, Vesna; Zlopaša, Gordan; Herman, Mislav; Planinić, Pavao; Micevska, Ana

    2012-01-01

    In Marfan syndrome, with dilatation of the aortic root secondary to an underlying connective tissue defect, pregnancy can cause hemodynamic stress leading to the development of an aortic aneurysm and even a fatal aortic dissection. In the presence of existing aortic root enlargement and a family history of aortic dissection, preventative elective surgery is suggested. Aortic root replacement with or without a valve-sparing procedure is superior to total aortic root replacement with ...

  10. Mitral valve-sparing procedures and prosthetic heart valve failure: A case report

    Khan, Nasir A; Butany, Jagdish; Leong, Shaun W; Rao, Vivek; Cusimano, Robert J; Ross, Heather J

    2009-01-01

    Prosthetic heart valve dysfunction due to thrombus or pannus formation can be a life-threatening complication. The present report describes a 47-year-old woman who developed valvular cardiomyopathy after chorda-sparing mitral valve replacement, and subsequently underwent heart transplantation for progressive heart failure. The explanted mitral valve prosthesis showed significant thrombus and pannus leading to reduced leaflet mobility and valvular stenosis. The present report illustrates the role of the subvalvular apparatus and pannus in prosthesis dysfunction. PMID:19279993

  11. CWT and RWT Metrics Measure the Performance of the Army's Logistics Chain for Spare Parts

    2003-01-01

    .... As part of its efforts to improve the logistics chain for spare parts, the Army must measure the performance of its supply system in filling orders for materiel. Velocity Management (VM) is a RAND-developed and Army implemented system that measures such performance and seeks ways to improve it through its Define-Measure- Improve (DMI) methodology. As the term DMI implies, measurement is central to this improvement approach.

  12. Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

    Mahadevan, Anand; Sampson, Carrie; LaRosa, Salvatore; Floyd, Scott R.; Wong, Eric T.; Uhlmann, Erik J.; Sengupta, Soma; Kasper, Ekkehard M.

    2015-01-01

    Whole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia. Suitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means. All six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V 24 (9 cc vs. 44 cc, p < 0.0000) and V 30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area. HS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia

  13. A simple lens-sparing technique to treat hypotonic maculopathy secondary to large cyclodialysis

    Masayo Kimura; Tsutomu Yasukawa; Yuichiro Ogura

    2018-01-01

    Purpose: Hypotonic maculopathy secondary to cyclodialysis often persists and causes irreversible visual loss despite a variety of treatments proposed. The purpose of this study is to report two cases with persistent hypotonic maculopathy due to a large cyclodialysis cleft treated with a simple, lens-sparing technique of external drainage, diathermy, and suturing under the placement of an infusion cannula. Observations: Both patients had sustained blunt trauma to one eye, causing persisting hy...

  14. Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies

    Georg, Petra; Georg, Dietmar; Hillbrand, Martin; Kirisits, Christian; Poetter, Richard

    2006-01-01

    Background and purpose: To evaluate the influence of uterus and bladder size on large and small bowel sparing with intensity modulated whole pelvic radiotherapy (IM-WPRT) in gynecologic patients. Patients and methods: Twenty patients were selected; 10 women with cervical cancer treated with definitive radiotherapy (group 'DEF') and 10 endometrial cancer patients treated postoperatively (group 'POST'). Bladder, rectal wall, small (SB) and large bowel (LB) were delineated as organs at risk. A conformal four field technique and a seven field IMRT plan (prescription dose 50.4 Gy) were compared in terms of DVH and various target parameters. Results: At doses between 40 and 50.4 Gy statistically significant improvements (P<0.05) were observed for IM-WPRT for irradiated volume of rectal wall and bladder. In both patient groups, with IMRT the average irradiated volume of SB was reduced by a factor of 6 at 50.4 Gy. This ratio was 2 for LB. In the DEF group the effect of SB-sparing with IMRT correlated with bladder size (correlation coefficient 0.70) while it did not correlate in the postoperative group. The effect of LB-sparing decreased with increasing bladder size in both groups but the impact of IMRT was larger for postoperative patients. Conclusions: IMRT significantly reduced the absolute volume of rectal wall, bladder and bowel irradiated at the prescribed dose level in gynaecologic patients. Main differences between POST and DEF patients receiving IM-WPRT were absolute volumes of LB irradiated to doses between 35 and 50 Gy, suggesting an impact of intact uterus on LB volume in the pelvis. POST patients seem to benefit most from elective nodal IMRT. Bladder filling is an important co-factor influencing the benefit of IMRT with respect to OAR sparing

  15. Preventive Maintenance Interval Prediction: a Spare Parts Inventory Cost and Lost Earning Based Model

    O. A. Adebimpe

    2015-06-01

    Full Text Available In this paper, some preventive maintenance parameters in manufacturing firms were identified and used to develop cost based functions in terms of machine preventive maintenance. The proposed cost based model considers system’s reliability, cost of keeping spare parts inventory and lost earnings in deriving optimal maintenance interval. A case of a manufacturing firm in Nigeria was observed and the data was used to evaluate the model.

  16. Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique.

    Brodin, N Patrik; Munck af Rosenschöld, Per; Blomstrand, Malin; Kiil-Berthlesen, Anne; Hollensen, Christian; Vogelius, Ivan R; Lannering, Birgitta; Bentzen, Søren M; Björk-Eriksson, Thomas

    2014-04-01

    We investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy. We included 17 pediatric medulloblastoma patients to represent the variability in tumor location relative to the hippocampal region. Treatment plans were generated using 3D conformal radiotherapy, hippocampal sparing intensity-modulated radiotherapy, and spot-scanned proton therapy, using 3 different treatment margins for the conformal tumor boost. Neurocognitive impairment risk was estimated based on dose-response models from pediatric CNS malignancy survivors and compared among different margins and treatment techniques. Mean hippocampal dose and corresponding risk of cognitive impairment were decreased with decreasing treatment margins (P < .05). The largest risk reduction, however, was seen when applying hippocampal sparing proton therapy-the estimated risk of impaired task efficiency (95% confidence interval) was 92% (66%-98%), 81% (51%-95%), and 50% (30%-70%) for 3D conformal radiotherapy, intensity-modulated radiotherapy, and proton therapy, respectively, for the smallest boost margin and 98% (78%-100%), 90% (60%-98%), and 70% (39%-90%) if boosting the whole posterior fossa. Also, the distance between the closest point of the planning target volume and the center of the hippocampus can be used to predict mean hippocampal dose for a given treatment technique. We estimate a considerable clinical benefit of hippocampal sparing radiotherapy. In choosing treatment margins, the tradeoff between margin size and risk of neurocognitive impairment quantified here should be considered.

  17. SUPPLIER EVALUATION AND SELECTION: CASE OF AN AUTOMOTIVE SPARE-PARTS SUPPLIER

    Oflac, Bengu Sevil

    2015-01-01

     The main aim of this study is to conduct a current state analysis for a leading original and spare parts producer operating in automobile industry. In the focused company, due to having some problems about purchasing process, there was a need for reviewing and restructuring supplier evaluation mechanism. In this perspective, based on the results of qualitative techniques conducted, reasons for poor evaluation systems were found. As a contribution to practice, in line with the needs of compan...

  18. Relationship between plasma analytes and SPARE-AD defined brain atrophy patterns in ADNI.

    Jon B Toledo

    Full Text Available Different inflammatory and metabolic pathways have been associated with Alzheimeŕs disease (AD. However, only recently multi-analyte panels to study a large number of molecules in well characterized cohorts have been made available. These panels could help identify molecules that point to the affected pathways. We studied the relationship between a panel of plasma biomarkers (Human DiscoveryMAP and presence of AD-like brain atrophy patterns defined by a previously published index (SPARE-AD at baseline in subjects of the ADNI cohort. 818 subjects had MRI-derived SPARE-AD scores, of these subjects 69% had plasma biomarkers and 51% had CSF tau and Aβ measurements. Significant analyte-SPARE-AD and analytes correlations were studied in adjusted models. Plasma cortisol and chromogranin A showed a significant association that did not remain significant in the CSF signature adjusted model. Plasma macrophage inhibitory protein-1α and insulin-like growth factor binding protein 2 showed a significant association with brain atrophy in the adjusted model. Cortisol levels showed an inverse association with tests measuring processing speed. Our results indicate that stress and insulin responses and cytokines associated with recruitment of inflammatory cells in MCI-AD are associated with its characteristic AD-like brain atrophy pattern and correlate with clinical changes or CSF biomarkers.

  19. Age Disparities in the Use of Steroid-sparing Therapy for Inflammatory Bowel Disease.

    Govani, Shail M; Wiitala, Wyndy L; Stidham, Ryan W; Saini, Sameer D; Hou, Jason K; Feagins, Linda A; Sussman, Jeremy B; Higgins, Peter D R; Waljee, Akbar K

    2016-08-01

    Corticosteroids are effective rescue therapies for patients with inflammatory bowel disease (IBD), but have significant side effects, which may be amplified in the growing population of elderly patients with IBD. We aimed to compare the use of steroids and steroid-sparing therapies (immunomodulators and biologics) and rates of complications among elderly (≥65) and younger patients in a national cohort of veterans with IBD. We used national Veterans Health Administrative data to conduct a retrospective study of veterans with IBD between 2002 and 2010. Medications and the incidence of complications were obtained from the Veterans Health Administrative Decision Support Systems. Multivariate logistic regression accounting for facility-level clustering was used to identify predictors of use of steroid-sparing medications. We identified 30,456 veterans with IBD. Of these, 94% were men and 40% were more than 65, and 32% were given steroids. Elderly veterans were less likely to receive steroids (23.8% versus 38.3%, P fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Elderly veterans are less likely to receive steroids and steroid-sparing medications than younger veterans; elderly patients exposed to steroids were more likely to have fractures than the younger population.

  20. Valve-sparing operation for aortic root aneurysm in patients with Marfan syndrome.

    Wang, R; Ma, W G; Tian, L X; Sun, L Z; Chang, Q

    2010-03-01

    We report our experience with aortic valve-sparing procedures in patients with Marfan syndrome and aortic root aneurysm. Between August 2003 and July 2007, we performed aortic valve-sparing procedures in 20 patients with aortic root aneurysm resulting from Marfan syndrome. Mean age was 28 +/- 10 years (range, 10 to 57 years), and there were 9 females and 11 males. A reimplantation technique was used in 9 cases, a remodeling technique in 8 and a patch technique in 3 cases. Additional procedures included total aorta replacement in 1 patient, and aortic arch replacement plus stented elephant trunk in 2 patients. The mean follow-up time was 46 +/- 16 months (range, 17 to 64 months). No in-hospital or late death occurred. Reexploration for bleeding was required in one case on postoperative day 1. No valve-related complications occurred during the follow-up period. At the end of follow-up, trivial or no aortic regurgitation was demonstrated in 14 patients, mild in 4 patients, moderate in 1 and severe in 1. Two patients with moderate and severe aortic regurgitation required reoperation. The early and mid-term results of the valve-sparing operations were favorable, and the durability of the preserved valve should encourage use of this technique in patients with Marfan syndrome.

  1. Low GDP Solution and Glucose-Sparing Strategies for Peritoneal Dialysis.

    Szeto, Cheuk Chun; Johnson, David W

    2017-01-01

    Long-term exposure to a high glucose concentration in conventional peritoneal dialysis (PD) solution has a number of direct and indirect (via glucose degradation products [GDP]) detrimental effects on the peritoneal membrane, as well as systemic metabolism. Glucose- or GDP-sparing strategies often are hypothesized to confer clinical benefits to PD patients. Icodextrin (glucose polymer) solution improves peritoneal ultrafiltration and reduces the risk of fluid overload, but these beneficial effects are probably the result of better fluid removal rather than being glucose sparing. Although frequently used for glucose sparing, the role of amino acid-based solution in this regard has not been tested thoroughly. When glucose-free solutions are used in a combination regimen, published studies showed that glycemic control was improved significantly in diabetic PD patients, and there probably are beneficial effects on peritoneal function. However, the long-term effects of glucose-free solutions, used either alone or as a combination regimen, require further studies. On the other hand, neutral pH-low GDP fluids have been shown convincingly to preserve residual renal function and urine volume. The cost effectiveness of these solutions supports the regular use of neutral pH-low GDP solutions. Nevertheless, further studies are required to determine whether neutral pH-low GDP solutions exert beneficial effects on patient-level outcomes, such as peritonitis, technique survival, and patient survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery

    Minamikawa, Takeo; Harada, Yoshinori; Takamatsu, Tetsuro

    2017-02-01

    The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery, namely nerve-sparing surgery, is now promising technique to avoid functional deficits of the limbs and organs following surgery as an aspect of the improvement of quality of life of patients. Detection of peripheral nerves including myelinated and unmyelinated nerves is required for the nerve-sparing surgery; however, conventional nerve identification scheme is sometimes difficult to identify peripheral nerves due to similarity of shape and color to non-nerve tissues or its limited application to only motor peripheral nerves. To overcome these issues, we proposed a label-free detection technique of peripheral nerves by means of Raman spectroscopy. We found several fingerprints of peripheral myelinated and unmyelinated nerves by employing a modified principal component analysis of typical spectra including myelinated nerve, unmyelinated nerve, and adjacent tissues. We finally realized the sensitivity of 94.2% and the selectivity of 92.0% for peripheral nerves including myelinated and unmyelinated nerves against adjacent tissues. Although further development of an intraoperative Raman spectroscopy system is required for clinical use, our proposed approach will serve as a unique and powerful tool for peripheral nerve detection for nerve-sparing surgery in the future.

  3. Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements.

    Salgarello, Marzia; Visconti, Giuseppe; Barone-Adesi, Liliana

    2010-11-01

    Nipple-sparing mastectomy is gaining widespread popularity, as it could allow improved aesthetic outcome without increasing oncologic risk. To investigate the reconstructive issues experienced with immediate implant reconstruction, the authors reviewed the cosmetic outcomes of their series. The authors retrospectively analyzed the data on 33 cases of nipple-sparing mastectomy for both cancer and prophylaxis with immediate implant reconstruction using the submusculo-subfascial pocket. Cosmetic evaluation methods were clinical and photography-based assessments and a patient-satisfaction survey. The average follow-up period was 26.8 months. No nipple-areola complex cancer involvement was registered. The reconstructive outcomes ranged from good to excellent in 83 percent of the cases. Patients' satisfaction was high to very high, except in one patient who experienced total nipple-areola complex loss (one breast, 2.4 percent). Overall, early minor complications were registered in four breasts (9.5 percent) and late minor complications in five cases (12 percent). The authors' series suggest that nipple-sparing mastectomy is an option for carefully selected and screened patients. Larger studies with longer follow-up are needed, however. On the whole, the immediate one-stage implant reconstruction with hyperprojected anatomical gel implants represents a valid option. The skin incision algorithm proposed, which is based on the breast size, shape, and previous scars, might aid in the decision-making process to achieve satisfying results using this procedure. The radial approaches represent a good compromise between the oncologic and reconstructive procedures.

  4. Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy.

    Verstappen, Ralph; Djedovic, Gabriel; Morandi, Evi Maria; Heiser, Dietmar; Rieger, Ulrich Michael; Bauer, Thomas

    2018-03-01

    A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

  5. Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy

    Ralph Verstappen

    2018-03-01

    Full Text Available Background A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. Methods All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. Results We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. Conclusions In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

  6. Limbal Stem Cell-Sparing Corneoscleroplasty with Peripheral Intralamellar Tuck: A New Surgical Technique for Keratoglobus

    Elias Jarade

    2017-04-01

    Full Text Available Purpose: To describe the technique of limbal stem cell-sparing corneoscleroplasty for the management of advanced keratoglobus. Methods: A patient with bilateral advanced keratoglobus, with best-corrected visual acuity of 20/400 in the right eye and 20/200 in the left eye, underwent limbal stem cell-sparing corneoscleroplasty of the right eye. Initially, a 360-degree limbal incision with 200-μm depth was created, followed by a sublimbal tunnel dissection into the sclera, in order to conserve stem cells. Next, a limbus-to-limbus lamellar keratectomy at 200-μm depth was performed. Meanwhile, a donor corneoscleral button with preserved endothelium of the central 8 mm was fashioned. Prior to suturing the donor corneoscleral graft using a modified suturing technique to cover its scleral component, a full-thickness trephination of 8-mm diameter was completed in the central host cornea. Results: Reepithelialization occurred within the first week. No episodes of rejection, intraocular pressure spikes, or epithelial breakdown were observed postoperatively. At the 6-month follow-up, the patient had 20/70 best-corrected vision and a smooth cornea with regular astigmatism on topography. Conclusion: Limbal stem cell-sparing corneoscleroplasty is a single-step technique for restoring the structural integrity of the cornea in advanced keratoglobus while preserving the host limbal stem cells.

  7. Feasibility of MRI-guided Focused Ultrasound as Organ-Sparing Treatment for Testicular Cancer

    Staruch, Robert; Curiel, Laura; Chopra, Rajiv; Hynynen, Kullervo

    2009-04-01

    High cure rates for testicular cancer have prompted interest in organ-sparing surgery for patients with bilateral disease or single testis. Focused ultrasound (FUS) ablation could offer a noninvasive approach to organ-sparing surgery. The objective of this study was to determine the feasibility of using MR thermometry to guide organ-sparing focused ultrasound surgery in the testis. The testes of anesthetized rabbits were sonicated in several discrete locations using a single-element focused transducer operating at 2.787MHz. Focal heating was visualized with MR thermometry, using a measured PRF thermal coefficient of -0.0089±0.0003 ppm/° C. Sonications at 3.5-14 acoustic watts applied for 30 seconds produced maximum temperature elevations of 10-80° C, with coagulation verified by histology. Coagulation of precise volumes in the testicle is feasible with MRI-guided focused ultrasound. Variability in peak temperature for given sonication parameters suggests the need for online temperature feedback control.

  8. Split-field vs extended-field intensity-modulated radiation therapy plans for oropharyngeal cancer: Which spares the larynx? Which spares the thyroid?

    Yu, Yao; Chen, Josephine [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Leary, Celeste I. [Department of Radiation Medicine, Oregon Health Sciences University, Portland, OR (United States); Shugard, Erin [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Yom, Sue S., E-mail: yoms@radonc.ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, CA (United States)

    2016-07-01

    Radiation of the low neck can be accomplished using split-field intensity-modulated radiation therapy (sf-IMRT) or extended-field intensity-modulated radiation therapy (ef-IMRT). We evaluated the effect of these treatment choices on target coverage and thyroid and larynx doses. Using data from 14 patients with cancers of the oropharynx, we compared the following 3 strategies for radiating the low neck: (1) extended-field IMRT, (2) traditional split-field IMRT with an initial cord-junction block to 40 Gy, followed by a full-cord block to 50 Gy, and (3) split-field IMRT with a full-cord block to 50 Gy. Patients were planned using each of these 3 techniques. To facilitate comparison, extended-field plans were normalized to deliver 50 Gy to 95% of the neck volume. Target coverage was assessed using the dose to 95% of the neck volume (D{sub 95}). Mean thyroid and larynx doses were computed. Extended-field IMRT was used as the reference arm; the mean larynx dose was 25.7 ± 7.4 Gy, and the mean thyroid dose was 28.6 ± 2.4 Gy. Split-field IMRT with 2-step blocking reduced laryngeal dose (mean larynx dose 15.2 ± 5.1 Gy) at the cost of a moderate reduction in target coverage (D{sub 95} 41.4 ± 14 Gy) and much higher thyroid dose (mean thyroid dose 44.7 ± 3.7 Gy). Split-field IMRT with initial full-cord block resulted in greater laryngeal sparing (mean larynx dose 14.2 ± 5.1 Gy) and only a moderately higher thyroid dose (mean thyroid dose 31 ± 8 Gy) but resulted in a significant reduction in target coverage (D{sub 95} 34.4 ± 15 Gy). Extended-field IMRT comprehensively covers the low neck and achieves acceptable thyroid and laryngeal sparing. Split-field IMRT with a full-cord block reduces laryngeal doses to less than 20 Gy and spares the thyroid, at the cost of substantially reduced coverage of the low neck. Traditional 2-step split-field IMRT similarly reduces the laryngeal dose but also reduces low-neck coverage and delivers very high doses to the thyroid.

  9. Focal nodular hyperplasia: imaging findings

    Kehagias, D.; Moulopoulos, L.; Antoniou, A.; Hatziioannou, A.; Smyrniotis, V.; Trakadas, S.; Lahanis, S.; Vlahos, L. [Dept. of Radiology, University of Athens (Greece)

    2001-02-01

    Focal nodular hyperplasia is an uncommon benign hepatic tumor that continues to pose diagnostic dilemmas. Imaging techniques are of great value in diagnosis of this tumor. In this article we present the US, CT, MR imaging, scintigraphy, and angiography findings. The demonstration of a central vascular scar is very helpful. Although the radiologic features may be diagnostic, many atypical cases must be differentiated from other benign or malignant hepatic tumors. In these cases excisional biopsy and histopathologic examination are necessary to determine a definite diagnosis. (orig.)

  10. Focal nodular hyperplasia: imaging findings

    Kehagias, D.; Moulopoulos, L.; Antoniou, A.; Hatziioannou, A.; Smyrniotis, V.; Trakadas, S.; Lahanis, S.; Vlahos, L.

    2001-01-01

    Focal nodular hyperplasia is an uncommon benign hepatic tumor that continues to pose diagnostic dilemmas. Imaging techniques are of great value in diagnosis of this tumor. In this article we present the US, CT, MR imaging, scintigraphy, and angiography findings. The demonstration of a central vascular scar is very helpful. Although the radiologic features may be diagnostic, many atypical cases must be differentiated from other benign or malignant hepatic tumors. In these cases excisional biopsy and histopathologic examination are necessary to determine a definite diagnosis. (orig.)

  11. Analysis of Reliability Estimations and Spares Protection Levels on Life Cycle Costs of the Marine Corps H-1 Upgrades Program

    Thompson, David

    2004-01-01

    .... This will be accomplished through the integration of factors impacting spare parts levels and Life Cycle Costs into a spreadsheet model that will establish the appropriate relationship between the factors...

  12. Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

    Kumar, Rachit; Wild, Aaron T.; Ziegler, Mark A.; Hooker, Ted K.; Dah, Samson D.; Tran, Phuoc T.; Kang, Jun; Smith, Koren; Zeng, Jing [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States); Pawlik, Timothy M. [Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Tryggestad, Erik [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States); Ford, Eric [Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA (United States); Herman, Joseph M., E-mail: jherma15@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States)

    2013-10-01

    Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non–duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25 Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal D{sub max} of<30 Gy at any point. VMAT used 1 360° coplanar arc with 4° spacing between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal D{sub mean}, D{sub max}, D{sub 1cc}, D{sub 4%}, and V{sub 20} {sub Gy} compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V{sub 95%} (p = 0.01) and D{sub mean} (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p<0.001) and the spinal cord (p<0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p<0.001) and delivered treatment 2.4 minutes faster (p<0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at

  13. Pediatric radiological diagnostics in suspected child abuse

    Erfurt, C.; Schmidt, U.; Hahn, G.; Roesner, D.

    2009-01-01

    Advanced and specialized radiological diagnostics are essential in the case of clinical suspicion of pediatric injuries to the head, thorax, abdomen, and extremities when there is no case history or when ''battered child syndrome'' is assumed on the basis of inadequate trauma. In particular, the aim of this sophisticated diagnostic procedure is the detection of lesions of the central nervous system (CNS) in order to initiate prompt medical treatment. If diagnostic imaging shows typical findings of child abuse, accurate documented evidence of the diagnostic results is required to prevent further endangerment of the child's welfare. (orig.) [de

  14. Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?

    Frey, Jordan D; Stranix, John T; Chiodo, Michael V; Alperovich, Michael; Ahn, Christina Y; Allen, Robert J; Choi, Mihye; Karp, Nolan S; Levine, Jamie P

    2018-05-01

    Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p < 0.0001) were significantly greater in flaps incorporating a skin paddle. Comparing outcomes, there were no significant differences in flap failure (2.0 percent versus 2.3 percent; p = 1.000) or percentage of flaps requiring return to the operating room (6.0 percent versus 4.7 percent; p = 0.715) between groups. Buried flaps had an absolute greater mean number of revision procedures per nipple-sparing mastectomy (0.82) compared with the skin paddle group (0.44); however, rates of revision procedures per nipple-sparing mastectomy were statistically equivalent between the groups (p = 0.296). Although buried free flap reconstruction in nipple-sparing mastectomy has been shown to be safe and effective, the authors' technique has evolved to favor incorporating a skin paddle, which allows for clinical monitoring and can be removed at the time of secondary revision. Therapeutic, III.

  15. Ordering decision-making methods on spare parts for a new aircraft fleet based on a two-sample prediction

    Yongquan, Sun; Xi, Chen; He, Ren; Yingchao, Jin; Quanwu, Liu

    2016-01-01

    Ordering decision-making on spare parts is crucial in maximizing aircraft utilization and minimizing total operating cost. Extensive researches on spare parts inventory management and optimal allocation could be found based on the amount of historical operation data or condition-monitoring data. However, it is challengeable to make an ordering decision on spare parts under the case of establishment of a fleet by introducing new aircraft with little historical data. In this paper, spare parts supporting policy and ordering decision-making policy for new aircraft fleet are analyzed firstly. Then two-sample predictions for a Weibull distribution and a Weibull process are incorporated into forecast of the first failure time and failure number during certain time period using Bayesian and classical method respectively, according to which the ordering time and ordering quantity for spare parts are identified. Finally, a case study is presented to illustrate the methods of identifying the ordering time and ordering number of engine-driven pumps through forecasting the failure time and failure number, followed by a discussion on the impact of various fleet sizes on prediction results. This method has the potential to decide the ordering time and quantity of spare parts when a new aircraft fleet is established. - Highlights: • A modeling framework of ordering spare parts for a new fleet is proposed. • Models for ordering time and number are established based on two-sample prediction. • The computation of future failure time is simplified using Newtonian binomial law. • Comparison of the first failure time PDFs is used to identify process parameters. • Identification methods for spare parts are validated by Engine Driven Pump case study.

  16. Sparing of descending axons rescues interneuron plasticity in the lumbar cord to allow adaptive learning after thoracic spinal cord injury

    Christopher Nelson Hansen

    2016-03-01

    Full Text Available This study evaluated the role of spared axons on structural and behavioral neuroplasticity in the lumbar enlargement after a thoracic spinal cord injury (SCI. Previous work has demonstrated that recovery in the presence of spared axons after an incomplete lesion increases behavioral output after a subsequent complete spinal cord transection (TX. This suggests that spared axons direct adaptive changes in below-level neuronal networks of the lumbar cord. In response to spared fibers, we postulate that lumbar neuron networks support behavioral gains by preventing aberrant plasticity. As such, the present study measured histological and functional changes in the isolated lumbar cord after complete TX or incomplete contusion (SCI. To measure functional plasticity in the lumbar cord, we used an established instrumental learning paradigm. In this paradigm, neural circuits within isolated lumbar segments demonstrate learning by an increase in flexion duration that reduces exposure to a noxious leg shock. We employed this model using a proof-of-principle design to evaluate the role of sparing on lumbar learning and plasticity early (7 days or late (42 days after midthoracic SCI in a rodent model. Early after SCI or TX at 7d, spinal learning was unattainable regardless of whether the animal recovered with or without axonal substrate. Failed learning occurred alongside measures of cell soma atrophy and aberrant dendritic spine expression within interneuron populations responsible for sensorimotor integration and learning. Alternatively, exposure of the lumbar cord to a small amount of spared axons for 6 weeks produced near-normal learning late after SCI. This coincided with greater cell soma volume and fewer aberrant dendritic spines on interneurons. Thus, an opportunity to influence activity-based learning in locomotor networks depends on spared axons limiting maladaptive plasticity. Together, this work identifies a time dependent interaction between

  17. Cost Comparison of B-1B Non-Mission-Capable Drivers Using Finite Source Queueing with Spares

    2012-09-06

    COMPARISON OF B-1B NON-MISSION-CAPABLE DRIVERS USING FINITE SOURCE QUEUEING WITH SPARES GRADUATE RESEARCH PAPER Presented to the Faculty...step into the lineup making large-number approximations unusable. Instead, a finite source queueing model including spares is incorporated...were reported as flying time accrued since last occurrence. Service time was given in both start-stop format and MX man-hours utilized. Service time was

  18. Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer

    Saarilahti, Kauko; Kouri, Mauri; Collan, Juhani; Kangasmaeki, Aki; Atula, Timo; Joensuu, Heikki; Tenhunen, Mikko

    2006-01-01

    Background and purpose: The submandibular glands produce most of the unstimulated saliva output and are the key in prevention of radiation-related xerostomia. We investigated whether sparing of the submandibular function is feasible with intensity modulated radiotherapy (IMRT). Patients and methods: Thirty-six patients diagnosed with head and neck cancer were treated with IMRT and had at least one parotid gland excluded from the planning target volume. In a subset, of these patients (n=18) where the risk of cancer recurrence in the contralateral submandibular region was judged low, the contralateral submandibular gland was spared from full-dose irradiation. The total unstimulated and stimulated salivary flow rates and adverse effects were monitored. Results: Twelve months following IMRT mean unstimulated saliva flow was 60% of the baseline value among patients who had one submandibular gland spared and 25% among those who did not (P=0.006). Patients whose contralateral submandibular was spared reported less grade two or three xerostomia (4 vs. 11; P=0.018), and used less saliva substitutes. No cancer recurrences were detected at the vicinity of the spared glands during a median follow-up time of 31 months. Conclusions: Submandibular gland sparing with IMRT is safe in selected patients treated for head and neck cancer. It is effective in prevention of radiation-associated xerostomia

  19. A toll-like receptor 9 antagonist improves bladder function and white matter sparing in spinal cord injury.

    David, Brian T; Sampath, Sujitha; Dong, Wei; Heiman, Adee; Rella, Courtney E; Elkabes, Stella; Heary, Robert F

    2014-11-01

    Spinal cord injury (SCI) affects motor, sensory, and autonomic functions. As current therapies do not adequately alleviate functional deficits, the development of new and more effective approaches is of critical importance. Our earlier investigations indicated that intrathecal administration of a toll-like receptor 9 (TLR9) antagonist, cytidine-phosphate-guanosine oligodeoxynucleotide 2088 (CpG ODN 2088), to mice sustaining a severe, mid-thoracic contusion injury diminished neuropathic pain but did not alter locomotor deficits. These changes were paralleled by a decrease in the pro-inflammatory response at the injury epicenter. Using the same SCI paradigm and treatment regimen, the current studies investigated the effects of the TLR9 antagonist on bladder function. We report that the TLR9 antagonist decreases SCI-elicited urinary retention and ameliorates bladder morphopathology without affecting kidney function. A significant improvement in white matter sparing was also observed, most likely due to alterations in the inflammatory milieu. These findings indicate that the TLR9 antagonist has beneficial effects not only in reducing sensory deficits, but also on bladder dysfunction and tissue preservation. Thus, modulation of innate immune receptor signaling in the spinal cord can impact the effects of SCI.

  20. High-yield oil palm expansion spares land at the expense of forests in the Peruvian Amazon

    Gutiérrez-Vélez, Víctor H; DeFries, Ruth; Uriarte, María; Lim, Yili; Pinedo-Vásquez, Miguel; Padoch, Christine; Baethgen, Walter; Fernandes, Katia

    2011-01-01

    High-yield agriculture potentially reduces pressure on forests by requiring less land to increase production. Using satellite and field data, we assessed the area deforested by industrial-scale high-yield oil palm expansion in the Peruvian Amazon from 2000 to 2010, finding that 72% of new plantations expanded into forested areas. In a focus area in the Ucayali region, we assessed deforestation for high- and smallholder low-yield oil palm plantations. Low-yield plantations accounted for most expansion overall (80%), but only 30% of their expansion involved forest conversion, contrasting with 75% for high-yield expansion. High-yield expansion minimized the total area required to achieve production but counter-intuitively at higher expense to forests than low-yield plantations. The results show that high-yield agriculture is an important but insufficient strategy to reduce pressure on forests. We suggest that high-yield agriculture can be effective in sparing forests only if coupled with incentives for agricultural expansion into already cleared lands.

  1. MOLECULAR DIAGNOSTICS OF YERSINIA RUCKERI

    Yu. Rud

    2014-06-01

    Full Text Available Purpose. The analysis of nucleotide sequences of the 16S rDNA gene of virulent strains of Yersinia ruckeri and to develop the method of molecular diagnostic of enteric redmouth disease. Methodology. By the method of CLUSTALW algorithm in MEGA software version 6.0 the nucleotide sequences of the 16S rDNA gene of virulent strains of Yersinia ruckeri were analysed. For development of molecular diagnostic of Y. ruckeri the method of polymerase chain reaction (PCR was used. Primer selection was carried out in software VectorNTI11 and on-line-service BLAST. The PCR products were investigated by the methods of sequencing and nucleotide analysis. Findings. Based on PCR assay the method of molecular diagnostic of enteric redmouth disease agent, bacterium Y. ruckeri was developed. It was shown that specific oligonucleotide primers generated PCR products in size of 600 base pairs. PCR products were investigated by the sequencing that showed right targeting of primers in reaction. Originality. Among high-conservative gene of 16S rDNA of Y. ruckeri the fragment of DNA was determined to which the specific primers for rapid diagnostic of virulent strains were selected. Practical Value. Rapid diagnostic of yersiniosis will allow to identify an agent of this infectious disease, bacterium Y. ruckeri, and to provide the prophylactic or medical measures in the fish farming of Ukraine.

  2. Improving Communication of Diagnostic Radiology Findings through Structured Reporting

    Panicek, David M.; Berk, Alexandra R.; Li, Yuelin; Hricak, Hedvig

    2011-01-01

    Purpose: To compare the content, clarity, and clinical usefulness of conventional (ie, free-form) and structured radiology reports of body computed tomographic (CT) scans, as evaluated by referring physicians, attending radiologists, and radiology fellows at a tertiary care cancer center. Materials and Methods: The institutional review board approved the study as a quality improvement initiative; no written consent was required. Three radiologists, three radiology fellows, three surgeons, and two medical oncologists evaluated 330 randomly selected conventional and structured radiology reports of body CT scans. For nonradiologists, reports were randomly selected from patients with diagnoses relevant to the physician’s area of specialization. Each physician read 15 reports in each format and rated both the content and clarity of each report from 1 (very dissatisfied or very confusing) to 10 (very satisfied or very clear). By using a previously published radiology report grading scale, physicians graded each report’s effectiveness in advancing the patient’s position on the clinical spectrum. Mixed-effects models were used to test differences between report types. Results: Mean content satisfaction ratings were 7.61 (95% confidence interval [CI]: 7.12, 8.16) for conventional reports and 8.33 (95% CI: 7.82, 8.86) for structured reports, and the difference was significant (P radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101913/-/DC1 PMID:21518775

  3. Procedures in diagnostic radiology

    Doyle, T.; Hare, W.S.C.; Thomson, K.; Tess, B.

    1989-01-01

    This book outlines the various procedures necessary for the successful practice of diagnostic radiology. Topics covered are: general principles, imaging of the urinary and gastrointestinal tracts, vascular radiology, arthrography, and miscellaneous diagnostic radiologic procedures

  4. Diagnostic Algorithm Benchmarking

    Poll, Scott

    2011-01-01

    A poster for the NASA Aviation Safety Program Annual Technical Meeting. It describes empirical benchmarking on diagnostic algorithms using data from the ADAPT Electrical Power System testbed and a diagnostic software framework.

  5. Veterinary Molecular Diagnostics

    Roest, H.I.J.; Engelsma, M.Y.; Weesendorp, E.; Bossers, A.; Elbers, A.R.W.

    2017-01-01

    In veterinary molecular diagnostics, samples originating from animals are tested. Developments in the farm animals sector and in our societal attitude towards pet animals have resulted in an increased demand for fast and reliable diagnostic techniques. Molecular diagnostics perfectly matches this

  6. Reducing Xerostomia After Chemo-IMRT for Head and Neck Cancer: Beyond Sparing the Parotid Glands

    Little, Michael; Schipper, Matthew; Feng, Felix Y.; Vineberg, Karen; Cornwall, Craig; Murdoch-Kinch, Carol-Anne; Eisbruch, Avraham

    2011-01-01

    Purpose To assess whether in addition to sparing parotid glands (PGs), xerostomia after chemo-IMRT of head and neck cancer is affected by reducing doses to other salivary glands. Methods Prospective study: 78 patients with stages III/IV oropharynx/nasopharynx cancers received chemo-IMRT aiming to spare the parts outside the targets of bilateral PGs, oral cavity (OC) containing the minor salivary glands, and contralateral submandibular gland (SMG) (when contralateral level I was not a target). Pretherapy and periodically through 24 months, validated patient-reported xerostomia questionnaires (XQ) scores and observer-graded xerostomia were recorded, and stimulated and unstimulated saliva measured selectively from each of the PGs and SMGs. Mean OC doses served as surrogates of minor salivary glands dysfunction. Regression models assessed XQ and observer-graded xerostomia predictors. Results Statistically significant predictors of the XQ score in univariate analysis included OC, PG, and SMG mean doses, as well as baseline XQ score, time since RT, and both stimulated and unstimulated PG saliva flow rates. Similar factors were statistically significant predictors of observer-graded xerostomia. OC, PG and SMG mean doses were moderately inter-correlated (r=0.47–0.55). In multivariate analyses, after adjusting for PG and SMG doses, OC mean dose (p xerostomia. While scatter plots showed no thresholds, OC mean doses xerostomia at almost all post-therapy time points. Conclusion PG, SMG and OC mean doses were significant predictors of both patient-reported and observer-rated xerostomia after chemo-IMRT, with OC doses remaining significant after adjusting for PG and SMG doses. These results support efforts to spare all salivary glands by IMRT, beyond the PGs alone. PMID:22056067

  7. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life

    van Rij, CM; Oughlane-Heemsbergen, WD; Ackerstaff, AH; Lamers, EA; Balm, AJM; Rasch, CRN

    2008-01-01

    Background and purpose To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and nethods Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Results Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy. Conclusion Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT. PMID:19068126

  8. The influence of parotid gland sparing on radiation damages of dental hard tissues.

    Hey, Jeremias; Seidel, Johannes; Schweyen, Ramona; Paelecke-Habermann, Yvonne; Vordermark, Dirk; Gernhardt, Christian; Kuhnt, Thomas

    2013-07-01

    The aim of the present study was to evaluate whether radiation damage on dental hard tissue depends on the mean irradiation dose the spared parotid gland is subjected to or on stimulated whole salivary flow rate. Between June 2002 and October 2008, 70 patients with neck and cancer curatively irradiated were included in this study. All patients underwent dental treatment referring to the guidelines and recommendations of the German Society of Dental, Oral and Craniomandibular Sciences prior, during, and after radiotherapy (RT). During the follow-up period of 24 months, damages on dental hard tissues were classified according to the RTOG/EORTC guidelines. The mean doses (D(mean)) during spared parotid gland RT were determined. Stimulated whole saliva secretion flow rates (SFR) were measured before RT and 1, 6, 12, 24 months after RT. Thirty patients showed no carious lesions (group A), 18 patients developed sporadic carious lesions (group B), and 22 patients developed general carious lesions (group C). Group A patients received a D mean of 21.2 ± 11.04 Gy. Group B patients received a D(mean) of 26.5 ± 11.59 Gy and group C patients received a D(mean) of 33.9 ± 9.93 Gy, respectively. The D(mean) of group A was significantly lower than the D(mean) of group C (p dental hard tissue correlates with increased mean irradiation doses as well as decreased salivary flow rates. Parotid gland sparing resulting in a dose below 20 Gy reduces radiation damage on dental hard tissues, and therefore, the dose may act as a predictor for the damage to be expected.

  9. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome.

    David, Tirone E; Armstrong, Sue; Maganti, Manjula; Colman, Jack; Bradley, Timothy J

    2009-10-01

    The appropriateness of aortic valve-sparing operations in patients with Marfan syndrome has been questioned. This study examines the long-term results of these operations in patients with Marfan syndrome. From 1988 to 2006, 103 consecutive patients with Marfan syndrome (mean age, 37 +/- 12 years) and aortic root aneurysm had aortic valve-sparing operations. Emergency surgery was performed in 11 patients: 8 for acute type A aortic dissection and 3 for unexplained persistent chest pain. Fourteen patients also had mitral valve surgery. The technique of aortic valve reimplantation was used in 77 patients, and aortic root remodeling was used in 26 patients. Patients were followed prospectively and underwent annual echocardiographic studies. The mean follow-up was 7.3 +/- 4.2 years and 100% complete. There was 1 operative death and 5 late deaths. Four of the 6 deaths were due to complications of aortic dissections. The patients' survival at 15 years was 87.2% compared with 95.6% for the general population of Ontario matched for age and sex. Seven patients had important aortic insufficiency: 4 mild to moderate, 2 moderate, and 1 moderate to severe. Freedom from greater than mild aortic insufficiency at 15 years was 79.2%. Three patients, all after aortic root remodeling, had aortic valve replacement, 2 for aortic insufficiency and 1 for endocarditis. At the most recent follow-up, 97 patients were alive: 86 were in functional class I, and 11 were in functional class II. Aortic valve-sparing operations provided excellent clinical outcomes in this series of patients with Marfan syndrome. Postoperatively, complications of aortic dissections were the leading cause of death.

  10. Midterm outcome of valve-sparing aortic root replacement in inherited connective tissue disorders.

    Tanaka, Hiroshi; Ogino, Hitoshi; Matsuda, Hitoshi; Minatoya, Kenji; Sasaki, Hiroaki; Iba, Yutaka

    2011-11-01

    This study determined the midterm outcome of valve-sparing aortic root replacement for patients with inherited connective tissue disorders. From 1993 to 2008, 94 patients underwent valve-sparing aortic root replacement. Sixty patients (64%), average age 33 years (range, 15 to 61 years), had inherited connective tissue disorders: Marfan syndrome, 54 (92%); Loeys-Dietz syndrome, 5 (8%); and smooth muscle α-actin (ACTA2) mutation in 1. Median preoperative sinus diameter was 52 mm (range, 42 to 76 mm), and moderate/severe aortic regurgitation was present in 14 (23%). Seven (12%, 1993 to 1999) underwent remodeling procedures, and 53 had reimplantation procedures. Cusp repair was performed in 4. Median follow-up was 55 months (range, 1 to 149 months). There were 15 patients in the early term (1993 to 2000) and 45 in the late term (2001 to 2008). Four late deaths occurred (cardiac, 3; aortic, 1), with 10-year survival of 86%. Rates of freedom from aortic valve replacement at 5 and 10 years were 85% and 58% in remodeling and 96% and 58% in reimplantation. Risk factors for reoperations were postprocedure intraoperative aortic insufficiency greater than mild (p = 0.046), remodeling procedure (p = 0.016), and early term (p = 0.0002). One patient (2%) with none/trivial postprocedure aortic insufficiency required aortic valve replacement. Freedom from reoperation in patients with none/trivial postprocedure aortic insufficiency at 5 and 10 years was 100% and 67%. Meticulous control of aortic insufficiency during operation would bring favorable midterm durability in valve-sparing aortic root replacement using a reimplantation technique, even in patients with inherited connective tissue disorders. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia.

    Gamba, Amando; Tasca, Giordano; Giannico, Floriana; Lobiati, Elisabetta; Skouse, Douglas; Galanti, Andrea; Martino, Antonello Stefano; Triggiani, Michele

    2015-04-01

    The aim of this retrospective study was to evaluate our experience of using a simplified aortic valve sleeve procedure to treat aortic root ectasia and aneurysms with or without aortic regurgitation. In experienced hands, 2 aortic valve-sparing procedures, ie, Yacoub and David, have yielded excellent long-term results in the treatment of aortic root aneurysms, with or without aortic regurgitation. However, these techniques are demanding and not widely used. Recently, a new and simplified valve-sparing technique, named "sleeve procedure," has been proposed, and has yielded encouraging early results. Ninety consecutive patients with aortic root aneurysms underwent sleeve procedures from October 2006 to October 2012. Follow-up data (clinical 100% complete and echocardiographic 93% complete) were acquired from our outpatient clinic or from the referring cardiologist. The mean age of the patients was 61.5 ± 12.5 years, 79% were male, 16 (18%) had a bicuspid valve, 3 had Marfan syndrome, and 2 had aortic dissection. Over a mean clinical follow-up of 34 ± 19 months, 2 patients died from noncardiac causes and 1 was reoperated on for the recurrence of aortic regurgitation. On follow-up echocardiography after a mean of 18 ± 9 months, aortic regurgitation was absent/negligible, mild or moderate in 62%, 37%, and 1% of patients, respectively, and the diameters of the annulus, Valsalva sinuses, and sinotubular junction were 27.3 + 2.2, 37.0 + 3.4, and 30.6 + 3.1 mm, respectively. Our encouraging early and medium term results suggest that the sleeve procedure is a safe and effective aortic valve-sparing technique for the treatment of aortic root ectasia and aneurysm. However, longer follow-up is needed in order to draw definitive conclusions. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Aortic regurgitation after valve-sparing aortic root replacement: modes of failure.

    Oka, Takanori; Okita, Yutaka; Matsumori, Masamichi; Okada, Kenji; Minami, Hitoshi; Munakata, Hiroshi; Inoue, Takeshi; Tanaka, Akiko; Sakamoto, Toshihito; Omura, Atsushi; Nomura, Takuo

    2011-11-01

    Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure. From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2. The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ± 20.9 months after reimplantation and survived. Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcin-formalin glue, cusp degeneration, or progression of cusp prolapse. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Comparison of Spares Logistics Analysis Techniques for Long Duration Human Spaceflight

    Owens, Andrew; de Weck, Olivier; Mattfeld, Bryan; Stromgren, Chel; Cirillo, William

    2015-01-01

    As the durations and distances involved in human exploration missions increase, the logistics associated with the repair and maintenance becomes more challenging. Whereas the operation of the International Space Station (ISS) depends upon regular resupply from the Earth, this paradigm may not be feasible for future missions. Longer mission durations result in higher probabilities of component failures as well as higher uncertainty regarding which components may fail, and longer distances from Earth increase the cost of resupply as well as the speed at which the crew can abort to Earth in the event of an emergency. As such, mission development efforts must take into account the logistics requirements associated with maintenance and spares. Accurate prediction of the spare parts demand for a given mission plan and how that demand changes as a result of changes to the system architecture enables full consideration of the lifecycle cost associated with different options. In this paper, we utilize a range of analysis techniques - Monte Carlo, semi-Markov, binomial, and heuristic - to examine the relationship between the mass of spares and probability of loss of function related to the Carbon Dioxide Removal System (CRS) for a notional, simplified mission profile. The Exploration Maintainability Analysis Tool (EMAT), developed at NASA Langley Research Center, is utilized for the Monte Carlo analysis. We discuss the implications of these results and the features and drawbacks of each method. In particular, we identify the limitations of heuristic methods for logistics analysis, and the additional insights provided by more in-depth techniques. We discuss the potential impact of system complexity on each technique, as well as their respective abilities to examine dynamic events. This work is the first step in an effort that will quantitatively examine how well these techniques handle increasingly more complex systems by gradually expanding the system boundary.

  14. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life

    Balm AJM

    2008-12-01

    Full Text Available Abstract Background and purpose To assess the impact of intensity modulated radiotherapy (IMRT versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and nethods Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192. Overall response was 85% (n = 163; 97% in the IMRT group (n = 75 and 77% in the control group (n = 88 the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Results Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the "spared" parotid below 26 Gy. Conclusion Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.

  15. Normal liver tissue sparing by intensity-modulated proton stereotactic body radiotherapy for solitary liver tumours

    Petersen, Joergen B. B.; Hansen, Anders T.; Lassen, Yasmin; Grau, Cai; Hoeyer, Morten; Muren, Ludvig P.

    2011-01-01

    Background. Stereotactic body radiotherapy (SBRT) is often the preferred treatment for the advanced liver tumours which owing to tumour distribution, size and multi-focality are out of range of surgical resection or radiofrequency ablation. However, only a minority of patients with liver tumours may be candidates for conventional SBRT because of the limited radiation tolerance of normal liver, intestine and other normal tissues. Due to the favourable depth-dose characteristics of protons, intensity-modulated proton therapy (IMPT) may be a superior alternative to photon-based SBRT. The purpose of this treatment planning study was therefore to investigate the potential sparing of normal liver by IMPT compared to photon-based intensity-modulated radiotherapy (IMRT) for solitary liver tumours. Material and methods. Ten patients with solitary liver metastasis treated at our institution with multi-field SBRT were retrospectively re-planned with IMRT and proton pencil beam scanning techniques. For the proton plans, two to three coplanar fields were used in contrast to five to six coplanar and non-coplanar photon fields. The same planning objectives were used for both techniques. A risk adapted dose prescription to the PTV surface of 12.5-16.75 Gy x 3 was used. Results. The spared liver volume for IMPT was higher compared to IMRT in all 10 patients. At the highest prescription dose level, the median liver volume receiving less than 15 Gy was 1411 cm 3 for IMPT and 955 cm 3 for IMRT (p D 15 Gy > 700 cm 3 constraint. For the D mean = 15 Gy constraint, nine of 10 cases could be treated at the highest dose level using IMPT whereas with IMRT, only two cases met this constraint at the highest dose level and six at the lowest dose level. Conclusion. A considerable sparing of normal liver tissue can be obtained using proton-based SBRT for solitary liver tumours

  16. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life

    Rij, CM van; Oughlane-Heemsbergen, WD; Ackerstaff, AH; Lamers, EA; Balm, AJM; Rasch, CRN

    2008-01-01

    To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n = 192). Overall response was 85% (n = 163); 97% in the IMRT group (n = 75) and 77% in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the 'spared' parotid below 26 Gy. Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT

  17. Refractive changes after lens-sparing vitrectomy for macular hole and epiretinal membrane

    Muto T

    2017-08-01

    Full Text Available Tetsuya Muto,1 Tomoharu Nishimura,1 Takefumi Yamaguchi,2 Makoto Chikuda,1 Shigeki Machida1 1Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan; 2Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan Purpose: Cataract progression after lens-sparing vitrectomy might differ according to original posterior segment diseases. Our objective was to analyze the refractive values after lens-sparing vitrectomy for macular hole (MH and epiretinal membrane (ERM. Materials and methods: We reviewed the medical records of 25 MH patients (25 eyes and 23 ERM patients (23 eyes who underwent lens-sparing vitrectomy. Refractive changes in both groups were compared. All patients underwent 20-gauge three-port pars plana vitrectomy. Fluid–air exchange was performed during vitrectomy only in the MH group. The results were analyzed using the unpaired t-test, chi-square test, or Fisher exact probability test, and multivariate analysis. Results: There were no significant differences in the patient’s age (P=0.45. The myopia progression rate (D/month was higher in the MH group after surgery than that in the ERM group (P=0.035. MH group had more females (P=0.043, longer surgical time (P<0.001, and higher frequencies of surgical adjuvants use (triamcinolone acetonide, P=0.019; brilliant blue G, P<0.001. The myopia progression rate in the MH group (R=0.568, P<0.001 correlated with female gender. However, no correlation was observed between longer surgical time and the use of surgical adjuvants. Conclusion: The rate of myopia progression was higher in the MH group. Fluid–air exchange and gender may affect the rate of myopia progression. Keywords: cataract, vitrectomy, macular hole, epiretinal membrane

  18. Valve-sparing aortic root replacement in Loeys-Dietz syndrome.

    Patel, Nishant D; Arnaoutakis, George J; George, Timothy J; Allen, Jeremiah G; Alejo, Diane E; Dietz, Harry C; Cameron, Duke E; Vricella, Luca A

    2011-08-01

    Loeys-Dietz syndrome (LDS) is a recently recognized aggressive aortic disorder characterized by root aneurysm, arterial tortuosity, hypertelorism, and bifid uvula or cleft palate. The results of prophylactic root replacement using valve-sparing procedures (valve-sparing root replacement [VSRR]) in patients with LDS is not known. We reviewed all patients with clinical and genetic (transforming growth factor-β receptor mutations) evidence of LDS who underwent VSRR at our institution. Echocardiographic and clinical data were obtained from hospital and follow-up clinic records. From 2002 to 2009, 31 patients with a firm diagnosis of LDS underwent VSRR for aortic root aneurysm. Mean age was 15 years, and 24 (77%) were children. One (3%) patient had a bicuspid aortic valve. Preoperative sinus diameter was 3.9±0.8 cm (z score 7.0±2.9) and 2 (6%) had greater than 2+ aortic insufficiency. Thirty patients (97%) underwent reimplantation procedures using a Valsalva graft. There were no operative deaths. Mean follow-up was 3.6 years (range, 0 to 7 years). One patient required late repair of a pseudoaneurysm at the distal aortic anastomosis, and 1 had a conversion to a David reimplantation procedure after a Florida sleeve operation. No patient suffered thromboembolism or endocarditis, and 1 (3%) patient experienced greater than 2+ late aortic insufficiency. No patient required late aortic valve repair or replacement. Loeys-Dietz syndrome is an aggressive aortic aneurysm syndrome that can be addressed by prophylactic aortic root replacement with low operative risk. Valve-sparing procedures have encouraging early and midterm results, similar to those in Marfan syndrome, and are an attractive option for young patients. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report.

    Sarfati, Benjamin; Honart, Jean-Francois; Leymarie, Nicolas; Rimareix, Francoise; Al Khashnam, Heba; Kolb, Frederic

    2018-05-01

    Nipple-sparing mastectomy (NSM) is increasingly popular for the treatment of selected breast cancers and prophylactic mastectomy. Surgical scarring and esthetic outcomes are important patient-related cosmetic considerations. Today, the concept of minimally invasive surgery has become popular, especially using robotic surgery. The authors report the first case of NSM using the latest version of the da Vinci Xi surgical system (Xi). The final incision used to remove the entire mammary gland was located behind the axillary line. In this position, hidden by the arm of the patient, the incision was not visible and was compatible with immediate breast reconstruction. © 2017 Wiley Periodicals, Inc.

  20. PRACTICE AND BUSINESS STRATEGIES FOR DECISION -MAKING IN THE AUTOMOTIVE SPARE PARTS SECTOR

    Neyda Ibañez

    2017-09-01

    Full Text Available This paper aims to describe the practices and prospective strategies used by the Venezuelan automotive spare parts sector. The study was located in the post positivist paradigm using the descriptive method of scientist mode. The results showed that the industry uses more than 54.83 percent in qualitative prospective methods for constructing scenarios that enable their decision making, and 19,35 percent in quantitative forward-looking strategies, and the rest corresponding to a 25,82 percent in practices and prospective strategies that combine both. We conclude that made a new type of design with nine steps to build their scenarios.

  1. Preventative valve-sparing aortic root replacement and pregnancy outcome in Marfan syndrome.

    Sokol, Vesna; Zlopasa, Gordan; Herman, Mislav; Planinić, Pavao; Micevska, Ana

    2012-06-01

    In Marfan syndrome, with dilatation of the aortic root secondary to an underlying connective tissue defect, pregnancy can cause hemodynamic stress leading to the development of an aortic aneurysm and even a fatal aortic dissection. In the presence of existing aortic root enlargement and a family history of aortic dissection, preventative elective surgery is suggested. Aortic root replacement with or without a valve-sparing procedure is superior to total aortic root replacement with prosthetic valve/tube graft. It provides excellent survival with low rates of aortic - valve related complications.

  2. Valve-sparing root and ascending aorta replacement after heart transplantation.

    Elhenawy, Abdelsalam M; Feindel, Christopher M; Ross, Heather; Butany, Jagdish; Yau, Terrence M

    2012-12-01

    A 45-year-old female underwent heart transplantation 17 years ago, with a heart from a 15-year-old donor. Recently, she had developed an aneurysm of the donor aortic root and ascending aorta, with severe aortic insufficiency. Two surgical options were considered; retransplantation versus replacement of the aortic root and ascending aorta. A valve-sparing replacement of the aortic root and ascending aortic aneurysm was performed. The donor aorta showed pathologic changes typical of Marfan syndrome. Nineteen months postoperatively, the patient remains in functional class I, with trivial aortic insufficiency. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Safe current in home and spare time. Sicherer Strom in Heim und Freizeit. Vortraege

    1982-01-01

    The papers read at the meeting of the Association of Electrical Engineers (VDE) in May 1982 are intended on the one hand to create awareness of sources of danger and, on the other hand, to demonstrate and discuss how safety can be further enhanced by consistent use of standardization and enlightenment. They are titled as follows: Power accidents in home and spare time; Physiological aspects of accidents; Tasks of the state in consumer protection; Consumer protection through laws and standards; Test institutions and test-marks; Installation technology at home and abroad; Protective measures; Teaching and learning safety; Training for electricians and continuation training.

  4. Project W-320, 241-C-106 waste retrieval spare parts list

    Hays, W.H.

    1998-01-01

    Spare parts for equipment installed in the tank dome space or pump or valve pits should not be inventoried onsite due to the extensive, time-consuming work package planning, personnel/equipment mobilization, and funding requirements that are prerequisites to any repair or replacement. These issues provide adequate time to procure parts from offsite sources. All parts listed in this inventory can either be stocked in the DynCorp Tri-Cities Services, Inc., 2101-M Warehouse, or are available from the vendor/manufacturer

  5. Project W-320, 241-C-106 waste retrieval spare parts list

    Hays, W.H.

    1998-03-23

    Spare parts for equipment installed in the tank dome space or pump or valve pits should not be inventoried onsite due to the extensive, time-consuming work package planning, personnel/equipment mobilization, and funding requirements that are prerequisites to any repair or replacement. These issues provide adequate time to procure parts from offsite sources. All parts listed in this inventory can either be stocked in the DynCorp Tri-Cities Services, Inc., 2101-M Warehouse, or are available from the vendor/manufacturer.

  6. ANALISIS KLASIFIKASI PERSEDIAAN SUKU CADANG MENGGUNAKAN MUSIC-3D VIEW OF SPARES (Studi Kasus Perusahaan Farmasi di PT. XYZ

    Yuli Dwi Astanti

    2015-04-01

    Full Text Available PT. XYZ is a pharmaceutical company that manufactures both pharmaceuticals and herbal medicinal chemistry. The drug is a vital necessity to society, therefore, the drug production process must be maintained so that its performance can be met drug availability. One way to maintain smooth production process is to maintain engine performance. An engine production facility that is vital and requires periodic maintenance or at any time in case of damage. Each performed maintenance or repairs due to damage, an engine needs replacement parts for the machine to run as before. To support the maintenance activities, PT. XYZ has a warehouse used to store spare parts. During this time, parts storage system in PT. XYZ is not based on consideration of the appropriate classification of its characteristics, but each part has different characteristics, both in terms of price, suppliers, materials, usage, and so on. Due to the large number of stocks and the importance of spare parts, the supply system must be considered in order not to cause any harm to the company. The present study will attempt to analyze the system parts inventory in the warehouse by using MUSIC-3D View of Spares. MUSIC-3D View of spares in the analysis using a 3-dimensional approach that values consumption, availability and critically. The third dimension is represented by the three approaches, namely System ABC, VED, and SDE. Based on the results of the analysis of MUSIC-3D Views of Spares in mind that parts each having a different classification, so it requires a different treatment according to their classification.   Keywords : spare parts, supplies, MUSIC-3D View of Spares

  7. Esophagus and contralateral lung-sparing IMRT for locally advanced lung cancer in the community hospital setting

    Johnny eKao

    2015-06-01

    Full Text Available Background: The optimal technique for performing lung IMRT remains poorly defined. We hypothesize that improved dose distributions associated with normal tissue sparing IMRT can allow for safe dose escalation resulting in decreased acute and late toxicity. Methods: We performed a retrospective analysis of 82 consecutive lung cancer patients treated with curative intent from 1/10 to 9/14. From 1/10 to 4/12, 44 patients were treated with the community standard of 3-dimensional conformal radiotherapy or IMRT without specific esophagus or contralateral lung constraints (standard RT. From 5/12 to 9/14, 38 patients were treated with normal tissue-sparing IMRT with selective sparing of contralateral lung and esophagus. The study endpoints were dosimetry, toxicity and overall survival.Results: Despite higher mean prescribed radiation doses in the normal tissue-sparing IMRT cohort (64.5 Gy vs. 60.8 Gy, p=0.04, patients treated with normal tissue-sparing IMRT had significantly lower lung V20, V10, V5, mean lung, maximum esophagus and mean esophagus doses compared to patients treated with standard RT (p≤0.001. Patients in the normal tissue-sparing IMRT group had reduced acute grade ≥3 esophagitis (0% vs. 11%, p<0.001, acute grade ≥2 weight loss (2% vs. 16%, p=0.04, late grade ≥2 pneumonitis (7% vs. 21%, p=0.02. The 2-year overall survival was 52% with normal tissue-sparing IMRT arm compared to 28% for standard RT (p=0.015.Conclusion: These data provide proof of principle that suboptimal radiation dose distributions are associated with significant acute and late lung and esophageal toxicity that may result in hospitalization or even premature mortality. Strict attention to contralateral lung and esophageal dose volume constraints are feasible in the community hospital setting without sacrificing disease control.

  8. Towards diagnostics for a fusion reactor

    Costley, A. E.

    2009-01-01

    The requirements for measurements on modern tokamak fusion plasmas are outlined, and the techniques and systems used to make the measurements, usually referred to as 'diagnostics', are introduced. The basics of three particular diagnostics - magnetics, neutron systems and a laser based optical system - are outlined as examples of modern diagnostic systems, and the implementation of these diagnostics on a current tokamak (JET) are described. The next major step in magnetic confinement fusion is the construction and operation of the International Thermonuclear Experimental Reactor (ITER), which is a joint project of China, Europe, Japan, India, Korea, the Russian Federation, and the United States. Construction has begun in Cadarache, France. It is expected that ITER will operate at the 500 MW level. Because of the harsh environment in the vacuum vessel where many diagnostic components are located, the development of diagnostics for ITER is a major challenge - arguably the most difficult challenge ever undertaken in the field of diagnostics. The main elements in the diagnostic step are outlined using the three chosen techniques as examples. Finally, the step beyond ITER to a demonstration reactor, DEMO, that is expected to produce several GWs of fusion power is considered and the impact on diagnostics outlined. It is shown that the applicability and development steps needed for the individual diagnostics techniques will differ. The challenges for DEMO diagnostics are substantial and a dedicated effort should be made to find and develop new techniques, and especially techniques appropriate to the DEMO environment. It is argued that the limitations and difficulties in diagnostics should be a consideration in the optimization and designs of DEMO. (author)

  9. Multi-echelon, multi-indenture spare parts inventory control subject to system availability and budget constraints

    Costantino, Francesco; Di Gravio, Giulio; Tronci, Massimo

    2013-01-01

    Inventory management of spare parts is one of the most critical issues in the aeronautical industry, given the required level of system availability related to the strategic importance and high stocking costs of the components. Even if a large number of spare parts increases warehousing costs, every single shortage have a greater impact: the adoption of best-in-class inventory management techniques becomes crucial. On these considerations, the paper presents an innovative model of spare parts allocation for the Italian Air Force with the aim of minimizing backorders and, at the same time, ensuring an availability of 99% depending on the actual flight plan. The model, solved by a marginal analysis, considers an original configuration of features combining different skills of maintenance centers in a hierarchical multi-echelon, multi-item, multi-indenture structure. A real case is provided in order to analyze the solving method and the results. -- Highlights: •We studied a problem of allocations for spare parts of aeronautical systems. •The model presents different repair capabilities of maintenance centers. •The model fits constraints on budget and on total operational availability. •The model is solved by a marginal analysis with a backorder/price ratio. •A numerical example shows a spare parts allocation with relative considerations

  10. Recurrence in Region of Spared Parotid Gland After Definitive Intensity-Modulated Radiotherapy for Head and Neck Cancer

    Cannon, Donald M.; Lee, Nancy Y.

    2008-01-01

    Purpose: To discuss the implications of three examples of periparotid recurrence after definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods and Materials: We present 3 patients with HNC who underwent definitive IMRT with concurrent chemotherapy and later had treatment failure in or near a spared parotid gland. Two patients had bilateral multilevel nodal disease, and all had Level II nodal disease ipsilateral to the site of recurrence. The patients were treated using dose-painting IMRT with a dose of 70 Gy to the gross tumor volume and 59.4 Gy or 54 Gy to the high-risk or low-risk clinical tumor volume, respectively. The parotid glands were spared bilaterally. The patients had not undergone any surgical treatment for HNC before radiotherapy. Results: All patients had treatment failure in the region of a spared parotid gland. Failure in the 2 patients with bilateral multilevel nodal involvement occurred in the periparotid lymph nodes. The third patient developed a dermal metastasis near the tail of a spared parotid gland. On pretreatment imaging, the 2 patients with nodal failure had small nonspecific periparotid nodules that showed no hypermetabolic activity on positron emission tomography. Conclusion: For HNC patients receiving definitive IMRT, nonspecific positron emission tomography-negative periparotid nodules on pretreatment imaging should raise the index of suspicion for subclinical disease in the presence of multilevel or Level II nodal metastases. Additional evaluation of such nodules might be indicated before sparing the ipsilateral parotid gland

  11. Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy

    Kazda, Tomas; Slampa, Pavel; Laack, Nadia N; Jancalek, Radim; Pospisil, Petr; Sevela, Ondrej; Prochazka, Tomas; Vrzal, Miroslav; Burkon, Petr; Slavik, Marek; Hynkova, Ludmila

    2014-01-01

    The goal of this review is to summarize the rationale for and feasibility of hippocampal sparing techniques during brain irradiation. Radiotherapy is the most effective non-surgical treatment of brain tumors and with the improvement in overall survival for these patients over the last few decades, there is an effort to minimize potential adverse effects leading to possible worsening in quality of life, especially worsening of neurocognitive function. The hippocampus and associated limbic system have long been known to be important in memory formation and pre-clinical models show loss of hippocampal stem cells with radiation as well as changes in architecture and function of mature neurons. Cognitive outcomes in clinical studies are beginning to provide evidence of cognitive effects associated with hippocampal dose and the cognitive benefits of hippocampal sparing. Numerous feasibility planning studies support the feasibility of using modern radiotherapy systems for hippocampal sparing during brain irradiation. Although results of the ongoing phase II and phase III studies are needed to confirm the benefit of hippocampal sparing brain radiotherapy on neurocognitive function, it is now technically and dosimetrically feasible to create hippocampal sparing treatment plans with appropriate irradiation of target volumes. The purpose of this review is to provide a brief overview of studies that provide a rationale for hippocampal avoidance and provide summary of published feasibility studies in order to help clinicians prepare for clinical usage of these complex and challenging techniques

  12. One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

    Hye Ri Kim

    2013-09-01

    Full Text Available BackgroundSkin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM.MethodsAmong the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview.ResultsDuring the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur.ConclusionsSince one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

  13. Using TRIZ to Improve the Procurement Process of Spare Parts in the Taiwan Navy

    Chia-Nan Wang

    2017-10-01

    Full Text Available Abstract: The Naval Maintenance and Repair Command Acquisition Management Unit (NMRC-AMU of the Taiwan Navy suffered from poor stock control of spare parts and inadequate modification of requested items and manufacturer/part codes during recent years. Therefore, the purpose of this study is to investigate core categorization, coordination, and procurement (CCP problems, to formulate feasible solutions and then to improve the CCP performances of spare parts in NMRC-AMU. The Teoriya Resheniya Izobreatatelskih Zadatch (TRIZ method was applied to solve this issue. A problem hierarchy analysis (PHA was first used to identify the core problems. Then, the 40 principles were used to determine the ideal improvement solution and formulate a solution strategy that simultaneously simplified CCP processed and enhanced the correctness of procurement tasks, thereby elevating CCP efficiency, supporting the Taiwan Navy repair missions, and satisfying fleet maintenance and servicing demands. The results indicated that total 6925 requests for coordination and procurement were submitted. Of these requests, 4366 requests had been completed (with total 102 cases, and the CCP efficiency is 63.0%. After improvement by this study, a total of 4529 items were submitted and 3592 executed items were completed (with a total of 172 cases, and the CCP efficiency is 79.3%. The improvement percentage of the CCP efficiency and completed cases are 30.6% and 68.6%, respectively. The performances are good and the TRIZ could be applied for other military forces.

  14. Simulation of an integrated age replacement and spare provisioning policy using SLAM

    Zohrul Kabir, A.B.M.; Farrash, S.H.A.

    1996-01-01

    This paper presents a SLAM simulation model for determining a jointly optimal age replacement and spare part provisioning policy. The policy, referred to as a stocking policy, is formulated by combining age replacement policy with a continuous review (s, S) type inventory policy, where s is the stock reorder level and S is the maximum stock level. The optimal values of the decision variables are obtained by minimizing the total cost of replacement and inventory. The simulation procedure outlined in the paper can be used to model any operating situation having either a single item or a number of identical items. Results from a number of case problems specifically constructed by 5-factor second order rotatory design have been presented and the effects of different cost elements, item failure characteristics and lead time characteristics have been highlighted. For all case problems, optimal (s, S) policies to support the Barlow-Proschan age policy have also been determined. Simulation results clearly indicate the separate optimizations of replacement and spare provisioning policies do not ensure global optimality when total system cost has to be minimized

  15. Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade?

    Kallenbach, Klaus; Baraki, Hassina; Khaladj, Nawid; Kamiya, Hiroyuki; Hagl, Christian; Haverich, Axel; Karck, Matthias

    2007-02-01

    We assessed the outcome in patients with Marfan syndrome operated on exclusively with the aortic valve-sparing reimplantation technique for aortic root aneurysms during more than a decade. Between July 1993 and April 2005, the aortic valve-sparing reimplantation technique (David I) was used in 325 patients. In 59 patients with clinical evidence of Marfan syndrome, procedures were done for aortic root aneurysm (n = 55) or aortic dissection type A (n = 4). Their mean age was 30 +/- 12 years (range, 9 to 62 years), and 37 (63%) were male. Additional procedures were arch replacement in 4 patients, coronary artery bypass grafting in 1, mitral valve surgery in 9, and closure of atrial septal defect in 3. Mean follow-up was 54 +/- 37 months (range, 0 to 139 months). No patient died during the first 30 days postoperatively. Mean bypass time was 163 +/- 34 minutes (range, 99 to 248 minutes), and mean aortic cross clamp time was 126 +/- 28 minutes (range, 78 to 202 minutes). Four patients (6.8%) required rethoracotomy for postoperative bleeding. Five late deaths (8.5%) occurred during follow-up. Reoperation of the reconstructed valve was required in 7 patients. Freedom from reoperation was 88% +/- 5% at 5 years and 80% +/- 9% at 10 years. Mean grade of aortic insufficiency was 1.81 preoperatively compared with 0.20 early postoperatively (p valve should encourage use of this technique in patients with Marfan syndrome.

  16. One-stage nipple and breast reconstruction following areola-sparing mastectomy.

    Kim, Hye Ri; Lim, Jin Soo; Kim, Sue Min; Jung, Sung No; Yoo, Gyeol; Rha, Eun Young

    2013-09-01

    Skin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM) has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM. Among the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview. During the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur. Since one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

  17. Diuretics in the treatment of hypertension. Part 2: loop diuretics and potassium-sparing agents.

    Tamargo, Juan; Segura, Julian; Ruilope, Luis M

    2014-04-01

    Diuretics enhance the renal excretion of Na(+) and water due to a direct action at different tubular sites of the nephron where solute re-absorption occurs. This paper focuses on the mechanism of action, pharmacodynamics, antihypertensive effects, adverse effects, interactions and contraindications of loop diuretics and potassium-sparing agents (including mineralocorticoid receptor antagonists (MRAs) and epithelial Na(+) channel blockers). Loop diuretics are less effective than thiazide diuretics in lowering blood pressure, so that their major use is in edematous patients with congestive heart failure (HF), cirrhosis with ascites and nephritic edema. MRAs represent a major advance in the treatment of resistant hypertension, primary and secondary hyperaldosteronism and in patients with systolic HF to reduce the risks of hospitalization and of premature death. Potassium-sparing diuretics when coadministered with diuretics (thiazides and loop diuretics) working at more proximal nephron locations reduce the risk of hypokalemia and hypomagnesemia and the risk of cardiac arrhythmias. At the end of the article, the basis for the combination of diuretics with other antihypertensive drugs to achieve blood pressure targets is presented.

  18. Rare presentation of a testicular angiofibroma treated with testis sparing surgery

    Luca Leone

    2016-12-01

    Full Text Available Introduction: Testicular benign tumors are very rare (< 5%. Testicular Angiofibroma (AF is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

  19. Positive surgical margins in nephron-sparing surgery; the great unknown

    Dan Spinu

    2018-04-01

    Full Text Available There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations. Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM, not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations.

  20. Tackling Fragmented Last Mile Deliveries to Nanostores by Utilizing Spare Transportation Capacity—A Simulation Study

    Bram Kin

    2018-02-01

    Full Text Available Last mile deliveries in urban areas cause a disproportionate unsustainable impact, while it is also the most expensive part of the supply chain. This is particularly true for freight flows that are characterized by fragmentation. Logistically, this becomes apparent in vehicles that are driving around with a low vehicle fill rate, leading to the unnecessary presence of freight vehicles in our cities. This study focuses on the operational feasibility of utilizing the spare transportation capacity of a service-driven company as a potential solution to supply small independent retailers, or nanostores. The aim is to reduce inefficient vehicle movement. Based on a real-life implementation, we use SYnchronization Model for Belgian Inland Transport (SYMBIT, an agent-based model, to simulate various bundling scenarios. Results show the total vehicle kilometers and lead times to supply nanostores for the service-driven company to serve its customers. There is a potential to utilize spare capacity to supply nanostores while maintaining a decent service level. The number of vehicle kilometers driven highly depends on the location of the distribution center where the service-driven company operates. Based on these results, the conditions that have to be met to replicate this solution in other urban areas are discussed.

  1. Sparing effect of x-ray fractionation in mammary tumours and skin reactions of mice

    Fowler, J.F.; Denekamp, J.; Sheldon, P.W.; Smith, A.M.; Begg, A.C.; Harris, S.R.; Page, A.L.

    1975-01-01

    The increase in total dose with number of fractions of x-rays between 2 and 15 was found to be similar for local control of tumours (TCD 50 ) and for skin reactions. This result could be explained if the gain from reoxygenation of hypoxic tumour cells was the same for two fractions as for larger numbers, and the dose-sparing effect of repair and repopulation was similar for the tumour and for skin. In addition, a split-dose experiment was carried out with the tumours clamped off to make them acutely hypoxic during irradiation. The resulting value of (D 2 -D 1 )sub(24h) was not significantly smaller than the value previously found for skin reactions. 1290 rad was found in anoxic conditions, corresponding to a dose increment for repair in oxygenated conditions of 430 to 520 rad, assuming an oxygen enhancement ratio of 3 to 2.5. Reduced values have been found from regrowth experiments on two other types of tumour in mice. These results are consistent with no significant difference in the sparing effect of x-ray fractionation on skin or C 3 H mammary tumours in mice for up to 15 equal fractions given in 18 days; but reduced repair plus more proliferation in tumours than in skin cannot be excluded. (author)

  2. Verification of protein sparing by feeding carbohydrate to common carp Cyprinus carpio

    Cheng, Zhenyan; Li, Jinghui; Zhang, Baolong; Fang, Zhenzhen; Sun, Jinhui; Bai, Dongqing; Sun, Jinsheng; Qiao, Xiuting

    2017-03-01

    A 9-week feeding trial in floating freshwater cages (1.0 m×1.0 m×2.0 m) was conducted to study the effects of different dietary levels of protein and starch on growth, body composition, and gene expression of enzymes in common carp, Cyprinus carpio (mean body weight, 36.12±1.18 g) to evaluate the protein-sparing effect of dietary carbohydrate. Four diets were formulated with corn starch as the carbohydrate source to obtain corn starch levels of 6.5%, 13%, 19.5%, or 26% and protein levels of 30.5%, 28.2%, 26.4%, and 24.2%. The results showed no differences in growth performance of fish fed the diets with different protein and corn starch levels, but body composition and glucose metabolic enzyme activity of carp were significantly affected by the different diets ( P 0.05). In summary, the results indicate a protein-sparing effect by substituting carbohydrate in the diet of common carp.

  3. Is the stripping technique a tissue-sparing procedure in large simple ovarian cysts in children?

    Arena, Francesco; Romeo, Carmelo; Castagnetti, Marco; Scalfari, GianFranco; Cimador, Marcello; Impellizzeri, Pietro; Villari, Daniela; Zimbaro, Fabrizio; DeGrazia, Enrico

    2008-07-01

    Stripping of the cystic wall is performed by gynecologists to treat large ovarian cysts. Information in the pediatric population is poor. We prospectively evaluated the pathologic specimens of large ovarian cyst to determine whether the stripping technique is a tissue-sparing procedure even in this age. We evaluated 5 patients. Samples were taken from the intermediate part of the cystic wall and from the layer covering the cyst during excision. The presence of ovarian tissue adjacent to the cyst wall, and the morphological features of the surrounding tissue were both evaluated. Pelvic ultrasound follow-up was also performed. Patients' mean age was 4.5 years (7 days to 12 years). All cysts were removed because all were symptomatic. The mean diameter was 86.6 mm (74-100 mm). Cysts were follicular in 2 cases, serous in other two, and endometriotic in 1 case. Adjacent ovarian tissue was present in 1 of 5 specimens and was approximately 1 to 2 mm in thickness. The layer adjacent to the cystic wall always appeared as normal ovarian tissue. Ultrasound scans at follow-up revealed presence of ovarian tissue. The stripping procedure for large ovarian cyst excision allows to spare the adjacent normal ovarian tissue even in pediatric age because ovarian tissue is rarely excised with the cyst wall during the procedure.

  4. Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury

    Liu, N; Xing, H; Zhou, M-W

    2017-01-01

    -report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination......STUDY DESIGN: An observational study. OBJECTIVE: To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI. SETTING: Peking University Third Hospital, Beijing, China. METHODS: A 5-item SCI sacral sparing self......: The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations...

  5. HRCT findings of scrub typhus

    Kim, Kyu Sik; Kang, Sung Soo; Jin, Kong Yong; Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Chung, Gyung Ho; Lee, Sang Yong; Sohn, Myung Hee; Choi, Ki Chul

    1997-01-01

    To evaluate high-resolution CT (HRCT) findings of scrub typhus. We retrospectively reviewed the HRCT scans of 26 serologically confirmed scrub typhus patients. One underwent follow-up HRCT scanning. Twenty-three(88.5%) of the 26 patients showed abnormal findings. All 23 had lung parenchymal lesions; a small amount of pleural effusion was seen in 11 patients, and lymphadenopathy in six. The predominant parenchymal lesion was thickening of interlobular septae and the axial and intralobular interstitium (n=16). Most lesions were located in both lower lung zones. Other findings were ground-glass attenuation (n=11) and focal parenchymal consolidation (n=8). In one patient, parenchymal lesions were resolved on follow-up HRCT scanning. HRCT findings of interstitial thickening, abnormally increased parenchymal attenuation, pleural effusion and lymphadenopathy with typical clinical symptoms were diagnostic of scrub typhus

  6. HRCT findings of scrub typhus

    Kim, Kyu Sik; Kang, Sung Soo; Jin, Kong Yong; Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Chung, Gyung Ho; Lee, Sang Yong; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National Univ. Medical School, Chonju (Korea, Republic of)

    1997-06-01

    To evaluate high-resolution CT (HRCT) findings of scrub typhus. We retrospectively reviewed the HRCT scans of 26 serologically confirmed scrub typhus patients. One underwent follow-up HRCT scanning. Twenty-three(88.5%) of the 26 patients showed abnormal findings. All 23 had lung parenchymal lesions; a small amount of pleural effusion was seen in 11 patients, and lymphadenopathy in six. The predominant parenchymal lesion was thickening of interlobular septae and the axial and intralobular interstitium (n=16). Most lesions were located in both lower lung zones. Other findings were ground-glass attenuation (n=11) and focal parenchymal consolidation (n=8). In one patient, parenchymal lesions were resolved on follow-up HRCT scanning. HRCT findings of interstitial thickening, abnormally increased parenchymal attenuation, pleural effusion and lymphadenopathy with typical clinical symptoms were diagnostic of scrub typhus.

  7. Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy.

    Alexander Chi

    Full Text Available BACKGROUND: Helical tomotherapy (HT and volumetric modulated arc therapy (VMAT are both advanced techniques of delivering intensity-modulated radiotherapy (IMRT. Here, we conduct a study to compare HT and partial-arc VMAT in their ability to spare organs at risk (OARs when stereotactic ablative radiotherapy (SABR is delivered to treat centrally located early stage non-small-cell lung cancer or lung metastases. METHODS: 12 patients with centrally located lung lesions were randomly chosen. HT, 2 & 8 arc (Smart Arc, Pinnacle v9.0 plans were generated to deliver 70 Gy in 10 fractions to the planning target volume (PTV. Target and OAR dose parameters were compared. Each technique's ability to meet dose constraints was further investigated. RESULTS: HT and VMAT plans generated essentially equivalent PTV coverage and dose conformality indices, while a trend for improved dose homogeneity by increasing from 2 to 8 arcs was observed with VMAT. Increasing the number of arcs with VMAT also led to some improvement in OAR sparing. After normalizing to OAR dose constraints, HT was found to be superior to 2 or 8-arc VMAT for optimal OAR sparing (meeting all the dose constraints (p = 0.0004. All dose constraints were met in HT plans. Increasing from 2 to 8 arcs could not help achieve optimal OAR sparing for 4 patients. 2/4 of them had 3 immediately adjacent structures. CONCLUSION: HT appears to be superior to VMAT in OAR sparing mainly in cases which require conformal dose avoidance of multiple immediately adjacent OARs. For such cases, increasing the number of arcs in VMAT cannot significantly improve OAR sparing.

  8. Diagnostic Development on NSTX

    A.L. Roquemore; D. Johnson; R. Kaita; et al

    1999-01-01

    Diagnostics are described which are currently installed or under active development for the newly commissioned NSTX device. The low aspect ratio (R/a less than or equal to 1.3) and low toroidal field (0.1-0.3T) used in this device dictate adaptations in many standard diagnostic techniques. Technical summaries of each diagnostic are given, and adaptations, where significant, are highlighted

  9. TFTR diagnostic vacuum controller

    Olsen, D.; Persons, R.

    1981-01-01

    The TFTR diagnostic vacuum controller (DVC) provides in conjunction with the Central Instrumentation Control and Data Acquisition System (CICADA), control and monitoring for the pumps, valves and gauges associated with each individual diagnostic vacuum system. There will be approximately 50 systems on TFTR. Two standard versions of the controller (A and B) wil be provided in order to meet the requirements of two diagnostic manifold arrangements. All pump and valve sequencing, as well as protection features, will be implemented by the controller

  10. Managing Renal Cell Carcinoma Associated Paraneoplastic Syndrome with Nephron-sparing Surgery in a Patient with von Hippel-Lindau

    John M. DiBianco

    2017-07-01

    Full Text Available A patient with germline von Hippel-Lindau (VHL gene alteration and history of multiple tumors present with classical paraneoplastic syndrome (PNS associated with renal cell carcinoma (RCC. She underwent open nephron sparing surgery with resolution of symptoms. She remained without recurrence of RCC for the initial 2 years of her follow-up. To the best of our knowledge, this case represents the first in which PNS was specifically resolved using a partial nephrectomy in a patient with VHL. This case report provides initial evidence for the potential role of nephron sparing surgery in the management of paraneoplastic symptoms associated with hereditary RCC.

  11. Fibrin glue on an aortic cusp detected by transesophageal echocardiography after valve-sparing aortic valve replacement: a case report.

    Nakahira, Junko; Ishii, Hisanari; Sawai, Toshiyuki; Minami, Toshiaki

    2015-03-07

    Fibrin glue is used commonly during cardiac surgery but can behave as an intracardiac abnormal foreign body following surgery. There have been few such cases reported, and they were typically noticed only because of the resulting catastrophic cardiac conditions, such as valvular malfunction. We report a case where, for the first time, transesophageal echocardiography was used to detected fibrin glue that was adherent to the ventricular side of a patient's aortic valve immediately after aortic declamping. A 45-year-old Japanese man with Marfan syndrome underwent an aortic valve-sparing operation to treat moderate aortic valve regurgitation resulting from enlargement of his right coronary cusp. Fibrin glue was lightly applied to the suture line between the previous and new grafts. Transesophageal echocardiography performed prior to weaning from the cardiopulmonary bypass revealed mild aortic valve regurgitation in addition to a mobile membranous structure attached to the ventricular side of his aortic valve. It was identified as fibrin glue. We resolved the regurgitation by removing the fibrin glue and repeating the aortic cusp plication. The patient had no complications during recovery. Fibrin glue can act as an intracardiac foreign body and lead to a potentially fatal embolism. We demonstrated the use of transesophageal echocardiography to detect a fibrin glue-derived intracardiac abnormal foreign body and to confirm its removal. To the best of our knowledge, this is the first case where fibrin glue adherent to the aortic valve was detected by transesophageal echocardiography. These findings demonstrate the importance of using transesophageal echocardiography during cardiac surgery that involves using biological glues.

  12. Electrophysiology of glioma: a Rho GTPase-activating protein reduces tumor growth and spares neuron structure and function.

    Vannini, Eleonora; Olimpico, Francesco; Middei, Silvia; Ammassari-Teule, Martine; de Graaf, Erik L; McDonnell, Liam; Schmidt, Gudula; Fabbri, Alessia; Fiorentini, Carla; Baroncelli, Laura; Costa, Mario; Caleo, Matteo

    2016-12-01

    Glioblastomas are the most aggressive type of brain tumor. A successful treatment should aim at halting tumor growth and protecting neuronal cells to prevent functional deficits and cognitive deterioration. Here, we exploited a Rho GTPase-activating bacterial protein toxin, cytotoxic necrotizing factor 1 (CNF1), to interfere with glioma cell growth in vitro and vivo. We also investigated whether this toxin spares neuron structure and function in peritumoral areas. We performed a microarray transcriptomic and in-depth proteomic analysis to characterize the molecular changes triggered by CNF1 in glioma cells. We also examined tumor cell senescence and growth in vehicle- and CNF1-treated glioma-bearing mice. Electrophysiological and morphological techniques were used to investigate neuronal alterations in peritumoral cortical areas. Administration of CNF1 triggered molecular and morphological hallmarks of senescence in mouse and human glioma cells in vitro. CNF1 treatment in vivo induced glioma cell senescence and potently reduced tumor volumes. In peritumoral areas of glioma-bearing mice, neurons showed a shrunken dendritic arbor and severe functional alterations such as increased spontaneous activity and reduced visual responsiveness. CNF1 treatment enhanced dendritic length and improved several physiological properties of pyramidal neurons, demonstrating functional preservation of the cortical network. Our findings demonstrate that CNF1 reduces glioma volume while at the same time maintaining the physiological and structural properties of peritumoral neurons. These data indicate a promising strategy for the development of more effective antiglioma therapies. © The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

    Bahl, Manisha; Pien, Irene J; Buretta, Kate J; Hwang, E Shelley; Greenup, Rachel A; Ghate, Sujata V; Hollenbeck, Scott T

    2016-08-01

    Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed. One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis. Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

    Satoh, Fumitoshi; Morimoto, Ryo; Seiji, Kazumasa; Satani, Nozomi; Ota, Hideki; Iwakura, Yoshitsugu; Ono, Yoshikiyo; Kudo, Masataka; Nezu, Masahiro; Omata, Kei; Tezuka, Yuta; Kawasaki, Yoshihide; Ishidoya, Shigeto; Arai, Yoichi; Takase, Kei; Nakamura, Yasuhiro; McNamara, Keely; Sasano, Hironobu; Ito, Sadayoshi

    2015-10-01

    Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens. S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue. © 2015 European Society of Endocrinology.

  15. Fermentable soluble fibres spare amino acids in healthy dogs fed a low-protein diet.

    Wambacq, Wendy; Rybachuk, Galena; Jeusette, Isabelle; Rochus, Kristel; Wuyts, Brigitte; Fievez, Veerle; Nguyen, Patrick; Hesta, Myriam

    2016-06-28

    Research in cats has shown that increased fermentation-derived propionic acid and its metabolites can be used as alternative substrates for gluconeogenesis, thus sparing amino acids for other purposes. This amino acid sparing effect could be of particular interest in patients with kidney or liver disease, where this could reduce the kidneys'/liver's burden of N-waste removal. Since dogs are known to have a different metabolism than the obligatory carnivorous cat, the main objective of this study was to assess the possibility of altering amino acid metabolism through intestinal fermentation in healthy dogs. This was studied by supplementing a low-protein diet with fermentable fibres, hereby providing an initial model for future studies in dogs suffering from renal/liver disease. Eight healthy dogs were randomly assigned to one of two treatment groups: sugar beet pulp and guar gum mix (SF: soluble fibre, estimated to mainly stimulate propionic acid production) or cellulose (IF: insoluble fibre). Treatments were incorporated into a low-protein (17 %) extruded dry diet in amounts to obtain similar total dietary fibre (TDF) contents for both diets (9.4 % and 8.2 % for the SF and IF diet, respectively) and were tested in a 4-week crossover feeding trial. Apparent faecal nitrogen digestibility and post-prandial fermentation metabolites in faeces and plasma were evaluated. Dogs fed the SF diet showed significantly higher faecal excretion of acetic and propionic acid, resulting in a higher total SCFA excretion compared to IF. SF affected the three to six-hour postprandial plasma acylcarnitine profile by significantly increasing AUC of acetyl-, propionyl-, butyryl- + isobutyryl-, 3-OH-butyryl-, 3-OH-isovaleryl- and malonyl-L-carnitine. Moreover, the amino acid plasma profile at that time was modified as leucine + isoleucine concentrations were significantly increased by SF, and a similar trend for phenylalanine and tyrosine's AUC was found. These results indicate

  16. Technique for sparing previously irradiated critical normal structures in salvage proton craniospinal irradiation

    McDonald, Mark W; Wolanski, Mark R; Simmons, Joseph W; Buchsbaum, Jeffrey C

    2013-01-01

    Cranial reirradiation is clinically appropriate in some cases but cumulative radiation dose to critical normal structures remains a practical concern. The authors developed a simple technique in 3D conformal proton craniospinal irradiation (CSI) to block organs at risk (OAR) while minimizing underdosing of adjacent target brain tissue. Two clinical cases illustrate the use of proton therapy to provide salvage CSI when a previously irradiated OAR required sparing from additional radiation dose. The prior radiation plan was coregistered to the treatment planning CT to create a planning organ at risk volume (PRV) around the OAR. Right and left lateral cranial whole brain proton apertures were created with a small block over the PRV. Then right and left lateral “inverse apertures” were generated, creating an aperture opening in the shape of the area previously blocked and blocking the area previously open. The inverse aperture opening was made one millimeter smaller than the original block to minimize the risk of dose overlap. The inverse apertures were used to irradiate the target volume lateral to the PRV, selecting a proton beam range to abut the 50% isodose line against either lateral edge of the PRV. Together, the 4 cranial proton fields created a region of complete dose avoidance around the OAR. Comparative photon treatment plans were generated with opposed lateral X-ray fields with custom blocks and coplanar intensity modulated radiation therapy optimized to avoid the PRV. Cumulative dose volume histograms were evaluated. Treatment plans were developed and successfully implemented to provide sparing of previously irradiated critical normal structures while treating target brain lateral to these structures. The absence of dose overlapping during irradiation through the inverse apertures was confirmed by film. Compared to the lateral X-ray and IMRT treatment plans, the proton CSI technique improved coverage of target brain tissue while providing the least

  17. Parotid gland sparing radiotherapy technique using 3-D conformal radiotherapy for nasopharyngeal carcinoma

    Lim, Ji Hoon; Kim, Gwi Eon; Keum, Ki Chang; Suh, Chang Ok; Lee, Sang Wook; Park, Hee Chul; Cho, Jae Ho; Chang, Sei Kyung; Loh, Juhn Kyu

    2000-01-01

    Although using the high energy photon beam with conventional parallel-opposed beams radio-therapy for nasopgaryngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patients. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherapy (3-DCRT) in an effort to prevent the radiation-induced xerostomia. We performed three different planning for four clinically node-negative nasopharyngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dose was 70.2 Gy to the isocenter. For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy and afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54Gy was delivered by 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator, shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was performed. And bilateral posterior necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistics (Dmax, Dmin, Dmean, D95, D05, V95, V05, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 98, 69% for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96-100%, 79-99%, 51

  18. Under what conditions is recognition spared relative to recall after selective hippocampal damage in humans?

    Holdstock, J S; Mayes, A R; Roberts, N; Cezayirli, E; Isaac, C L; O'Reilly, R C; Norman, K A

    2002-01-01

    The claim that recognition memory is spared relative to recall after focal hippocampal damage has been disputed in the literature. We examined this claim by investigating object and object-location recall and recognition memory in a patient, YR, who has adult-onset selective hippocampal damage. Our aim was to identify the conditions under which recognition was spared relative to recall in this patient. She showed unimpaired forced-choice object recognition but clearly impaired recall, even when her control subjects found the object recognition task to be numerically harder than the object recall task. However, on two other recognition tests, YR's performance was not relatively spared. First, she was clearly impaired at an equivalently difficult yes/no object recognition task, but only when targets and foils were very similar. Second, YR was clearly impaired at forced-choice recognition of object-location associations. This impairment was also unrelated to difficulty because this task was no more difficult than the forced-choice object recognition task for control subjects. The clear impairment of yes/no, but not of forced-choice, object recognition after focal hippocampal damage, when targets and foils are very similar, is predicted by the neural network-based Complementary Learning Systems model of recognition. This model postulates that recognition is mediated by hippocampally dependent recollection and cortically dependent familiarity; thus hippocampal damage should not impair item familiarity. The model postulates that familiarity is ineffective when very similar targets and foils are shown one at a time and subjects have to identify which items are old (yes/no recognition). In contrast, familiarity is effective in discriminating which of similar targets and foils, seen together, is old (forced-choice recognition). Independent evidence from the remember/know procedure also indicates that YR's familiarity is normal. The Complementary Learning Systems model can

  19. A quarter of a century of experience with aortic valve-sparing operations.

    David, Tirone E; Feindel, Christopher M; David, Carolyn M; Manlhiot, Cedric

    2014-09-01

    To examine the late outcomes of aortic valve-sparing operations to treat patients with aortic root aneurysm with and without aortic insufficiency (AI) in a cohort of patients followed up prospectively since 1988. A total of 371 consecutive patients had undergone aortic valve-sparing surgery (mean age, 47 ± 15 years; 78% men) from 1988 through 2010. In addition to the aortic root aneurysm, 47% had moderate or severe AI, 35.5% had Marfan syndrome, 12.1% had type A aortic dissection, 9.2% had bicuspid aortic valve, 8.4% had mitral insufficiency, 16.1% had aortic arch aneurysm, and 10.2% had coronary artery disease. Reimplantation of the aortic valve was used in 296 patients and remodeling of the aortic root in 75. Cusp repair by plication of the free margin along the nodule of Arantius was used in 36.6% of patients, and reinforcement of the free margin with a double layer of fine Gore-Tex suture in 24.2%. The patients were followed up prospectively with images of the aortic root for a median follow-up of 8.9 ± 5.2 years. A total of 4 operative and 39 late deaths occurred. Survival at 18 years was 76.8% ± 4.31%, lower than that for the general population matched for age and gender. Age, type A aortic dissection, impaired ventricular function, and preoperative AI were associated with increased mortality on multivariable analysis. Reoperations on the aortic valve were performed in 8 patients for recurrent AI and in 2 for infective endocarditis. Freedom from reoperation on the aortic valve at 18 years was 94.8% ± 2.0%. No predictors of the need for reoperation were found on multivariable analysis. Eighteen patients developed AI greater than mild. Freedom from AI greater than mild at 18 years was 78.0% ± 4.8%. No predictors of recurrent AI were identified on multivariable analysis. Aortic valve-sparing operations continue to provide excellent clinical outcomes, although a slow but progressive deterioration of aortic valve function seems to occur during the first 2

  20. Sparing of extraocular muscle in aging and muscular dystrophies: A myogenic precursor cell hypothesis

    Kallestad, Kristen M.; Hebert, Sadie L.; McDonald, Abby A.; Daniel, Mark L.; Cu, Sharon R.; McLoon, Linda K., E-mail: mcloo001@tc.umn.edu

    2011-04-01

    The extraocular muscles (EOM) are spared from pathology in aging and many forms of muscular dystrophy. Despite many studies, this sparing remains an enigma. The EOM have a distinct embryonic lineage compared to somite-derived muscles, and we have shown that they continuously remodel throughout life, maintaining a population of activated satellite cells even in aging. These data suggested the hypothesis that there is a population of myogenic precursor cells (mpcs) in EOM that is different from those in limb, with either elevated numbers of stem cells and/or mpcs with superior proliferative capacity compared to mpcs in limb. Using flow cytometry, EOM and limb muscle mononuclear cells were compared, and a number of differences were seen. Using two different cell isolation methods, EOM have significantly more mpcs per mg muscle than limb skeletal muscle. One specific subpopulation significantly increased in EOM compared to limb was positive for CD34 and negative for Sca-1, M-cadherin, CD31, and CD45. We named these the EOMCD34 cells. Similar percentages of EOMCD34 cells were present in both newborn EOM and limb muscle. They were retained in aged EOM, whereas the population decreased significantly in adult limb muscle and were extremely scarce in aged limb muscle. Most importantly, the percentage of EOMCD34 cells was elevated in the EOM from both the mdx and the mdx/utrophin{sup -/-} (DKO) mouse models of DMD and extremely scarce in the limb muscles of these mice. In vitro, the EOMCD34 cells had myogenic potential, forming myotubes in differentiation media. After determining a media better able to induce proliferation in these cells, a fusion index was calculated. The cells isolated from EOM had a 40% higher fusion index compared to the same cells isolated from limb muscle. The EOMCD34 cells were resistant to both oxidative stress and mechanical injury. These data support our hypothesis that the EOM may be spared in aging and in muscular dystrophies due to a

  1. Sparing of extraocular muscle in aging and muscular dystrophies: A myogenic precursor cell hypothesis

    Kallestad, Kristen M.; Hebert, Sadie L.; McDonald, Abby A.; Daniel, Mark L.; Cu, Sharon R.; McLoon, Linda K.

    2011-01-01

    The extraocular muscles (EOM) are spared from pathology in aging and many forms of muscular dystrophy. Despite many studies, this sparing remains an enigma. The EOM have a distinct embryonic lineage compared to somite-derived muscles, and we have shown that they continuously remodel throughout life, maintaining a population of activated satellite cells even in aging. These data suggested the hypothesis that there is a population of myogenic precursor cells (mpcs) in EOM that is different from those in limb, with either elevated numbers of stem cells and/or mpcs with superior proliferative capacity compared to mpcs in limb. Using flow cytometry, EOM and limb muscle mononuclear cells were compared, and a number of differences were seen. Using two different cell isolation methods, EOM have significantly more mpcs per mg muscle than limb skeletal muscle. One specific subpopulation significantly increased in EOM compared to limb was positive for CD34 and negative for Sca-1, M-cadherin, CD31, and CD45. We named these the EOMCD34 cells. Similar percentages of EOMCD34 cells were present in both newborn EOM and limb muscle. They were retained in aged EOM, whereas the population decreased significantly in adult limb muscle and were extremely scarce in aged limb muscle. Most importantly, the percentage of EOMCD34 cells was elevated in the EOM from both the mdx and the mdx/utrophin -/- (DKO) mouse models of DMD and extremely scarce in the limb muscles of these mice. In vitro, the EOMCD34 cells had myogenic potential, forming myotubes in differentiation media. After determining a media better able to induce proliferation in these cells, a fusion index was calculated. The cells isolated from EOM had a 40% higher fusion index compared to the same cells isolated from limb muscle. The EOMCD34 cells were resistant to both oxidative stress and mechanical injury. These data support our hypothesis that the EOM may be spared in aging and in muscular dystrophies due to a subpopulation of

  2. Radiologic findings of sacroiliitis : emphasis on MR findings

    Yang, Ik; Park, Hai Jung; Lee, Yul; Chung, Soo Young; Park, Jong Ho

    1997-01-01

    To compare the characteristic MR findings of infectious sacroiliitis (IS) and ankylosing spondylitis (AS). We retrospectively reviewed MR findings in eight patients with IS (pyogenic in six, tuberculosis in two) confirmed by culture and clinical follow-up, and in six with AS by HLA-B27 typing. AA control group of 13 asymptomatic volunteers was formed, and they underwent MRI Findings were analysed for morphology, degree of bone erosion, and adjacent soft tissue change. CT findings of AS in four patients and IS in four were also compared to MR findings. MR characteristics of IS included unilaterality (100%), abnormal cartilage signal intensity (100%), bone marrow change (100%), contrast enhancement (100%), erosion (63%), and soft tissue change (63%). MR findings of AS showed bilaterality (67%), abnormal cartilage signal intensity (80%), bone marrow change (80%), erosion (80%), contrast enhancement (44%) and soft tissue change (10%). CT scan showed bony sclerosis and erosion (86%), and abnormal joint space (71%). MR findings of sacroiliitis were loss of thin zone of a cartilage and erosions on T1-weighted image, and increased signal intensity on T2-weighted image. MRI is regarded as a useful diagnostic method where conventional diagnosis is difficult, and is able to image cartilage abnormalities directly and noninvasively. Significant differences in MR findings between IS and AS were not noted, however

  3. Advances in medical diagnostic technology

    Lai, Khin Wee; Mohamad Salim, Maheza Irna; Ong, Sang-Bing; Utama, Nugraha Priya; Myint, Yin Mon; Mohd Noor, Norliza; Supriyanto, Eko

    2014-01-01

    This book provides the most recent findings and knowledge in advanced diagnostics technology, covering a wide spectrum including brain activity analysis, breast and lung cancer detection, echocardiography, computer aided skeletal assessment to mitochondrial biology imaging at the cellular level. The authors explored magneto acoustic approaches and tissue elasticity imaging for the purpose of breast cancer detection. Perspectives in fetal echocardiography from an image processing angle are included. Diagnostic imaging in the field of mitochondrial diseases as well as the use of Computer-Aided System (CAD) are also discussed in the book. This book will be useful for students, lecturers or professional researchers in the field of biomedical sciences and image processing.

  4. MRI finding of hemangioblastomas

    Park, Seung Cheol; Oh, Min Cheol; Chung, Hwan Hoon; Seol, Hye Young; Lee, Nam Joon; Kim, Jung Hyuk

    1994-01-01

    The purpose of this study is to evaluate the findings of magnetic resonance imaging (MRI) of posterior fossa hemanangioblastoma and usefulness of contrast enhancement with Gd-DTPA. Seven patients with posterior fossa hemangioblastoma were studied with both pre- and post-enhanced MRI. The MR images were reviewed regarding the location, size, signal intensities of cysts and mural nodules, and their contrast enhancement pattern. Five tumors were located in cerebellar hemisphere, one in vermis, and one in posterior part of medulla. One patient with von Hippel-Lindau disease had a medullary hemangioblastoma with multiple pancreatic cysts. In 6 cases, the major portion of the tumor was cysts and had small mulkal nodules. The solid portion was relatively lange in one cases, cemprising half of the tumor cysts were oval shaped and their sized were 3-6.7 cm in diameter. In five cases(71%), septations were noted within the cysts. Cysts were isointense or slightly hyperintense on T1-weighted image and hyperintense on T2- weighted image compared with cerebrospinal fluid. Mural nodules were oval or rounded radiotherapy had better prognosis than those treated with radiotherapy alwas 0.5-2.5 cm in diameter. Mural nodules were isointense to gray matter. They were detected in five cases on T1-weighted images and one case on T2-weighted images. In two cases, vascular signal void area was noted in mural nodules. On contrast-enhanced T1-weighted images, all mural nodules were intensely enhanced. MRI provide to be a good diagnostic method to detect and characterize posterior fossa hemangioblastoma. The most common finding is Cystic posterior fossa lesion with enhancing mural nodule. Contrast enhancement is essential for specific diagnosis

  5. Psychologists' diagnostic processes during a diagnostic interview

    Groenier, Marleen; Beerthuis, Vos R.J.; Pieters, Julius Marie; Witteman, C.L.M.; Witteman, Cilia L.M.; Swinkels, Jan A.

    2011-01-01

    In mental health care, psychologists assess clients’ complaints, analyze underlying problems, and identify causes for these problems, to make treatment decisions. We present a study on psychologists’ diagnostic processes, in which a mixed-method approach was employed. We aimed to identify a common

  6. The steroid-sparing effect of long-term plasmapheresis in pemphigus

    Søndergaard, Klaus; Carstens, Jan; Jørgensen, Jan

    1995-01-01

    Glucocorticoids and immunosuppressive agents can induce remission in most patients with pemphigus, but mortality remains at 5 to 15% due to complications from these drugs. We reviewed the adjunctive effect of long-term plasmapheresis in 8 patients with pemphigus. Four cases had been resistant to ...... where cyclosporine was introduced. This first report of long-term plasmapheresis demonstrates clinical efficacy in pemphigus and a considerable steroid-sparing effect.......Glucocorticoids and immunosuppressive agents can induce remission in most patients with pemphigus, but mortality remains at 5 to 15% due to complications from these drugs. We reviewed the adjunctive effect of long-term plasmapheresis in 8 patients with pemphigus. Four cases had been resistant...

  7. Radiological aspects in hot-spot removal from spare LPRM location

    Nagarajan, V.; Raveendran, P.S.; Parashar, Vivek; Mharse, R.S.; Phadnis, P.S.

    2012-01-01

    TAPS 1 and 2 comprises of twin units of boiling water reactors with vertical core. Cruciform shaped control blades are driven from the bottom through the core using hydraulic Control Rod Drives (CRD). Neutron flux monitoring is carried out by in-core devices such as Source Range Monitors (SRM) and Intermediate Range Monitors (IRM) during the start up and later using Power Range Monitors located in the biological shield. In addition, Local Power Range Monitor (LPRM) assemblies located symmetrically in the core gives information about axial and radial neutron flux. There are 18 LPRM locations out of which 13 are used for mounting the LPRMs and rest are spare locations. The lower head of the reactor vessel has 120 nozzles for CRD housings, SRM, IRM, LPRMs, vessel drain etc. Maintenance work on CRDs, removal and installation of in-core monitoring devices etc are carried out from under vessel area in the primary containment known as CRD housing area. While conducting radiation survey of CRD housing area after shut down of unit no. 1 for the 21st refueling outage, hotspot was observed at spare LPRM 40-21 location showing radiation level of 10 Gy/h and general back ground of 30-50 mGy/h. An attempt is made to bring out the ALARA efforts taken during hot spot removal. Options like hotspot shielding were not feasible. After core unloading, efforts were made to remove the hotspot. To assess the change in radiation levels, a high range silicon semiconductor based gamma monitor's detector was mounted on a pole and fixed near hotspot. Radiation level at the detector was 6 Gy/h. In addition detector of another low range area monitor was fixed at the trolley in the CRD housing area and radiation level was 7 mGy/h. Monitors of both the detectors were kept outside the primary containment in low back ground area at reactor building 103' El. Hotspot removal was attempted initially by vacuuming from the top of reactor vessel using 1 inch dia tube from spare LPRM location. Vacuum

  8. Sparing functional anatomical structures during intensity-modulated radiotherapy: an old problem, a new solution.

    Tan, Wenyong; Han, Guang; Wei, Shaozhong; Hu, Desheng

    2014-08-01

    During intensity-modulated radiotherapy, an organ is usually assumed to be functionally homogeneous and, generally, its anatomical and spatial heterogeneity with respect to radiation response are not taken into consideration. However, advances in imaging and radiation techniques as well as an improved understanding of the radiobiological response of organs have raised the possibility of sparing the critical functional structures within various organs at risk during intensity-modulated radiotherapy. Here, we discuss these structures, which include the critical brain structure, or neural nuclei, and the nerve fiber tracts in the CNS, head and neck structures related to radiation-induced salivary and swallowing dysfunction, and functional structures in the heart and lung. We suggest that these structures can be used as potential surrogate organs at risk in order to minimize their radiation dose and/or irradiated volume without compromising the dose coverage of the target volume during radiation treatment.

  9. Diode-Pumped Laser for Lung-Sparing Surgical Treatment of Malignant Pleural Mesothelioma.

    Bölükbas, Servet; Biancosino, Christian; Redwan, Bassam; Eberlein, Michael

    2017-06-01

    Surgical resection represents one of the essential cornerstones in multimodal treatment of malignant pleural mesothelioma. In cases of tumor infiltration of the lung, lung-scarifying procedures such as lobectomies or pneumonectomies might be necessary to achieve macroscopic complete resection. However, this increases the morbidity of the patients because it leads to possible delay of the planned chemotherapy or radiotherapy. Innovative surgical techniques are therefore required to enable salvage of the lung parenchyma and optimization of surgical treatment. Here we report our first experience with a diode-pumped neodymium-doped yttrium aluminium garnet laser for parenchyma-sparing lung resection during surgery for malignant pleural mesothelioma. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection?

    Bannout, Firas; Harder, Sheri; Lee, Michael; Zouros, Alexander; Raghavan, Ravi; Fogel, Travis; De Los Reyes, Kenneth; Losey, Travis

    2018-01-01

    The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the hippocampus without long-term intracranial electroencephalogram (EEG) monitoring. Encephaloceles were detected by magnetic resonance imaging (MRI) and confirmed by maxillofacial head computed tomography (CT) scans. Seizures were captured by scalp video-EEG recording. One case underwent intraoperative electrocorticography (ECoG) with pathology demonstrating neuronal heterotopia. We propose that in some patients with skull base temporal encephaloceles, minimal surgical resection of herniated and adjacent temporal cortex (lesionectomy) is sufficient to render seizure freedom. In future cases, where an associated malformation of cortical development is suspected, newer techniques such as minimally invasive EEG monitoring with stereotactic-depth EEG electrodes should be considered to tailor the surrounding margins of the resected epileptogenic zone. PMID:29534521

  11. Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

    Jason K. Panchamia

    2017-01-01

    Full Text Available Background. Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report. We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion. This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management.

  12. Synaptic molecular imaging in spared and deprived columns of mouse barrel cortex with array tomography.

    Weiler, Nicholas C; Collman, Forrest; Vogelstein, Joshua T; Burns, Randal; Smith, Stephen J

    2014-01-01

    A major question in neuroscience is how diverse subsets of synaptic connections in neural circuits are affected by experience dependent plasticity to form the basis for behavioral learning and memory. Differences in protein expression patterns at individual synapses could constitute a key to understanding both synaptic diversity and the effects of plasticity at different synapse populations. Our approach to this question leverages the immunohistochemical multiplexing capability of array tomography (ATomo) and the columnar organization of mouse barrel cortex to create a dataset comprising high resolution volumetric images of spared and deprived cortical whisker barrels stained for over a dozen synaptic molecules each. These dataset has been made available through the Open Connectome Project for interactive online viewing, and may also be downloaded for offline analysis using web, Matlab, and other interfaces.

  13. Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery

    Ma, Lijun; Sahgal, Arjun; Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny

    2014-01-01

    Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R T ) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R T , where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R 2 >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R T values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets

  14. Fundiciones aleadas para piezas de repuesto. // Alloy foundries for spare parts.

    J. Hernández de la Torre

    2003-09-01

    Full Text Available En el presente trabajo se aborda la concepción de mejorar las piezas mediante el análisis cuidadoso de las propiedades quelas mismas deben poseer, para responder a las severas exigencias del trabajo y en base a ello seleccionar la aleación y lasvías para mejorar sus cualidades y por ende su durabilidad. Como vías, en el caso de las fundiciones, se seleccionan laaleación en la carga y la modificación en la cazuela; en ambos casos con elementos aleantes que influyen sobre la matrizmetálica y la forma, tamaño y distribución del grafito. Se ejemplifica en base a piezas, como cuchillas centrales paramolinos azucareros.Palabras claves: fundición gris aleada, matriz metálica, grafito, cuchillas centrales._________________________________________________________________________________Abstract:This paper deals with the improvement of spare parts by means of a careful analysis of their properties, to face the hardexploitation conditions. Based on this analysis, the type of alloy and the ways to improve its properties and durability arefound. Two ways were applied for cast iron; the addition of alloy elements in the charge and the modification of moltenmetal in the ladle. In both cases, alloy elements are used to influence on the metallic matrix and the graphite distribution,size and form. The research is applied in spare parts such as central knives for sugar mills.Key words: alloy gray cast iron, metallic matrix, graphite, central knifes.

  15. ''Spare'' alpha 1-adrenergic receptors and the potency of agonists in rat vas deferens

    Minneman, K.P.; Abel, P.W.

    1984-01-01

    The existence of ''spare'' alpha 1-adrenergic receptors in rat vas deferens was examined directly using radioligand binding assays and contractility measurements. Alpha 1-adrenergic receptors in homogenates of rat vas deferens were labeled with [ 125 I]BE 2254 ( 125 IBE). Norepinephrine and other full alpha 1-adrenergic receptor agonists were much less potent in inhibiting 125 IBE binding than in contracting the vas deferens in vitro. Treatment with 300 nM phenoxybenzamine for 10 min to irreversibly inactivate alpha 1-adrenergic receptors caused a large decrease in the potency of full agonists in causing contraction of this tissue and a 23-48% decrease in the maximal contraction observed. Using those data, equilibrium constants for activation (Kact values) of the receptors by agonists were calculated. These Kact values agreed well with the equilibrium binding constants (KD values) determined from displacement of 125 IBE binding. The reduction in alpha 1-adrenergic receptor density following phenoxybenzamine treatment was determined by Scatchard analysis of specific 125 IBE binding sites and compared with the expected reduction (q values) calculated from the agonist dose-response curves before and after phenoxybenzamine treatment. This suggests that phenoxybenzamine functionally inactivates alpha 1-adrenergic receptors at or near the receptor binding site. These experiments suggest that the potencies of agonists in activating alpha 1-adrenergic receptors in rat vas deferens agree well with their potencies in binding to the receptors. The greater potency of agonists in causing contraction may be due to spare receptors in this tissue. The data also demonstrate that phenoxybenzamine irreversibly inactivates alpha 1-adrenergic receptors in rat vas deferens, but that the decrease in receptor density is much smaller than that predicted from receptor theory

  16. Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients

    Briere, Tina Marie; Crane, Christopher H.; Beddar, Sam; Bhosale, Priya; Mok, Henry; Delclos, Marc E.; Krishnan, Sunil; Das, Prajnan

    2012-01-01

    Purpose: Acute vulvitis, acute urethritis, and permanent sexual dysfunction are common among patients treated with chemoradiation for squamous cell carcinoma of the anal canal. Avoidance of the genitalia may reduce sexual dysfunction. A vaginal dilator may help delineate and displace the vulva and lower vagina away from the primary tumor. The goal of this study was to evaluate the positional reproducibility and vaginal sparing with the use of a vaginal dilator. Materials and methods: Ten female patients treated with IMRT for anal cancer were included in this study. A silicone vaginal dilator measuring 29 mm in diameter and 114 mm in length was inserted into the vagina before simulation and each treatment. The reproducibility of dilator placement was investigated with antero-posterior and lateral images acquired daily. Weekly cone beam CT (CBCT) imaging was used to confirm coverage of the GTV, which was typically posterior and inferior to the dilator apex. Finally, a planning study was performed to compare the vaginal doses for these 10 patients to a comparable group of 10 female patients who were treated for anal cancer with IMRT without vaginal dilators. Results: The absolute values of the location of the dilator apex were 7.0 ± 7.8 mm in the supero-inferior direction, 7.5 ± 5.5 mm in the antero-posterior, and 3.8 ± 3.1 mm in the lateral direction. Coverage of the GTV and CTV was confirmed from CBCT images. The mean dose to the vagina was lower by 5.5 Gy, on average, for the vaginal dilator patients, compared to patients treated without vaginal dilators. Conclusion: The vaginal dilator tended to be inserted more inferiorly during treatment than during simulation. For these ten patients, this did not compromise tumor coverage. Combined with IMRT treatment planning, use of a vaginal dilator could allow for maximum sparing of female genitalia for patients undergoing radiation therapy for anal cancer.

  17. Endovenous Laser Ablation of the Small Saphenous Vein Sparing the Saphenopopliteal Junction

    Janne d'Othee, Bertrand; Walker, T. Gregory; Kalva, Sanjeeva P.; Ganguli, Suvranu; Davison, Brian

    2010-01-01

    To assess outcomes after endovenous laser ablation (EVLA) of the small saphenous vein (SSV). Retrospective review was performed of all consecutive EVLA procedures performed over a 39-month period at three neighboring vein practices for symptomatic, duplex ultrasound-proven incompetence of the SSV. EVLA was performed under ultrasound guidance with an 810- or 980-nm diode laser in continuous mode using the pullback method while sparing the deep, most cephalad segment of the SSV near the saphenopopliteal junction. Follow-up after EVLA included patient symptoms, physical examination, and duplex ultrasound. Pretreatment variables were similar across all three practices. EVLA was performed to treat 67 incompetent SSVs in 63 patients (86% women; mean age and 95% confidence interval, 50 ± 3 years; range, 20-82 years). Average energy delivered was 92 J/cm. Immediate technical success and occlusion of the treated vein at 1-2 weeks was 100%. Imaging follow-up length was 243 ± 65 days (range, 3-893 days). Clinical follow-up (243 ± 66 days) showed symptomatic improvement in 66 (99%) of 67 patients; one patient had recanalization with recurrent reflux by ultrasound (2%). Complications included one case of paresthesias lasting beyond 1 month of follow-up (2%) and three cases of superficial phlebitis (4%), but no deep vein thrombosis, skin burns, or other complications. Although ablation involved only the superficial portion of the SSV and spared its deep segment in the popliteal fossa, SSV occlusion typically extended up to the saphenopopliteal junction or to a gastrocnemial collateral, without popliteal vein involvement. EVLA of the SSV is safe and effective when the saphenopopliteal junction and popliteal fossa are avoided. This approach may help reduce the risk of paresthesias or other complications while maintaining low recanalization rates.

  18. Subcutaneously Placed Breast Implants after a Skin-Sparing Mastectomy: Do We Always Need ADM?

    Apresh Singla, MBBS, MSc

    2017-07-01

    Full Text Available Background:. Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM and with a vertical inframammary incision. Methods:. A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive. Patient, operative and treatment variables were extracted. All patients with viable mastectomy skin flaps intraoperatively and at least 5 mm of subcutaneous tissue were eligible except for patients who were deemed too slim by the senior surgeon preoperatively and thus at risk of implant visibility or skin rippling. Results:. There were 26 patients (bilateral n = 12 and unilateral n = 14 eligible for analysis, with a median long-term follow-up of 51.5 months. The majority of complications were classified as minor affecting 46.2% of the cohort (n = 12. There were 20 episodes of complications overall. The most frequent episodes were contour defects (x = 5, minor seroma (x = 4, and malrotation and minor infection (x = 3. There was 1 episode of capsular contracture. Conclusion:. Skin-sparing mastectomy with immediate subcutaneous silicon implant reconstruction with a vertical incision and without the need for mesh or ADM is an acceptable and safe treatment option. Accurate patient selection and skin flap viability is the key to achieving optimal outcomes with this approach.

  19. Long-term results after aortic valve-sparing operation (David I).

    Shrestha, Malakh; Baraki, Hassina; Maeding, Ilona; Fitzner, Sebastian; Sarikouch, Samir; Khaladj, Nawid; Hagl, Christian; Haverich, Axel

    2012-01-01

    Aortic valve-sparing David procedure has gained broad acceptance. However, few long-term results have been published. We present our results. More than 450 David procedures have been performed in our institution so far. Of these, 126 patients were operated between July 1993 and December 2000. Median age was 57 (8-83) years and 46 (36.5%) were female. As many as 26 (20.6%) had Marfan syndrome, 21 (16.7%) had acute aortic dissection type A (AADA) and 67 (53.2%) had additional procedures. There were six (4.8%) deaths in 30 post-operative period (POD), four of whom had AADA. In the follow-up, there were 32 (25.4%) late deaths, 11 (34.4%) of these were caused by cardiac or underlying disease or op-related. As many as 15 (11.9%) patients were re-operated; six (40%) were Marfan patients and two (13.3%) had early endocarditis. Follow-up echocardiography of 76 (60.3%) event-free patients showed valve insufficiency (AI)≤AI I° in 68 (89.5%) and grade II in 7 (9.2%) patients. Leaflet degeneration due to proposed leaflet contact with the straight Dacron graft was not observed. A total of 36 (47.4%) patients were in New York Heart Association (NYHA) class I, 33 (43.4%) in NYHA II, and five (6.6%) were in class III. During the entire follow-up of 790 patient-years, there was no stroke or major bleeding. Survival at 1, 5 and 10 years was 93%, 85% and 70%, respectively. Freedom from valve replacement at 1, 5 and 10 years was 96%, 91% and 87%, respectively. Regardless of the underlying pathology, valve-sparing David I procedure has acceptable long-term results. Valve-related complications such as stroke or major bleeding is exceedingly low.

  20. Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting.

    Karck, Matthias; Kallenbach, Klaus; Hagl, Christian; Rhein, Christine; Leyh, Rainer; Haverich, Axel

    2004-02-01

    The objective of this study was to compare the results of aortic valve-sparing reimplantation and aortic root replacement with mechanical valve conduits in patients with Marfan syndrome undergoing operation for aortic root aneurysms. Patients and methods Between March 1979 and April 2002, 119 patients with clinical evidence of Marfan syndrome underwent composite graft replacement with mechanical valve conduits (n = 74) or aortic valve-sparing reimplantation according to David (n = 45). The underlying causes were aortic dissection type A (43 patients) and aneurysms (76 patients). Patients undergoing aortic valve reimplantation were younger compared with patients undergoing composite grafting (28 vs 35 years, P =.002) and had longer intraoperative aortic crossclamp times (125 vs 78 minutes, P valve reimplantation (P =.15). Mean follow-up was 30 months for patients undergoing aortic valve reimplantation and 114 months for patients undergoing composite grafting. Freedom from reoperation and death after 5 years postoperatively was 92% and 89% in patients undergoing composite grafting and 84% and 96% in patients undergoing aortic valve reimplantation (P =.31; P =.54), respectively. Thromboembolic complications or late postoperative bleeding occurred in 17 patients undergoing composite grafting, and an early postoperative event occurred in 1 patient undergoing aortic valve reimplantation. The results of aortic valve reimplantation and composite grafting of the aortic valve and ascending aorta with mechanical valve conduits are similar with regard to early and mid-term postoperative mortality and to the incidence of late reoperations in patients with Marfan syndrome. The low risk of thromboembolic or bleeding complications favors aortic valve reimplantation in these patients.

  1. Long-term results after aortic valve-sparing operation (David I)†

    Shrestha, Malakh; Baraki, Hassina; Maeding, Ilona; Fitzner, Sebastian; Sarikouch, Samir; Khaladj, Nawid; Hagl, Christian; Haverich, Axel

    2012-01-01

    OBJECTIVE Aortic valve-sparing David procedure has gained broad acceptance. However, few long-term results have been published. We present our results. METHODS More than 450 David procedures have been performed in our institution so far. Of these, 126 patients were operated between July 1993 and December 2000. Median age was 57 (8–83) years and 46 (36.5%) were female. As many as 26 (20.6%) had Marfan syndrome, 21 (16.7%) had acute aortic dissection type A (AADA) and 67 (53.2%) had additional procedures. RESULTS There were six (4.8%) deaths in 30 post-operative period (POD), four of whom had AADA. In the follow-up, there were 32 (25.4%) late deaths, 11 (34.4%) of these were caused by cardiac or underlying disease or op-related. As many as 15 (11.9%) patients were re-operated; six (40%) were Marfan patients and two (13.3%) had early endocarditis. Follow-up echocardiography of 76 (60.3%) event-free patients showed valve insufficiency (AI) ≤ AI I° in 68 (89.5%) and grade II in 7 (9.2%) patients. Leaflet degeneration due to proposed leaflet contact with the straight Dacron graft was not observed. A total of 36 (47.4%) patients were in New York Heart Association (NYHA) class I, 33 (43.4%) in NYHA II, and five (6.6%) were in class III. During the entire follow-up of 790 patient-years, there was no stroke or major bleeding. Survival at 1, 5 and 10 years was 93%, 85% and 70%, respectively. Freedom from valve replacement at 1, 5 and 10 years was 96%, 91% and 87%, respectively. CONCLUSIONS: Regardless of the underlying pathology, valve-sparing David I procedure has acceptable long-term results. Valve-related complications such as stroke or major bleeding is exceedingly low. PMID:21632258

  2. Joint optimization of LORA and spares stocks considering corrective maintenance time

    Linhan Guo; Jiujiu Fan; Meilin Wen; Rui Kang

    2015-01-01

    Level of repair analysis (LORA) is an important method of maintenance decision for establishing systems of operation and maintenance in the equipment development period. Currently, the research on equipment of repair level focuses on economic analy-sis models which are used to optimize costs and rarely considers the maintenance time required by the implementation of the main-tenance program. In fact, as to the system requiring high mission complete success, the maintenance time is an important factor which has a great influence on the availability of equipment sys-tems. Considering the relationship between the maintenance time and the spares stocks level, it is obvious that there are contra-dictions between the maintenance time and the cost. In order to balance these two factors, it is necessary to build an optimization LORA model. To this end, the maintenance time representing per-formance characteristic is introduced, and on the basis of spares stocks which is traditional y regarded as a decision variable, a de-cision variable of repair level is added, and a multi-echelon multi-indenture (MEMI) optimization LORA model is built which takes the best cost-effectiveness ratio as the criterion, the expected num-ber of backorder (EBO) as the objective function and the cost as the constraint. Besides, the paper designs a convex programming algorithm of multi-variable for the optimization model, provides solutions to the non-convex objective function and methods for improving the efficiency of the algorithm. The method provided in this paper is proved to be credible and effective according to the numerical example and the simulation result.

  3. Does Smoking History Confer a Higher Risk for Reconstructive Complications in Nipple-Sparing Mastectomy?

    Frey, Jordan D; Alperovich, Michael; Levine, Jamie P; Choi, Mihye; Karp, Nolan S

    2017-07-01

    History of smoking has been implicated as a risk factor for reconstructive complications in nipple-sparing mastectomy (NSM), however there have been no direct analyses of outcomes in smokers and nonsmokers. All patients undergoing NSM at New York University Langone Medical Center from 2006 to 2014 were identified. Outcomes were compared for those with and without a smoking history and stratified by pack-year smoking history and years-to-quitting (YTQ). A total of 543 nipple-sparing mastectomies were performed from 2006 to 2014 with a total of 49 in patients with a history of smoking. Reconstructive outcomes in NSM between those with and without a smoking history were equivalent. Those with a smoking history were not significantly more likely to have mastectomy flap necrosis (p = 0.6251), partial (p = 0.8564), or complete (p = 0.3365) nipple-areola complex (NAC) necrosis. Likewise, active smokers alone did not have a higher risk of complications compared to nonsmokers or those with smoking history. Comparing nonsmokers and those with a less or greater than 10 pack-year smoking history, those with a > 10 pack-year history had significantly more complete NAC necrosis (p = 0.0114, smoking history or >5 YTQ prior to NSM were equivalent to those without a smoking history. We demonstrate that NSM may be safely offered to those with a smoking history although a > 10 pack-year smoking history or <5 YTQ prior to NSM may impart a higher risk of reconstructive complications, including complete NAC necrosis. © 2017 Wiley Periodicals, Inc.

  4. SU-F-T-392: Superior Brainstem and Cochlea Sparing with VMAT for Glioblastoma Multiforme

    Briere, TM; McAleer, MF; Levy, LB; Yang, JN; Anderson, MD [Cancer Ctr., Houston, TX (United States)

    2016-06-15

    Purpose: Volumetric arc therapy (VMAT) can provide similar target coverage and normal tissue sparing as IMRT but with shorter treatment times. At our institution VMAT was adopted for the treatment glioblastoma multiforme (GBM) after a small number of test plans demonstrated its non-inferiority. In this study, we compare actual clinical treatment plans for a larger cohort of patients treated with either VMAT or IMRT. Methods: 90 GBM patients were included in this study, 45 treated with IMRT and 45 with VMAT. All planning target volumes (PTVs) were prescribed a dose of 50 Gy, with a simultaneous integrated boost to 60 Gy. Most IMRT plans used 5 non-coplanar beams, while most VMAT plans used 2 coplanar beams. Statistical analysis was performed using Fisher’s exact test or the Wilcoxon-Mann-Whitney rank sum test. Included in the analysis were patient and treatment characteristics as well as the doses to the target volumes and organs at risk. Results: Treatment times for the VMAT plans were reduced by 5 minutes compared with IMRT. The PTV coverage was similar, with at least 95% covered for all plans, while the median boost PTV dose differed by 0.1 Gy between the IMRT and VMAT cohorts. The doses to the brain, optic chiasm, optic nerves and eyes were not significantly different. The mean dose to the brainstem, however, was 9.4 Gy less with VMAT (p<0.001). The dose to the ipsilateral and contralateral cochleae were respectively 19.7 and 9.5 Gy less (p<0.001). Conclusion: Comparison of clinical treatment plans for separate IMRT and VMAT cohorts demonstrates that VMAT can save substantial treatment time while providing similar target coverage and superior sparing of the brainstem and cochleae. To our knowledge this is the first study to demonstrate this benefit of VMAT in the management of GBM.

  5. Factors influencing the parotid function in nasopharyngeal carcinoma treated with parotid-sparing radiotherapy

    Liu Wenshan; Lee Jongkang; Su Maochang; Lee, S.P.; Chen Ginden; Lee Hongshen; Lee Huei

    2006-01-01

    The background of this study was to evaluate the factors influencing post-irradiation parotid gland function in nasopharyngeal cancer treated with parotid-sparing radiotherapy. This study consisted of 45 patients with nasopharyngeal cancer treated with radiotherapy including 3D conformal radiotherapy, intensity-modulated radiotherapy and high-dose-rate brachytherapy. The mean follow-up time was 37.5 months (range: 15-50 months). Objective parotid gland function was assessed by series sialoscintigraphy pre-irradiation and post-irradiation at 1, 6, 12 and 18 months. Subjective salivary function was recorded by the LENT/SOMA system. Wilcoxon signed-rank test was used to compare the secretion ratio (SR) of parotid gland before and after treatment. Mann-Whitney rank-sum test was used to determine the factors influencing the post-irradiated SR. Chi-square test was used to compare the correlation between subjective grading of xerostomia and objective grading of parotid glands. There was a significant difference between the pre-irradiation and post-irradiation parotid gland's SR at 1 (0.30 versus 0.01, P 0.05) and 18 months (0.30 versus 0.18, P>0.05). There was significant correlation between subjective and objective salivary function (P=0.024) at 12 months after radiotherapy. The factor that impacted the preservation of parotid function was mean dose to the parotid gland >38.0 Gy (P<0.05). Our results demonstrated that parotid function could recover 1 year after treatment with parotid-sparing radiotherapy in patients with nasopharyngeal cancer. The most important factor that influenced parotid function was the mean dose to the parotid gland. (author)

  6. Simvastatin in the treatment of asthma: lack of steroid-sparing effect.

    Cowan, Douglas C; Cowan, Jan O; Palmay, Rochelle; Williamson, Avis; Taylor, D Robin

    2010-10-01

    Statins have anti-inflammatory actions which in theory are potentially beneficial in asthma. Small trials have failed to show a significant benefit, but a systematic study to evaluate the steroid-sparing effect of statin treatment has not been carried out. A randomised, placebo-controlled, crossover trial was conducted of simvastatin 40 mg at night with simultaneous stepwise reduction of fluticasone propionate dose until loss of control occurred, followed by an increase until regain of control ('minimum' dose required) in 51 patients with asthma and sputum eosinophils (steroid-free) ≥ 2%. 43 patients completed the study. There was no significant difference in 'minimum' inhaled corticosteroid (ICS) dose requirement between simvastatin and placebo: (median (IQR) 50 μg daily (0-250) vs 100 μg daily (0-250), p=0.931). 'Minimum' dose distribution was similar (p=0.269). The fluticasone dose at which loss of control occurred did not differ significantly between simvastatin and placebo (p=0.404). In patients with loss of control in both treatment arms, fluticasone dose at loss of control was similar with simvastatin and placebo (median (IQR) 50 μg daily (0-100) for both, p=0.620). In those patients who reached 0 μg/day (n=18), Astma Control Questionnaire (ACQ) was lower (p=0.037), forced expiratory volume in 1 s (FEV(1)) higher (p<0.01) and sputum eosinophils lower with simvastatin compared with placebo (9.5% compared with 25.4%, p=0.033). Simvastatin does not have clinically important steroid-sparing effects in patients with eosinophilic asthma. In the absence of steroid, simvastatin is associated with minor improvements in symptoms and lung function, and a reduction in sputum eosinophils. Clinical trial number ACTRN12606000531516.

  7. Valve-sparing root replacement for freestanding pulmonary autograft aneurysm after the Ross procedure.

    Ratschiller, Thomas; Eva, Sames-Dolzer; Schimetta, Wolfgang; Paulus, Patrick; Müller, Hannes; Zierer, Andreas; Mair, Rudolf

    2018-02-20

    Autograft dilatation is the main long-term complication following the Ross procedure using the freestanding root replacement technique. We reviewed our 25-year experience with the Ross procedure with a special emphasis on valve-sparing reoperations. From 1991 to 2016, 153 patients (29.6 ± 16.6 years; 29.4% pediatric) underwent a Ross operation at our institution with implantation of the autograft as freestanding root replacement. The follow-up is 98.7% complete with a mean of 12.2 ± 5.5 years. Mortality at 30-days was 2.0%. Echocardiography documented no or trivial aortic regurgitation in 99.3% of the patients at discharge. Survival probability at 20 years was 85.4%. No case of autograft endocarditis occurred. Autograft deterioration rate was 2.01% per patient-year, and freedom from autograft reoperation was 75.3% at 15 years. A reoperation for autograft aneurysm was required in 35 patients (22.9%) at a mean interval of 11.1 ± 4.6 years after the Ross procedure. A valve-sparing root replacement was performed in 77% of patients, including 10 David and 17 Yacoub procedures with no early mortality. Three patients required prosthetic valve replacement within 2 years after a Yacoub operation. At latest follow-up, 92% of all surviving patients still carry the pulmonary autograft valve. Freedom from autograft valve replacement was 92.1% at 15 years. Using the David or Yacoub techniques, the autograft valve can be preserved in the majority of patients with root aneurysms after the Ross procedure. Reoperations can be performed with no early mortality, a good functional midterm result, and an acceptable reintervention rate. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  8. Management of acetabular fractures with modified posterior approach to spare external hip rotators.

    Sarlak, Ahmet Y; Selek, Ozgur; Inanir, Murat; Musaoglu, Resul; Baran, Tuncay

    2014-04-01

    In the present study the quality of reduction and incidence of complications in hip external rotator sparing modified posterior approach was assessed in both simple and complex acetabular fractures. This retrospective study includes 37 patients (38 hips) with a mean age of 42.1 years (range 21-60), that had been treated for displaced acetabular fractures from June 2007 through May 2011. They were reviewed at a mean of 3 years (20-67 months). The fractures were classified according to the Letournel-Judet classification. Anatomic reduction and stable fixation of the fracture with less than 2mm residual displacement was achieved in 28 of 38 hips. At the final follow up the patients were evaluated clinically according to Merle d'Aubigne and Postel scoring system which had been modified by Matta and radiologically based on the criteria described by Matta. The clinical results were excellent in 20, good in 8, fair in 8, and poor 2 hips. Complications included two superficial local wound infection and 10 heterotopic ossification with 7 of the cases having grade I heterotopic ossification. Avascular necrosis of the femoral head was not seen in any of the 38 hips. One patient with preoperative sciatic nerve palsy had complete recovery of neurologic function. There were no cases of deep vein thrombosis or pulmonary embolism. The functional outcome was satisfactory in most of the cases and comparable with other larger series. Using the limited part of Henry's sciatic nerve exposure skin incision - working in the plane between gluteus maximus and the tensor fascia lata as in the classical Gibson approach and two portal external rotator hip sparing approach resulted in good fracture reduction without approach related complications. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Placebo controlled comparison of the opioid sparing effect of meloxicam and diclofenac after abdominal hysterectomy

    Anwari, Jamil S.; Anjum, S.; Al-Khunain, S.

    2008-01-01

    Objective was to compare the opioid sparing effect of meloxicam and diclofenac after abdominal hysterectomy. This study was conducted at the Riyadh Military Hospital, Kingdom of Saudi Arabia from February 2004 to November 2006. Women of American Society of Anesthesiologist's classification I or II of ages 25-60 years scheduled for abdominal hysterectomy were included. Those with significant systematic disease or contraindication to opioid or non-steroidal anti-inflammatory drugs were excluded from the study. All patients received general anesthesia and intravenous (IV) morphine and were intubated and ventilated for the operation. The patients were randomized and rectally received meloxicam (15 mg), diclofenac (100 mg) or placebo suppository. Patients, postoperatively blinded were blinded to these drugs. In the recover room, (IV) patient controlled morphine was commenced. The information sought included patient characteristic (age, weight), duration operation and doses of morphine consumed in 24 hours. Seventy-five patients (25 in each group) participated in this study and only 5 patients dropped out. There was no difference in age and body weight of the patients and duration of operation. All underwent either total or sub-total hysterectomy. The mean (SD) morphine consumption in the 24 hour postoperative period was 37.7 (11.1) mg for the diclofenac group, 40.1 (7.8) mg for the meloxicam group and 45.2 (9.8) mg for the placebo group. As compared to placebo, the mean morphine consumption in diclofenac (but not in meloxicam) group was significantly (p<0.05) reduced. Our study demonstrates a significant opioid sparing effect after abdominal hysterectomy with diclofenac but not with meloxicam. (author)

  10. Diagnostic nerve ultrasonography

    Baeumer, T.; Grimm, A.; Schelle, T.

    2017-01-01

    For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [de

  11. Ongoing experiments: diagnostics requirements

    Dickerman, C.E.

    1976-01-01

    The paper reviews the fuel motion diagnostics needs for ongoing LMFBR safety experiments over approximately the next five years, with the discussion centered on TREAT. Brief comments on the direction in which clad motion diagnostics requirements are expected to develop are also presented

  12. Clinical diagnostic ultrasound

    Barnett, E.; Morley, P.

    1986-01-01

    This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

  13. Gearbox vibration diagnostic analyzer

    1992-01-01

    This report describes the Gearbox Vibration Diagnostic Analyzer installed in the NASA Lewis Research Center's 500 HP Helicopter Transmission Test Stand to monitor gearbox testing. The vibration of the gearbox is analyzed using diagnostic algorithms to calculate a parameter indicating damaged components.

  14. Insulin-sparing and fungible effects of E4orf1 combined with an adipocyte-targeting sequence in mouse models of type 1 and type 2 diabetes.

    Yoon, I-S; Park, S; Kim, R-H; Ko, H L; Nam, J-H

    2017-10-01

    Obesity impairs glycemic control and causes insulin resistance and type 2 diabetes. Adenovirus 36 (Ad36) infection can increase the uptake of excess glucose from blood into adipocytes by increasing GLUT4 translocation through the Ras-Akt signaling pathway, which bypasses PI3K-Akt-mediated insulin receptor signaling. E4orf1, a viral gene expressed early during Ad36 infection, is responsible for this insulin-sparing effect and may be an alternative target for improving insulin resistance. To deliver the gene to adipocytes only, we connected the adipocyte-targeting sequence (ATS) to the 5' end of E4orf1 (ATS-E4orf1). In vitro transfection of ATS-E4orf1 into preadipocytes activated factors for GLUT4 translocation and adipogenesis to the same extent as did Hemagglutinin (HA)-E4orf1 transfection as positive reference. Moreover, the Transwell migration assay also showed that ATS-E4orf1 secreted by liver cells activated Akt in preadipocytes. We used a hydrodynamic gene delivery technique to deliver ATS-E4orf1 into high-fat diet-fed and streptozotocin-injected mice (disease models of type 2 and type 1 diabetes, respectively). ATS-E4orf1 improved the ability to eliminate excess glucose from the blood and ameliorated liver function in both disease models. These findings suggest that ATS-E4orf1 has insulin-sparing and fungible effects in type 2 and 1 diabetes independent of the presence of insulin.

  15. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography Precisión diagnóstica e impacto terapéutico de la ultrasonografía endoscópica en los pacientes con sospecha intermedia de coledocolitiasis y colangiorresonancia normal

    Enrique Vázquez-Sequeiros

    2011-09-01

    Full Text Available Background: endoscopic ultrasonography (EUS and magnetic resonance cholangiography (MRC are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC. Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV and negative predictive value (NPV of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them. Sensitivity and diagnostic accuracy of EUS (100%, 92% were significantly higher than MRC values (0%, 70% (p Antecedentes: la ultrasonografía endoscópica (USE y la colangiografía por resonancia magnética nuclear (CRM son las técnicas de elección para el diagnóstico de litiasis en la vía biliar. Aunque la CRM es mejor aceptada por los pacientes, la sensibilidad de esta para detectar litiasis de pequeño tamaño podría ser insuficiente. Objetivo: estudiar de forma prospectiva la precisión diagnóstica y el impacto terapéutico de la USE en los pacientes con sospecha intermedia de coledocolitiasis y CRM normal. Material y métodos: se incluyeron prospectivamente durante 24 meses todos los pacientes con sospecha clínica intermedia de coledocolitiasis y CRM negativa. Se compar�� la sensibilidad, especificidad, precisión diagnóstica, valor predictivo positivo y negativo de CRM y USE, así como su impacto en el tratamiento. Resultados: se evaluaron 76 pacientes (litiasis en el 30%. La sensibilidad y precisión diagnóstica de USE (100%, 92% eran significativamente

  16. Effect of branched chain amino acid enrichment of total parenteral nutrition on nitrogen sparing and clinical outcome of sepsis and trauma: a prospective randomized double blind trial

    von Meyenfeldt, M. F.; Soeters, P. B.; Vente, J. P.; van Berlo, C. L.; Rouflart, M. M.; de Jong, K. P.; van der Linden, C. J.; Gouma, D. J.

    1990-01-01

    Administration of extra branched chain amino acids (BCAA) has been associated with a nitrogen sparing effect in septic and traumatized patients. Whether nitrogen sparing is associated with decreased morbidity and mortality rates is unknown. We therefore undertook a prospective, randomized, double

  17. TARGETED DELETION OF INDUCIBLE HEAT SHOCK PROTEIN 70 ABROGATES THE LATE INFARCT-SPARING EFFECT OF MYOCARDIAL ISCHEMIC PRECONDITIONING

    Abstract submitted for 82nd annual meeting of the American Association for Thoracic Surgery, May 4-8, 2002 in Washington D.C.Targeted Deletion of Inducible Heat Shock Protein 70 Abrogates the Late Infarct-Sparing Effect of Myocardial Ischemic PreconditioningCraig...

  18. Internal hemipelvectomy with intraoperative and external beam radiotherapy in the limb-sparing treatment of a pelvic girdle chondrosarcoma

    Hoekstra, HJ; Szabo, BG

    The case of a patient with an extensive pelvic girdle chondrosarcoma treated with internal hemipelvectomy and intraoperative radiotherapy, followed by adjuvant high-dose external beam radiotherapy, with a successful attempt in achieving long-term local tumor control and limb-sparing treatment is

  19. Clinical, Pathologic, and Functional Outcomes After Nephron-Sparing Surgery in Patients with a Solitary Kidney: A Multicenter Experience

    Mues, Adam C.; Korets, Ruslan; Graversen, Joseph A.; Badani, Ketan K.; Bird, Vincent G.; Best, Sara L.; Cadeddu, Jeffrey A.; Clayman, Ralph V.; McDougall, Elspeth; Barwari, Kurdo; Laguna, Pilar; de la Rosette, Jean; Kavoussi, Louis; Okhunov, Zhamshid; Munver, Ravi; Patel, Sutchin R.; Nakada, Stephen; Tsivian, Matvey; Polascik, Thomas J.; Shalhav, Arieh; Shingleton, W. Bruce; Johnson, Emilie K.; Wolf, J. Stuart; Landman, Jaime

    2012-01-01

    Background and Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and

  20. Preoperative Decision Making for Nephron-Sparing Procedure in the Renal Mass: Time for Using Standard Tools?

    Zondervan, Patricia J.; van Lienden, Krijn P.; van Delden, Otto M.; de La Rosette, Jean J. M. C. H.; Laguna, M. Pilar

    2016-01-01

    To determine if the application of using standard tools on tumor complexity and comorbidity indexes may replace the traditional choice of nephron-sparing procedure (NSP) based on clinical maximal tumor diameter (cMTD), age, and comorbidity. Anatomic complexity scores (PADUA and RENAL) and Charlson