A custom three-dimensional electron bolus technique for optimization of postmastectomy irradiation

International Nuclear Information System (INIS)

Perkins, George H.; McNeese, Marsha D.; Antolak, John A.; Buchholz, Thomas A.; Strom, Eric A.; Hogstrom, Kenneth R.

2001-01-01

Purpose: Postmastectomy irradiation (PMI) is a technically complex treatment requiring consideration of the primary tumor location, possible risk of internal mammary node involvement, varying chest wall thicknesses secondary to surgical defects or body habitus, and risk of damaging normal underlying structures. In this report, we describe the application of a customized three-dimensional (3D) electron bolus technique for delivering PMI. Methods and Materials: A customized electron bolus was designed using a 3D planning system. Computed tomography (CT) images of each patient were obtained in treatment position and the volume to be treated was identified. The distal surface of the wax bolus matched the skin surface, and the proximal surface was designed to conform to the 90% isodose surface to the distal surface of the planning target volume (PTV). Dose was calculated with a pencil-beam algorithm correcting for patient heterogeneity. The bolus was then fabricated from modeling wax using a computer-controlled milling device. To aid in quality assurance, CT images with the bolus in place were generated and the dose distribution was computed using these images. Results: This technique optimized the dose distribution while minimizing irradiation of normal tissues. The use of a single anterior field eliminated field junction sites. Two patients who benefited from this option are described: one with altered chest wall geometry (congenital pectus excavatum), and one with recurrent disease in the medial chest wall and internal mammary chain (IMC) area. Conclusion: The use of custom 3D electron bolus for PMI is an effective method for optimizing dose delivery. The radiation dose distribution is highly conformal, dose heterogeneity is reduced compared to standard techniques in certain suboptimal settings, and excellent immediate outcome is obtained

Bolus characteristics based on Magnetic Resonance Angiography

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Bi Xiaoming

2006-10-01

Full Text Available Abstract Background A detailed contrast bolus propagation model is essential for optimizing bolus-chasing Computed Tomography Angiography (CTA. Bolus characteristics were studied using bolus-timing datasets from Magnetic Resonance Angiography (MRA for adaptive controller design and validation. Methods MRA bolus-timing datasets of the aorta in thirty patients were analyzed by a program developed with MATLAB. Bolus characteristics, such as peak position, dispersion and bolus velocity, were studied. The bolus profile was fit to a convolution function, which would serve as a mathematical model of bolus propagation in future controller design. Results The maximum speed of the bolus in the aorta ranged from 5–13 cm/s and the dwell time ranged from 7–13 seconds. Bolus characteristics were well described by the proposed propagation model, which included the exact functional relationships between the parameters and aortic location. Conclusion The convolution function describes bolus dynamics reasonably well and could be used to implement the adaptive controller design.

Evaluation of a Water-based Bolus Device for Radiotherapy to the Extremities in Kaposi's Sarcoma Patients

International Nuclear Information System (INIS)

Ahn, Seung Kwon; Kim, Yong Bae; Lee, Ik Jae

2008-01-01

We designed a water-based bolus device for radiation therapy in Kaposi's sarcoma. This study evaluated the usefulness of this new device and compared it with the currently used rice-based bolus. Materials and Methods: We fashioned a polystyrene box and cut a hole in order to insert patient's extremities while the patient was in the supine position. We used a vacuum-vinyl based polymer to reduce water leakage. Next, we eliminated air using a vacuum pump and a vacuum valve to reduce the air gap between the water and extremities in the vacuum-vinyl box. We performed CT scans to evaluate the density difference of the fabricated water-based bolus device when the device in which the rice-based bolus was placed directly, the rice-based bolus with polymer-vinyl packed rice, and the water were all put in. We analyzed the density change with the air gap volume using a planning system. In addition, we measured the homogeneity and dose in the low-extremities phantom, attached to six TLD, and wrapped film exposed in parallel-opposite fields with the LINAC under the same conditions as the set-up of the CT-simulator. Results: The density value of the rice-based bolus with the rice put in directly was 14% lower than that of the water-based bolus. Moreover, the value of the other experiments in the rice-based bolus with the polymer-vinyl packed rice showed an 18% reduction in density. The analysis of the EDR2 film revealed that the water-based bolus shows a more homogeneous dose plan, which was superior by 4.0-4.4% to the rice-base bolus. The mean TLD readings of the rice-based bolus, with the rice put directly into the polystyrene box had a 3.4% higher density value. Moreover, the density value in the case of the rice-based bolus with polymer-vinyl packed rice had a 4.3% higher reading compared to the water-based bolus. Conclusion: Our custom-made water-based bolus device increases the accuracy of the set-up by confirming the treatment field. It also improves the accuracy of the

A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy.

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Park, So-Yeon; Choi, Chang Heon; Park, Jong Min; Chun, MinSoo; Han, Ji Hye; Kim, Jung-In

2016-01-01

The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique. We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected. There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm). The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy.

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So-Yeon Park

Full Text Available The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique.We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected.There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm.The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

Bolus fluid therapy and sodium homeostasis in paediatric gastroenteritis.

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Freedman, Stephen B; Geary, Denis F

2013-03-01

The study aims to assess the risk of developing hyponatraemia when large-volume bolus fluid rehydration therapy is administered. We conducted a prospective randomised study in a tertiary-care centre emergency department. Participants included children with gastroenteritis and dehydration requiring intravenous rehydration. They were randomised to receive 60 mL/kg (large) or 20 mL/kg (standard) 0.9% saline bolus followed by maintenance 0.9% saline for 3 h. Biochemical tests were performed at baseline and 4 h. The primary outcome measure was the development of hyponatraemia at 4 h. Secondary outcome measures were (i) change in sodium relative to baseline value; (ii) magnitude of decrease among those who experienced a decrease; (iii) risk of hypernatraemia; (iv) correlations between urine parameters and hyponatraemia; and (v) fluid overload. Eighty-four of 224 (38%) participants were hyponatraemic at baseline. At 4 h, 22% (48/217) had a dysnatraemia, and similar numbers of children were hyponatraemic in both groups: large (23% (26/112)) versus standard (21% (22/105)) (P = 0.69). Among initially hyponatraemic children, 63% (30/48) who received large-volume rehydration and 44% (15/34) of those administered standard rehydration were isonatraemic at 4 h (P = 0.10). Overall, children who received 60 mL/kg experienced a larger mean increase (1.6 ± 2.4 mEq/L vs. 0.9 ± 2.2 mEq/L; P = 0.04) and were less likely to experience a sodium decrease of ≥2 mEq/L (8/112 vs. 17/105; P = 0.04) than those administered 20 mL/kg. Large-volume bolus rehydration therapy with 0.9% saline is safe. It does not promote the development of hyponatraemia over the short term, but hastens the resolution of baseline hyponatraemia. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Bolus use in radiotherapy

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Sérgio Spezzia

2017-01-01

Full Text Available Preliminary to the radiation therapy, it is posisble to develop a therapeutic device contained in the buccomaxillofacial prosthesis resources, creating the bolus. Bolus are materials used to increase the dose on the entrance surface of a field or to compensate for a lack of tissue. The requirements for a material to be used as a bolus include to interact with ionizing radiations in a similar manner to tissues and to be soft enough to allow its molding to the patient’s contour. There are various materials available for this purpose, however, with a relatively high cost. Some inexpensive options can also be used, such as pressed cellophane and wet gauze, however, these materials do not present favorable malleability and do not offer true reproducibility. The aim of this article was to ascertain whether there is harmonious knowledge of this technique by dental surgeons, medical oncologists and radiotherapists. This technique or device minimizes the deleterious effects resulting from exposure to radiation. It was concluded the bolus can reduce possible complications arising from radiation therapy, concomitantly offering improved living conditions during treatment.

Lack of gender effects on gray matter volumes in adolescent generalized anxiety disorder.

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Liao, Mei; Yang, Fan; Zhang, Yan; He, Zhong; Su, Linyan; Li, Lingjiang

2014-02-01

Previous epidemiological and clinical studies have reported gender differences in prevalence and clinical features of generalized anxiety disorder (GAD). Such gender differences in clinical phenomenology suggest that the underlying neural circuitry of GAD could also be different in males and females. This study aimed to explore the possible gender effect on gray matter volumes in adolescents with GAD. Twenty-six adolescent GAD patients and 25 healthy controls participated and underwent high-resolution structural magnetic resonance scans. Voxel-based morphometry (VBM) was used to investigate gray matter alterations. Our study revealed a significant diagnosis main effect in the right putamen, with larger gray matter volumes in GAD patients compared to healthy controls, and a significant gender main effect in the left precuneus/posterior cingulate cortex, with larger gray matter volumes in males compared to females. No gender-by-diagnosis interaction effect was found in this study. The relatively small sample size in this study might result in a lack of power to demonstrate gender effects on brain structure in GAD. The results suggested that there are differences in gray matter volumes between males and females, but gray matter volumes in GAD are not influenced by gender. © 2013 Published by Elsevier B.V.

Comparison the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit

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Shahriari M

2015-05-01

Full Text Available Background and Objective: Proper nutritional support is one of the important caring aspects in patients who were hospitalized in Intensive Care Unit. Although the several studies have been done concerning the selection of proper nutrition method for patients, but there is no agreement on this issue. The aim of current study was the compare the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit.  Materials and Method: The current clinical trial was conducted on patients who were hospitalized in intensive care unit in Alzahra hospital in Isfahan, 2013. Fifty patients were selected through convenient sampling and were randomly assigned into two groups of 25 people of intervention and control. Nutrition was done through infusion pump in intervention group and by bolus in control group. Gastric residual volume and diarrhea was assessed each four hours for four days. Data were gathered through checklist and were analyzed by SPSS18 using descriptive and inferential statistics including independent T-test, Fisher's exact test and repeated measures ANOVA.  Results: The results showed that the mean of gastric residual volume in control group was more than the intervention group on the third day (p=0.04. Also, the mean of gastric residual volume did not show significant difference at different times in intervention group, but the mean of gastric residual volume was significantly increased in control group at different times (p=0.04. Fisher's exact test showed no significant difference between two groups concerning the diarrhea frequency.  Conclusion: In nutritional support with continuous infusion method, gastric residual volume was not increased and gastric emptying rate was not diminished. Therefore, this method can be used as an appropriate nutritional support in intensive care unit.

Bolus injections of measured amounts of radioactivity

International Nuclear Information System (INIS)

Wesolowski, C.A.; Hogendoorn, P.; Vandierendonck, R.; Driedger, A.A.

1988-01-01

Many time-based radionuclide techniques, such as glomerular filtration rate measurement (GFR), require prompt intravenous delivery of and accurately measured tracer bolus with minimal residual tracer retention at the injection site. The quality assurance aspects of two antecubital vein, quantitative injection techniques were investigated. A flush bolus technique using a tuberculin syringe piggybacked onto a 10-ml saline flush was compared to a single blood pressure cuff injection technique. Scintillation camera data for each technique were compared for bolus duration in the abdominal aorta and for residual activity at the injection site at 5 min. Bolus times were measured as the FWHM of the gamma variate fit to the abdominal aortic regional time-activity curves. Relatively little focal activity was seen in the antecubital injection site following the flush bolus: marked residual activity was seen following the blood pressure cuff injections. The injection site/arm background ratios averaged 1.3 for the flush bolus and 30.1 for the cuff technique. Although both methods allowed accurate in vitro determination of administered radioactivity, only the tuberculin syringe flush bolus technique was acceptable for time-based quantitation because of its superior in vivo characteristics

Gender dimorphism of brain reward system volumes in alcoholism.

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Sawyer, Kayle S; Oscar-Berman, Marlene; Barthelemy, Olivier J; Papadimitriou, George M; Harris, Gordon J; Makris, Nikos

2017-05-30

The brain's reward network has been reported to be smaller in alcoholic men compared to nonalcoholic men, but little is known about the volumes of reward regions in alcoholic women. Morphometric analyses were performed on magnetic resonance brain scans of 60 long-term chronic alcoholics (ALC; 30 men) and 60 nonalcoholic controls (NC; 29 men). We derived volumes of total brain, and cortical and subcortical reward-related structures including the dorsolateral prefrontal (DLPFC), orbitofrontal, and cingulate cortices, and the temporal pole, insula, amygdala, hippocampus, nucleus accumbens septi (NAc), and ventral diencephalon (VDC). We examined the relationships of the volumetric findings to drinking history. Analyses revealed a significant gender interaction for the association between alcoholism and total reward network volumes, with ALC men having smaller reward volumes than NC men and ALC women having larger reward volumes than NC women. Analyses of a priori subregions revealed a similar pattern of reward volume differences with significant gender interactions for DLPFC and VDC. Overall, the volume of the cerebral ventricles in ALC participants was negatively associated with duration of abstinence, suggesting decline in atrophy with greater length of sobriety. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Tranexamic Acid in Bolus Alone Vs Bolus and Continuous Infusion in Hip Arthroscopy

OpenAIRE

Fatih Karaaslan; Roberto Seijas; Andrea Sallent; Oscar Ares; Wenceslao Espinosa; Pedro Alvarez; Ramón Cugat; Patricia Lopez

2017-01-01

AIM: the present study examines the effects of tranexamic acid (TXA) on reducing blood loss during hip arthroscopy, comparing two different methods of administration (bolus vs infusion). METHODS: a prospective study with 70 patients undergoing hip arthroscopy was carried out. The patients within the TXA infusion group (group A) received TXA an 2-g intravenous bolus 30 min before skin incision intravenously followed by 10 mg/kg/h infusion (continued during the entire surgery)...

Study of dose modification in skin cancers induced by the kind of bolus used - Bibliography

International Nuclear Information System (INIS)

Camilleri, Jeremy

2011-01-01

As tumour irradiation modalities differ from one pathology to another, and are even proper to each pathology (they depend on tumour nature, histology, size, location, and so on), but as therapeutic objectives remain unchanged (to deliver the prescribed dose to the target-volume with the highest possible precision while preserving as much as possible sane tissues as well as neighbouring organs at risk), this bibliographical study aims, on the one hand, at quantifying the dose variation generated by heterogeneous structures crossed by the electron beam, and on the other hand, at optimising the use of boluses during surface irradiations, notably in the case of skin cancers. The author addresses therapeutic indications of irradiation of skin cancers and of thoracic wall for which the application of a bolus is required, and then the associated irradiation techniques as well as bolus characteristics

Comparison and evaluation between 3D-bolus and step-bolus, the assistive radiotherapy devices for the patients who had undergone modified radical mastectomy surgery

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Jang, Won Seok; Park, Kwang Woo; Shin, Dong Bong; Kim, Jong Dae; Kim, Sei Joon; Ha, Jin Sook; Jeon, Mi Jin; Cho, Yoojin; Jung, Inho [Dept. of Radiation Oncology, Gangnam Severance Hospital, Seoul, (Korea, Republic of)

2016-06-15

This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0

Comparison and evaluation between 3D-bolus and step-bolus, the assistive radiotherapy devices for the patients who had undergone modified radical mastectomy surgery

International Nuclear Information System (INIS)

Jang, Won Seok; Park, Kwang Woo; Shin, Dong Bong; Kim, Jong Dae; Kim, Sei Joon; Ha, Jin Sook; Jeon, Mi Jin; Cho, Yoojin; Jung, Inho

2016-01-01

This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0

Evaluation of various boluses in dose distribution for electron therapy of the chest wall with an inward defect

Science.gov (United States)

Mahdavi, Hoda; Jabbari, Keyvan; Roayaei, Mahnaz

2016-01-01

Delivering radiotherapy to the postmastectomy chest wall can be achieved using matched electron fields. Surgical defects of the chest wall change the dose distribution of electrons. In this study, the improvement of dose homogeneity using simple, nonconformal techniques of thermoplastic bolus application on a defect is evaluated. The proposed phantom design improves the capability of film dosimetry for obtaining dose profiles of a patient's anatomical condition. A modeled electron field of a patient with a postmastectomy inward surgical defect was planned. High energy electrons were delivered to the phantom in various settings, including no bolus, a bolus that filled the inward defect (PB0), a uniform thickness bolus of 5 mm (PB1), and two 5 mm boluses (PB2). A reduction of mean doses at the base of the defect was observed by any bolus application. PB0 increased the dose at central parts of the defect, reduced hot areas at the base of steep edges, and reduced dose to the lung and heart. Thermoplastic boluses that compensate a defect (PB0) increased the homogeneity of dose in a fixed depth from the surface; adversely, PB2 increased the dose heterogeneity. This study shows that it is practical to investigate dose homogeneity profiles inside a target volume for various techniques of electron therapy. PMID:27051169

Intravenous contrast medium administration at 128 multidetector row CT pulmonary angiography: Bolus tracking versus test bolus and the implications for diagnostic quality and effective dose

International Nuclear Information System (INIS)

Rodrigues, J.C.L.; Mathias, H.; Negus, I.S.; Manghat, N.E.; Hamilton, M.C.K.

2012-01-01

Aim: To investigate the effects of a test bolus protocol contrast medium administration on diagnostic image quality in computed tomography pulmonary angiography (CTPA). Materials and methods: Fifty patients referred for exclusion of pulmonary embolism underwent CTPA using a test bolus protocol CTPA at 120 kVp and were compared with 50 patients undergoing CTPA using a standard bolus-tracking protocol at 120 kVp, via assessment of attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) seen in the pulmonary arteries (PAs). An additional group of 10 non-obese patients who underwent CTPA using a test bolus protocol performed at 100 kVp were also analysed. Mean effective dose was calculated from the dose–length product, using standard conversion factors. Results: The test bolus protocol showed significantly higher attenuation, SNR, and CNR in the pulmonary vasculature down to the segmental level compared to bolus-tracking CTPA (p < 0.0001). There was no significant difference in effective dose between the test bolus and bolus tracking cohorts. The additional group of test bolus CTPA examinations performed at 100 kVp had a significantly reduced effective dose in comparison to both test bolus CTPA at 120 kVp and bolus-tracking CTPA at 120 kVp (p < 0.005) yet maintained mean PA attenuation to segmental level significantly better than bolus-tracking CTPA performed at 120 kVp and comparable to the test bolus cohort performed at 120 kVp. Conclusion: Test bolus contrast administration should be used as an optimal protocol. Performing test bolus CTPA at 100 kVp, as opposed to 120 kVp, significantly reduces dose without compromising PA attenuation in non-obese subjects.

Pharyngeal Pressure and Timing During Bolus Transit

Science.gov (United States)

Walczak, Chelsea C.; Jones, Corinne A.; McCulloch, Timothy M.

2018-01-01

Determining intrabolus pressure (IBP) at the upper esophageal sphincter (UES) and in the esophagus has given compelling evidence that IBP can be a predictor for swallowing dysfunction. Studies have looked most superiorly at the low hypopharynx region but there has been no inquiry into what IBP measures throughout the entire pharynx can tell us. We present a study to describe the pressures within and surrounding the moving bolus throughout the pharynx and into the UES. Simultaneous HRM and videofluoroscopy were performed in 10 healthy subjects swallowing ten 10 mL thin-liquid barium boluses. Three events surrounding bolus movement were tracked via videofluoroscopy, two additional events were found using manometric measures. As the bolus passes through the pharynx, low pressure is created at and below the head of the bolus. A modest pressure increase is seen as the bolus passes through the pharynx and finally, high pressure is observed at the bolus tail, followed by an even larger pressure generation of a clearance event. HRM allows for greater resolution in data collection in the pharynx and in this study, aided in identifying semi unique characteristics around the hypopharynx and the UES which are consistent with the complex anatomy of the regions and the transition of the UES from active closure to relaxed opening. In the future, additional studies designed to look at aged and diseased populations may lead to better understanding of disease etiology, and treatment options. PMID:27565155

Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care: A Quality Improvement Project.

Science.gov (United States)

Hochstetler, Jessica L; Thompson, A Jill; Ball, Natalie M; Evans, Melissa C; Frame, Shaun C; Haney, A Lauren; Little, Amelia K; O'Donnell, Jaime L; Rickett, Bryna M; Mack, Elizabeth H

2018-04-12

To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. This is a pre- and postimplementation quality improvement study. An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion. Change in practice from administering bolus doses from an automated dispensing machine to administering bolus medications from continuous infusion in PICUs. Timing studies were conducted pre- and post implementation in 29 and 26 occurrences, respectively. The median time from the decision to give a bolus until it began infusing decreased by 169 seconds (p 0.05). Annualized cost avoidance was $124,160. Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without negatively impacting patient safety.

A customized bolus produced using a 3-dimensional printer for radiotherapy.

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Shin-Wook Kim

Full Text Available OBJECTIVE: Boluses are used in high-energy radiotherapy in order to overcome the skin sparing effect. In practice though, commonly used flat boluses fail to make a perfect contact with the irregular surface of the patient's skin, resulting in air gaps. Hence, we fabricated a customized bolus using a 3-dimensional (3D printer and evaluated its feasibility for radiotherapy. METHODS: We designed two kinds of bolus for production on a 3D printer, one of which was the 3D printed flat bolus for the Blue water phantom and the other was a 3D printed customized bolus for the RANDO phantom. The 3D printed flat bolus was fabricated to verify its physical quality. The resulting 3D printed flat bolus was evaluated by assessing dosimetric parameters such as D1.5 cm, D5 cm, and D10 cm. The 3D printed customized bolus was then fabricated, and its quality and clinical feasibility were evaluated by visual inspection and by assessing dosimetric parameters such as Dmax, Dmin, Dmean, D90%, and V90%. RESULTS: The dosimetric parameters of the resulting 3D printed flat bolus showed that it was a useful dose escalating material, equivalent to a commercially available flat bolus. Analysis of the dosimetric parameters of the 3D printed customized bolus demonstrated that it is provided good dose escalation and good contact with the irregular surface of the RANDO phantom. CONCLUSIONS: A customized bolus produced using a 3D printer could potentially replace commercially available flat boluses.

A customized bolus produced using a 3-dimensional printer for radiotherapy.

Science.gov (United States)

Kim, Shin-Wook; Shin, Hun-Joo; Kay, Chul Seung; Son, Seok Hyun

2014-01-01

Boluses are used in high-energy radiotherapy in order to overcome the skin sparing effect. In practice though, commonly used flat boluses fail to make a perfect contact with the irregular surface of the patient's skin, resulting in air gaps. Hence, we fabricated a customized bolus using a 3-dimensional (3D) printer and evaluated its feasibility for radiotherapy. We designed two kinds of bolus for production on a 3D printer, one of which was the 3D printed flat bolus for the Blue water phantom and the other was a 3D printed customized bolus for the RANDO phantom. The 3D printed flat bolus was fabricated to verify its physical quality. The resulting 3D printed flat bolus was evaluated by assessing dosimetric parameters such as D1.5 cm, D5 cm, and D10 cm. The 3D printed customized bolus was then fabricated, and its quality and clinical feasibility were evaluated by visual inspection and by assessing dosimetric parameters such as Dmax, Dmin, Dmean, D90%, and V90%. The dosimetric parameters of the resulting 3D printed flat bolus showed that it was a useful dose escalating material, equivalent to a commercially available flat bolus. Analysis of the dosimetric parameters of the 3D printed customized bolus demonstrated that it is provided good dose escalation and good contact with the irregular surface of the RANDO phantom. A customized bolus produced using a 3D printer could potentially replace commercially available flat boluses.

Safe structural food bolus in elderly: the relevant parameters

OpenAIRE

Vandenberghe-Descamps, Mathilde; Septier, Chantal; Prot, Aurélie; Tournier, Carole; Hennequin, Martine; Vigneau, Evelyne; Feron, Gilles; Labouré, Hélène

2017-01-01

Mastication is essential to prepare food into a bolus ready to be swallowed safely, with no choking risk. Based on food bolus properties, a masticatory normative indicator was developed by Woda et al. (2010) to identify impaired masticatory function within good oral health population. The aim of the present study was to identify relevant parameters of bolus' structure to differentiate safe to unsafe bolus among elderly contrasting by their dental status.93 elderly, 58% with at least 7 posteri...

21 CFR 520.1660c - Oxytetracycline hydrochloride tablets/boluses.

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2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Oxytetracycline hydrochloride tablets/boluses. 520....1660c Oxytetracycline hydrochloride tablets/boluses. (a) Specifications. Each tablet or bolus contains 250, 500, or 1,000 milligrams of oxytetracycline hydrochloride. (b) Sponsors. For sponsors in § 510...

Delivery confirmation of bolus electron conformal therapy combined with intensity modulated x-ray therapy

International Nuclear Information System (INIS)

Kavanaugh, James A.; Hogstrom, Kenneth R.; Fontenot, Jonas P.; Henkelmann, Gregory; Chu, Connel; Carver, Robert A.

2013-01-01

Purpose: The purpose of this study was to demonstrate that a bolus electron conformal therapy (ECT) dose plan and a mixed beam plan, composed of an intensity modulated x-ray therapy (IMXT) dose plan optimized on top of the bolus ECT plan, can be accurately delivered. Methods: Calculated dose distributions were compared with measured dose distributions for parotid and chest wall (CW) bolus ECT and mixed beam plans, each simulated in a cylindrical polystyrene phantom that allowed film dose measurements. Bolus ECT plans were created for both parotid and CW PTVs (planning target volumes) using 20 and 16 MeV beams, respectively, whose 90% dose surface conformed to the PTV. Mixed beam plans consisted of an IMXT dose plan optimized on top of the bolus ECT dose plan. The bolus ECT, IMXT, and mixed beam dose distributions were measured using radiographic films in five transverse and one sagittal planes for a total of 36 measurement conditions. Corrections for film dose response, effects of edge-on photon irradiation, and effects of irregular phantom optical properties on the Cerenkov component of the film signal resulted in high precision measurements. Data set consistency was verified by agreement of depth dose at the intersections of the sagittal plane with the five measured transverse planes. For these same depth doses, results for the mixed beam plan agreed with the sum of the individual depth doses for the bolus ECT and IMXT plans. The six mean measured planar dose distributions were compared with those calculated by the treatment planning system for all modalities. Dose agreement was assessed using the 4% dose difference and 0.2 cm distance to agreement. Results: For the combined high-dose region and low-dose region, pass rates for the parotid and CW plans were 98.7% and 96.2%, respectively, for the bolus ECT plans and 97.9% and 97.4%, respectively, for the mixed beam plans. For the high-dose gradient region, pass rates for the parotid and CW plans were 93.1% and 94

Fabrication of malleable three-dimensional-printed customized bolus using three-dimensional scanner.

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Jae Won Park

Full Text Available A three-dimensional (3D-printed customized bolus (3D bolus can be used for radiotherapy application to irregular surfaces. However, bolus fabrication based on computed tomography (CT scans is complicated and also delivers unwanted irradiation. Consequently, we fabricated a bolus using a 3D scanner and evaluated its efficacy. The head of an Alderson Rando phantom was scanned with a 3D scanner. The 3D surface data were exported and reconstructed with Geomagic Design X software. A 3D bolus of 5-mm thickness designed to fit onto the nose was printed with the use of rubber-like printing material, and a radiotherapy plan was developed. We successfully fabricated the customized 3D bolus, and further, a CT simulation indicated an acceptable fit of the 3D bolus to the nose. There was no air gap between the bolus and the phantom surface. The percent depth dose (PDD curve of the phantom with the 3D bolus showed an enhanced surface dose when compared with that of the phantom without the bolus. The PDD of the 3D bolus was comparable with that of a commercial superflab bolus. The radiotherapy plan considering the 3D bolus showed improved target coverage when compared with that without the bolus. Thus, we successfully fabricated a customized 3D bolus for an irregular surface using a 3D scanner instead of a CT scanner.

Qualitative indices and enhancement rate of CT pulmonary angiography in patients with suspected pulmonary embolism: Comparison between test bolus and bolus-tracking methods

Directory of Open Access Journals (Sweden)

Maryam Moradi

2016-01-01

Full Text Available Background: The aim of the present study was to assess the qualitative indices and enhancement rate of computed tomographic pulmonary angiography (CTPA in patients with suspected pulmonary embolism using Test bolus and Bolus-tracking techniques. Materials and Methods: Fifty-two patients with suspected pulmonary embolism that passed informed consent were randomly divided in the two groups. In each group, demographic characteristics, qualitative indices, and enhancement rate of CTPA were recorded. Results: The diagnostic result obtained in majority of the participants in the two groups (88.5 % in Test bolus group vs. 73.1% in the Bolus tracking group. In the case of quantitative variables, no statistically significant differences were found between the groups (P > 0.05. The only statistically significant difference between the two groups is average of "X-ray dose". Conclusion: The results of our study show that there is no statistically significant difference between the Bolus Tracking and Test Bolus techniques for producing more homogeneous enhancement.

Evaluation of the Eclipse eMC algorithm for bolus electron conformal therapy using a standard verification dataset.

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Carver, Robert L; Sprunger, Conrad P; Hogstrom, Kenneth R; Popple, Richard A; Antolak, John A

2016-05-08

The purpose of this study was to evaluate the accuracy and calculation speed of electron dose distributions calculated by the Eclipse electron Monte Carlo (eMC) algorithm for use with bolus electron conformal therapy (ECT). The recent com-mercial availability of bolus ECT technology requires further validation of the eMC dose calculation algorithm. eMC-calculated electron dose distributions for bolus ECT have been compared to previously measured TLD-dose points throughout patient-based cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid-PTV (planning treatment volume) CT anatomy. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The treatment plans were imported into the Eclipse treatment planning system, and electron dose distributions calculated using 1% and processors (Intel Xeon E5-2690, 2.9 GHz) on a framework agent server (FAS). In comparison, the eMC was significantly more accurate than the pencil beam algorithm (PBA). The eMC has comparable accuracy to the pencil beam redefinition algorithm (PBRA) used for bolus ECT planning and has acceptably low dose calculation times. The eMC accuracy decreased when smoothing was used in high-gradient dose regions. The eMC accuracy was consistent with that previously reported for accuracy of the eMC electron dose algorithm and shows that the algorithm is suitable for clinical implementation of bolus ECT.

Optical tracking of contrast medium bolus to optimize bolus shape and timing in dynamic computed tomography

International Nuclear Information System (INIS)

Eisa, Fabian; Brauweiler, Robert; Peetz, Alexander; Hupfer, Martin; Nowak, Tristan; Kalender, Willi A

2012-01-01

One of the biggest challenges in dynamic contrast-enhanced CT is the optimal synchronization of scan start and duration with contrast medium administration in order to optimize image contrast and to reduce the amount of contrast medium. We present a new optically based approach, which was developed to investigate and optimize bolus timing and shape. The time-concentration curve of an intravenously injected test bolus of a dye is measured in peripheral vessels with an optical sensor prior to the diagnostic CT scan. The curves can be used to assess bolus shapes as a function of injection protocols and to determine contrast medium arrival times. Preliminary results for phantom and animal experiments showed the expected linear behavior between dye concentration and absorption. The kinetics of the dye was compared to iodinated contrast medium and was found to be in good agreement. The contrast enhancement curves were reliably detected in three mice with individual bolus shapes and delay times of 2.1, 3.5 and 6.1 s, respectively. The optical sensor appears to be a promising approach to optimize injection protocols and contrast enhancement timing and is applicable to all modalities without implying any additional radiation dose. Clinical tests are still necessary. (note)

Evaluation of a bolus/infusion protocol for 11C-ABP688, a PET tracer for mGluR5

International Nuclear Information System (INIS)

Burger, Cyrill; Deschwanden, Alexandra; Ametamey, Simon; Johayem, Anass; Mancosu, Bruno; Wyss, Matthias; Hasler, Gregor; Buck, Alfred

2010-01-01

11 C-ABP-688 is a selective tracer for the mGluR5 receptor. Its kinetics is fast and thus favourable for an equilibrium approach to determine receptor-related parameters. The purpose of this study was to test the hypothesis that the pattern of the 11 C-ABP688 uptake using a bolus-plus-infusion (B/I) protocol at early time points corresponds to the perfusion and at a later time point to the total distribution volume. Methods: A bolus and a B/I study (1 h each) was performed in five healthy male volunteers. With the B/I protocol, early and late scans were normalized to gray matter, cerebellum and white matter. The same normalization was done on the maps of the total distribution volume (Vt) and K 1 which were calculated in the study with bolus only injection and the Logan method (Vt) and a two-tissue compartment model (K 1 ). Results: There was an excellent correlation close to the identity line between the pattern of the late uptake in the B/I study and Vt of the bolus-only study for all three normalizations. The pattern of the early uptake in the B/I study correlated well with the K 1 maps, but only when normalized to gray matter and cerebellum, not to white matter. Conclusion: It is demonstrated that with a B/I protocol the 11 C-ABP688 distribution in late scans reflects the pattern of the total distribution volume and is therefore a measure for the density pattern of mGluR5. The early scans following injection are related to blood flow, although not in a fully quantitative manner. The advantage of the B/I protocol is that no arterial blood sampling is required, which is advantageous in clinical studies.

A mathematical model for the movement of food bolus of varying viscosities through the esophagus

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Tripathi, Dharmendra

2011-09-01

This mathematical model is designed to study the influence of viscosity on swallowing of food bolus through the esophagus. Food bolus is considered as viscous fluid with variable viscosity. Geometry of esophagus is assumed as finite length channel and flow is induced by peristaltic wave along the length of channel walls. The expressions for axial velocity, transverse velocity, pressure gradient, volume flow rate and stream function are obtained under the assumptions of long wavelength and low Reynolds number. The impacts of viscosity parameter on pressure distribution, local wall shear stress, mechanical efficiency and trapping are numerically discussed with the help of computational results. On the basis of presented study, it is revealed that swallowing of low viscous fluids through esophagus requires less effort in comparison to fluids of higher viscosity. This result is similar to the experimental result obtained by Raut et al. [1], Dodds [2] and Ren et al. [3]. It is further concluded that the pumping efficiency increases while size of trapped bolus reduces when viscosity of fluid is high.

Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation.

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Godfrey, Devon J; Patel, Bhavik N; Adamson, Justus D; Subashi, Ergys; Salama, Joseph K; Palta, Manisha

Bolus-tracked multiphasic contrast computed tomography (CT) is often used in diagnostic radiology to enhance the visibility of pancreas tumors, but is uncommon in radiation therapy pancreas CT simulation, and its impact on gross tumor volume (GTV) delineation is unknown. This study evaluates the lesion conspicuity and consistency of pancreas stereotactic body radiation therapy (SBRT) GTVs contoured in the different contrast phases of triphasic CT simulation scans. Triphasic, bolus-tracked planning CT simulation scans of 10 consecutive pancreas SBRT patients were acquired, yielding images of the pancreas during the late arterial (LA), portal venous (PV), and either the early arterial or delayed phase. GTVs were contoured on each phase by a gastrointestinal-specialized radiation oncologist and reviewed by a fellowship-trained abdominal radiologist who specializes in pancreatic imaging. The volumes of the registered GTVs, their overlap ratio, and the 3-dimensional margin expansions necessary for each GTV to fully encompass GTVs from the other phases were calculated. The contrast difference between tumor and normal pancreas was measured, and 2 radiation oncologists rank-ordered the phases according to their value for the lesion-contouring task. Tumor-to-pancreas enhancement was on average much larger for the LA and PV than the delayed phase or early arterial phases; the LA and PV phases were also consistently preferred by the radiation oncologists. Enhancement differences among the phases resulted in highly variable GTV volumes with no observed trends. Overlap ratios ranged from 18% to 75% across all 3 phases, improving to 43% to 91% when considering only the preferred LA and PV phases. GTV expansions necessary to encompass all GTVs ranged from 0.3 to 1.8 cm for all 3 phases, improving slightly to 0.1 to 1.4 cm when considering just the LA and PV phases. For pancreas SBRT, we recommend combining the GTVs from a multiphasic CT simulation with bolus-tracking, including

Correlations between aorto-popliteal bolus transit speed and aortic and popliteal bolus transit time during CT angiography of aortoiliac and lower extremity arteries

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Nakaya, Yasuhiro, E-mail: y-nakaya@radiol.med.osaka-u.ac.jp [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871 (Japan); Kim, Tonsok; Hori, Masatoshi; Onishi, Hiromitsu; Nakamoto, Atsushi; Tsuboyama, Takahiro; Maeda, Noboru; Higashihara, Hiroki; Tomoda, Kaname; Nakamura, Hironobu [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871 (Japan)

2011-08-15

Purpose: The purpose of this study was to investigate correlations between the aorto-popliteal bolus transit speed and aortic and popliteal bolus transit time in order to evaluate the possibility for prediction of bolus transit speed by single test injection technique. Materials and methods: Approval was obtained from our institutional review board for this study, which included 42 patients, from all of whom written informed consent was obtained. Low-dose serial CT scanning after injection of 12 ml contrast material (300 mg/ml) at a rate of 3 ml/s followed by saline flush was performed twice, first at the level of the upper abdomen and second at the level of the knee joint. The times needed to reach peak enhancement of the upper abdominal aorta (T-aorta) and bilateral popliteal arteries (T-popliteal) were obtained, and aorto-popliteal bolus transit speeds between the abdominal aorta and popliteal arteries were calculated. ABI was recorded for the bilateral feet. The Pearson's product-moment correlation coefficient was used to investigate the correlation between the bolus transit speed and T-aorta, T-popliteal, ABI, and patient age. Result: The respective correlation coefficients for bolus transit speed on the one hand and T-aorta, T-popliteal, ABI, patient age on the other were -0.50, -0.84, 0.36, and -0.52. Conclusion: The time to peak enhancement for popliteal arteries showed the strongest correlation with aorto-popliteal bolus transit speeds, and was considered to be the most accurate predictor for aorto-popliteal bolus transit speeds.

SU-C-213-03: Custom 3D Printed Boluses for Radiation Therapy

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Zhao, B; Yang, M; Yan, Y; Rahimi, A; Chopra, R; Jiang, S [UT Southwestern Medical Center, Dallas, TX (United States)

2015-06-15

Purpose: To develop a clinical workflow and to commission the process of creating custom 3d printed boluses for radiation therapy. Methods: We designed a workflow to create custom boluses using a commercial 3D printer. Contours of several patients were deformably mapped to phantoms where the test bolus contours were designed. Treatment plans were created on the phantoms following our institutional planning guideline. The DICOM file of the bolus contours were then converted to stereoLithography (stl) file for the 3d printer. The boluses were printed on a commercial 3D printer using polylactic acid (PLA) material. Custom printing parameters were optimized in order to meet the requirement of bolus composition. The workflow was tested on multiple anatomical sites such as skull, nose and chest wall. The size of boluses varies from 6×9cm2 to 12×25cm2. To commission the process, basic CT and dose properties of the printing materials were measured in photon and electron beams and compared against water and soft superflab bolus. Phantoms were then scanned to confirm the placement of custom boluses. Finally dose distributions with rescanned CTs were compared with those computer-generated boluses. Results: The relative electron density(1.08±0.006) of the printed boluses resemble those of liquid tap water(1.04±0.004). The dosimetric properties resemble those of liquid tap water(1.04±0.004). The dosimetric properties were measured at dmax with an ion chamber in electron and photon open beams. Compared with solid water and soft bolus, the output difference was within 1% for the 3D printer material. The printed boluses fit well to the phantom surfaces on CT scans. The dose distribution and DVH based on the printed boluses match well with those based on TPS generated boluses. Conclusion: 3d printing provides a cost effective and convenient solution for patient-specific boluses in radiation therapy.

SU-C-213-03: Custom 3D Printed Boluses for Radiation Therapy

International Nuclear Information System (INIS)

Zhao, B; Yang, M; Yan, Y; Rahimi, A; Chopra, R; Jiang, S

2015-01-01

Purpose: To develop a clinical workflow and to commission the process of creating custom 3d printed boluses for radiation therapy. Methods: We designed a workflow to create custom boluses using a commercial 3D printer. Contours of several patients were deformably mapped to phantoms where the test bolus contours were designed. Treatment plans were created on the phantoms following our institutional planning guideline. The DICOM file of the bolus contours were then converted to stereoLithography (stl) file for the 3d printer. The boluses were printed on a commercial 3D printer using polylactic acid (PLA) material. Custom printing parameters were optimized in order to meet the requirement of bolus composition. The workflow was tested on multiple anatomical sites such as skull, nose and chest wall. The size of boluses varies from 6×9cm2 to 12×25cm2. To commission the process, basic CT and dose properties of the printing materials were measured in photon and electron beams and compared against water and soft superflab bolus. Phantoms were then scanned to confirm the placement of custom boluses. Finally dose distributions with rescanned CTs were compared with those computer-generated boluses. Results: The relative electron density(1.08±0.006) of the printed boluses resemble those of liquid tap water(1.04±0.004). The dosimetric properties resemble those of liquid tap water(1.04±0.004). The dosimetric properties were measured at dmax with an ion chamber in electron and photon open beams. Compared with solid water and soft bolus, the output difference was within 1% for the 3D printer material. The printed boluses fit well to the phantom surfaces on CT scans. The dose distribution and DVH based on the printed boluses match well with those based on TPS generated boluses. Conclusion: 3d printing provides a cost effective and convenient solution for patient-specific boluses in radiation therapy

Comparison of first-pass and second-bolus dynamic susceptibility perfusion MRI in brain tumors

International Nuclear Information System (INIS)

Spampinato, M.V.; Besenski, Nada; Rumboldt, Zoran; Wooten, Caroline; Dorlon, Margaret

2006-01-01

Our goal was to evaluate whether the T1 shortening effect caused by contrast leakage into brain tumors, a well-known confounding effect in the quantification of relative cerebral blood volume (rCBV) measurements, may be corrected by the administration of a predose of gadolinium-DTPA. As part of their presurgical imaging protocol, 25 patients with primary brain tumors underwent two consecutive dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion MR studies. Intratumoral rCBV measurements and normalized rCBV values obtained during the first-pass and second-bolus studies were compared (Wilcoxon signed-ranks test). The frequency of relatively increased rCBV ratios on the second-bolus study was compared between enhancing and non-enhancing neoplasms (Fisher's exact test). Postprocessing perfusion studies were evaluated for image quality on a scale of 0-3 (Wilcoxon signed-ranks test). Four studies were excluded due to unacceptable image quality. Mean normalized rCBVs were 9.04 (SD 4.64) for the first-pass and 7.99 (SD 3.84) for the second-bolus study. There was no statistically significant difference between the two perfusion studies in either intratumoral rCBV (P=0.237) or rCBV ratio (P=0.181). Five enhancing and four non-enhancing tumors showed a relative increase in rCBV ratio on the second-bolus study, without a significant difference between the groups. Image quality was not significantly different between perfusion studies. Our results did not demonstrate a significant difference between first-pass and second-bolus rCBV measurements in DSC perfusion MR imaging. The administration of a predose of gadolinium-DTPA does not appear to be an efficient way of compensating for the underestimation of intratumoral rCBV values due to the T1 shortening effect. (orig.)

SU-F-T-442: Dose Distribution Comparison for Post-Laryngectomy Stoma Area Between Conventional AP and VMAT Plans with Or Without Bolus

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Lee, B [University of California, Los Angeles, Los Angeles, CA (United States); Zhang, J; Cho-Lim, J [VA Long Beach Healthcare System, Long Beach, CA (United States); University of California, Irvine, Orange, CA (United States); Leu, M [VA Greater Los Angeles Healthcare System, Los Angeles, CA (United States); Inouye, W [VA Long Beach Healthcare System, Long Beach, CA (United States); Lorentz, W [University of California, Los Angeles, Los Angeles, CA (United States); VA Greater Los Angeles Healthcare System, Los Angeles, CA (United States); Lee, S [University of California, Los Angeles, Los Angeles, CA (United States); VA Long Beach Healthcare System, Long Beach, CA (United States); VA Greater Los Angeles Healthcare System, Los Angeles, CA (United States)

2016-06-15

Purpose: To compare dose distributions of conventional AP vs. VMAT treatment plans with or without bolus around post-laryngectomy stoma. Methods: Radiation dose coverage for post-laryngectomy stoma was analyzed using a set of real-case CT-simulation images. After meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed at the larynx, the resulting dosimetry plans were analyzed with or without a 5 mm bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dose of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results: For the conventional AP SCV plan, the peri-stoma skin dose is sensitive to bolus placement as well as air gap compensation by wetted gauze (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). For stoma lumen, the dose drops off rapidly in depth. The catheter cuff may have certain dose-buildup effect, but air gap around it and under the bolus placed can pose a more serious problem. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). VMAT allows beamlets with different angles of incidence that helped achieve such dose distribution around the stoma even without bolus placement. Conclusion: Overall, the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. To achieve optimal dose distribution, it is still recommended to place physical bolus and reduce the air gaps.

On bolus for megavoltage photon and electron radiation therapy

International Nuclear Information System (INIS)

Vyas, Vedang; Palmer, Lisa; Mudge, Ray; Jiang, Runqing; Fleck, Andre; Schaly, Bryan; Osei, Ernest; Charland, Paule

2013-01-01

Frequently, in radiation therapy one must treat superficial lesions on cancer patients; these are at or adjacent to the skin. Megavoltage photon radiotherapy penetrates through the skin to irradiate deep-seated tumors, with skin-sparing property. Hence, to treat superficial lesions, one must use a layer of scattering material to feign as the skin surface. Although megavoltage electron beams are used for superficial treatments, one occasionally needs to enhance the dose near the surface. Such is the function of a “bolus,” a natural or synthetically developed material that acts as a layer of tissue to provide a more effective treatment to the superficial lesions. Other uses of boluses are to correct for varying surface contours and to add scattering material around the patient's surface. Materials used as bolus vary from simple water to metal and include various mixtures and compounds. Even with the modernization of the technology for external-beam therapy and the emergence of various commercial boluses, the preparation and utilization of a bolus in clinical radiotherapy remains an art. Considering the varying experiences and practices, this paper briefly summarizes available boluses that have been proposed and are employed in clinical radiotherapy. Although this review is not exhaustive, it provides some initial guidance and answers questions that may arise in clinical practice

Intravenous Tranexamic Acid Bolus plus Infusion Is Not More Effective than a Single Bolus in Primary Hip Arthroplasty: A Randomized Controlled Trial.

Science.gov (United States)

Zufferey, Paul J; Lanoiselée, Julien; Chapelle, Céline; Borisov, Dmitry B; Bien, Jean-Yves; Lambert, Pierre; Philippot, Rémi; Molliex, Serge; Delavenne, Xavier

2017-09-01

Preoperative administration of the antifibrinolytic agent tranexamic acid reduces bleeding in patients undergoing hip arthroplasty. Increased fibrinolytic activity is maintained throughout the first day postoperation. The objective of the study was to determine whether additional perioperative administration of tranexamic acid would further reduce blood loss. This prospective, double-blind, parallel-arm, randomized, superiority study was conducted in 168 patients undergoing unilateral primary hip arthroplasty. Patients received a preoperative intravenous bolus of 1 g of tranexamic acid followed by a continuous infusion of either tranexamic acid 1 g (bolus-plus-infusion group) or placebo (bolus group) for 8 h. The primary outcome was calculated perioperative blood loss up to day 5. Erythrocyte transfusion was implemented according to a restrictive transfusion trigger strategy. The mean perioperative blood loss was 919 ± 338 ml in the bolus-plus-infusion group (84 patients analyzed) and 888 ± 366 ml in the bolus group (83 patients analyzed); mean difference, 30 ml (95% CI, -77 to 137; P = 0.58). Within 6 weeks postsurgery, three patients in each group (3.6%) underwent erythrocyte transfusion and two patients in the bolus group experienced distal deep-vein thrombosis. A meta-analysis combining data from this study with those of five other trials showed no incremental efficacy of additional perioperative administration of tranexamic acid. A preoperative bolus of tranexamic acid, associated with a restrictive transfusion trigger strategy, resulted in low erythrocyte transfusion rates in patients undergoing hip arthroplasty. Supplementary perioperative administration of tranexamic acid did not achieve any further reduction in blood loss.

Accuracy of pencil-beam redefinition algorithm dose calculations in patient-like cylindrical phantoms for bolus electron conformal therapy.

Science.gov (United States)

Carver, Robert L; Hogstrom, Kenneth R; Chu, Connel; Fields, Robert S; Sprunger, Conrad P

2013-07-01

The purpose of this study was to document the improved accuracy of the pencil beam redefinition algorithm (PBRA) compared to the pencil beam algorithm (PBA) for bolus electron conformal therapy using cylindrical patient phantoms based on patient computed tomography (CT) scans of retromolar trigone and nose cancer. PBRA and PBA electron dose calculations were compared with measured dose in retromolar trigone and nose phantoms both with and without bolus. For the bolus treatment plans, a radiation oncologist outlined a planning target volume (PTV) on the central axis slice of the CT scan for each phantom. A bolus was designed using the planning.decimal(®) (p.d) software (.decimal, Inc., Sanford, FL) to conform the 90% dose line to the distal surface of the PTV. Dose measurements were taken with thermoluminescent dosimeters placed into predrilled holes. The Pinnacle(3) (Philips Healthcare, Andover, MD) treatment planning system was used to calculate PBA dose distributions. The PBRA dose distributions were calculated with an in-house C++ program. In order to accurately account for the phantom materials a table correlating CT number to relative electron stopping and scattering powers was compiled and used for both PBA and PBRA dose calculations. Accuracy was determined by comparing differences in measured and calculated dose, as well as distance to agreement for each measurement point. The measured doses had an average precision of 0.9%. For the retromolar trigone phantom, the PBRA dose calculations had an average ± 1σ dose difference (calculated - measured) of -0.65% ± 1.62% without the bolus and -0.20% ± 1.54% with the bolus. The PBA dose calculation had an average dose difference of 0.19% ± 3.27% without the bolus and -0.05% ± 3.14% with the bolus. For the nose phantom, the PBRA dose calculations had an average dose difference of 0.50% ± 3.06% without bolus and -0.18% ± 1.22% with the bolus. The PBA dose calculations had an average dose difference of 0.65% �

Role of physical bolus properties as sensory inputs in the trigger of swallowing.

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Peyron, Marie-Agnès; Gierczynski, Isabelle; Hartmann, Christoph; Loret, Chrystel; Dardevet, Dominique; Martin, Nathalie; Woda, Alain

2011-01-01

Swallowing is triggered when a food bolus being prepared by mastication has reached a defined state. However, although this view is consensual and well supported, the physical properties of the swallowable bolus have been under-researched. We tested the hypothesis that measuring bolus physical changes during the masticatory sequence to deglutition would reveal the bolus properties potentially involved in swallowing initiation. Twenty normo-dentate young adults were instructed to chew portions of cereal and spit out the boluses at different times in the masticatory sequence. The mechanical properties of the collected boluses were measured by a texture profile analysis test currently used in food science. The median particle size of the boluses was evaluated by sieving. In a simultaneous sensory study, twenty-five other subjects expressed their perception of bolus texture dominating at any mastication time. Several physical changes appeared in the food bolus as it was formed during mastication: (1) in rheological terms, bolus hardness rapidly decreased as the masticatory sequence progressed, (2) by contrast, adhesiveness, springiness and cohesiveness regularly increased until the time of swallowing, (3) median particle size, indicating the bolus particle size distribution, decreased mostly during the first third of the masticatory sequence, (4) except for hardness, the rheological changes still appeared in the boluses collected just before swallowing, and (5) physical changes occurred, with sensory stickiness being described by the subjects as a dominant perception of the bolus at the end of mastication. Although these physical and sensory changes progressed in the course of mastication, those observed just before swallowing seem to be involved in swallowing initiation. They can be considered as strong candidates for sensory inputs from the bolus that are probably crucially involved in the triggering of swallowing, since they appeared in boluses prepared in various

Role of physical bolus properties as sensory inputs in the trigger of swallowing.

Directory of Open Access Journals (Sweden)

Marie-Agnès Peyron

Full Text Available BACKGROUND: Swallowing is triggered when a food bolus being prepared by mastication has reached a defined state. However, although this view is consensual and well supported, the physical properties of the swallowable bolus have been under-researched. We tested the hypothesis that measuring bolus physical changes during the masticatory sequence to deglutition would reveal the bolus properties potentially involved in swallowing initiation. METHODS: Twenty normo-dentate young adults were instructed to chew portions of cereal and spit out the boluses at different times in the masticatory sequence. The mechanical properties of the collected boluses were measured by a texture profile analysis test currently used in food science. The median particle size of the boluses was evaluated by sieving. In a simultaneous sensory study, twenty-five other subjects expressed their perception of bolus texture dominating at any mastication time. FINDINGS: Several physical changes appeared in the food bolus as it was formed during mastication: (1 in rheological terms, bolus hardness rapidly decreased as the masticatory sequence progressed, (2 by contrast, adhesiveness, springiness and cohesiveness regularly increased until the time of swallowing, (3 median particle size, indicating the bolus particle size distribution, decreased mostly during the first third of the masticatory sequence, (4 except for hardness, the rheological changes still appeared in the boluses collected just before swallowing, and (5 physical changes occurred, with sensory stickiness being described by the subjects as a dominant perception of the bolus at the end of mastication. CONCLUSIONS: Although these physical and sensory changes progressed in the course of mastication, those observed just before swallowing seem to be involved in swallowing initiation. They can be considered as strong candidates for sensory inputs from the bolus that are probably crucially involved in the triggering of

Comparison of Intermittent and Bolus Enteral Feeding Methods on Enteral Feeding Intolerance of Patients with Sepsis: A Triple-blind Controlled Trial in Intensive Care Units.

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Nasiri, Morteza; Farsi, Zahra; Ahangari, Mojtaba; Dadgari, Fahimeh

2017-10-01

BACKGROUND Recent trials have shown controversial results on which enteral feeding methods has a lower risk of enteral feeding intolerance. Therefore, we aimed to compare two methods of bolus and intermittent feeding on enteral feeding intolerance of patients with sepsis. METHODS This triple-blind randomized controlled trial was conducted on 60 patients with sepsis, who were fed through tubes for at least 3 days. The patients were randomly assigned into bolus feeding, intermittent feeding, and control groups. Enteral feeding intolerance of all patients was recorded in 3 consecutive days by a researcher-made checklist including the data on gastric residual volume, vomiting, diarrhea, constipation, and abdominal distension. RESULTS There were no significant differences between the three studied groups in none of the intervention days pertaining to constipation, diarrhea, vomiting, abdominal distention, and gastric residual volume ( p > 0.05). Also, no statistically significant difference was found between all variables in the three studied groups during the 3 days ( p > 0.05). CONCLUSION As enteral feeding intolerance of patients with sepsis was similar in both bolus and intermittent feeding methods, it can be concluded that bolus method can still be used as a standard method to decrease the risk of enteral feeding intolerance if it is used properly.

INFLUENCE OF AGE ON SWALLOWS OF A HIGHLY VISCOUS LIQUID BOLUS

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Weslania Viviane NASCIMENTO

2015-03-01

Full Text Available Background Swallow function has a decline with aging, mainly in those over 80 years old. In the population over 69 years, about 11% of subjects reported symptoms indicative of significant dysphagia. Objectives Our objective was to evaluate the hypothesis that older asymptomatic subjects before 80 years old have compensations to sustain a safe and efficient swallow, at least with swallows of liquid bolus. Methods We performed videofluoroscopic evaluation of swallows in 55 normal volunteers, a younger group with 33 subjects (16 men and 17 women aged 19 to 55 years, mean 35.5±9.8 years, and an older group with 22 subjects (15 men and 7 women aged 56 to 77 years, mean 64.8±6.8 years. The subjects swallowed in duplicate 5 mL and 10 mL of liquid barium with a pH of 7.9, density of 1.82 g/cm3, and viscosity of 895 cp. Results The mean duration of pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were longer in the younger group compared with the older group. The relation between pharyngeal clearance duration and hyoid movement duration was similar in younger and older subjects, for 5 mL and 10 mL bolus volumes. Conclusions On average, a highly viscous liquid bolus crosses the pharynx faster in older subjects (56-77 years old than in younger subjects (19-55 years old, which suggested an adaptation to the aging process to maintain a safe swallow.

Bolus obstruction by Ascaris lumbricoides | Wynne | South African ...

African Journals Online (AJOL)

Bolus obstruction by Ascaris lumbricoides. J.M. Wynne, B.A.H. Ellman. Abstract. Seventy-three cases of obstruction due to a bolus of Ascaris worms are reviewed, The diagnosis was made on the basis either of a characteristic palpable mass or a characteristic radiographic appearance. In 67 cases conservative treatment ...

Solid bolus swallowing in the radiologic evaluation of dysphagia

International Nuclear Information System (INIS)

Westen, D. van; Ekberg, O.

1993-01-01

Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is ususally not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important. (orig.)

Solid bolus swallowing in the radiologic evaluation of dysphagia

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Westen, D. van (Dept. of Diagnostic Radiology, Malmoe General Hospital, Univ. Lund (Sweden)); Ekberg, O. (Dept. of Diagnostic Radiology, Malmoe General Hospital, Univ. Lund (Sweden))

1993-07-01

Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is ususally not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important. (orig.).

Safety and efficacy of Bolus administration of magnesium sulphate ...

African Journals Online (AJOL)

Safety and efficacy of Bolus administration of magnesium sulphate for preeclampsia. ... On-going research is addressing its administration in terms of dosage, duration and safety. Objective: We evaluated a ... Keywords: safety, efficacy, bolus magnesium sulphate, preeclampsia, University of Benin Teaching Hospital

Care-bolus tracking systems in multislice-helical computed tomography - a new method in the screening of cardiovascular failure?

International Nuclear Information System (INIS)

Stueckle, C.A.; Kickuth, R.; Kirchner, E.M.; Liermann, D.; Kirchner, J.

2002-01-01

Purpose. Recently bolus tracking systems were developed to improve the timing of intravenous contrast media application in helical computed tomography. We investigated the benefit of this new method as a parameter of the cardiac function.Material and methods. Retrospective analysis of 64 patients which incidentally underwent bolus triggered contrast enhanced helical CT and invasive investigation of the heart within one week. All examinations were performed on the CT scanner Somatom Plus 4 Volume Zoom (Siemens Corp., Forchheim, Germany) using the C.A.R.E. trademark Bolus software. This performs repetitive low- dose test scans (e.g. for the abdomen: 140 kV, 20 mA, TI 0,5 s) and measures the Hounsfield attenuation (increase over the baseline) in a preselected region of interest. The displayed increase of vascular density over the time after peripheral contrast media injection (75 ml Iopromid (300 mg/ml), 2 ml/s) was categorised to three types: (a) rapid increase, (b) deceleration before a 100 HE threshold was reached and (c) one or more peaks. The findings of the invasive investigation of the heart were correlated to the findings of the bolus-tracking measurements.Results. The examinations were categorized as follows: 19 type A, 34 type B, 11 type C. We found a high significant correlation between the type of the Hounsfield attenuation and systolic pressure in the left ventricle. There was no correlation between the type of the Hounsfield attenuation and the diastolic pressure in the left ventricle, the pressures related to the right ventricle or the ejection fraction. The bolus- tacking system showed a sensitivity of 53, a specificity of 82, an accuracy of 70%, a positive predictive value of 70% and a negative predictive value of 70% in detection of left heart failure.Conclusion. The bolus tracking system C.A.R.E.-bolus copyright often shows atypical Hounsfield attenuation in cases of cardiac failure but is not suitable as a screening method of the cardiopulmonary

Differential Response Pattern of Oropharyngeal Pressure by Bolus and Dry Swallows.

Science.gov (United States)

Hasegawa, Mana; Kurose, Masayuki; Okamoto, Keiichiro; Yamada, Yoshiaki; Tsujimura, Takanori; Inoue, Makoto; Sato, Taisuke; Narumi, Takatsune; Fujii, Noritaka; Yamamura, Kensuke

2018-02-01

The aim of this study was to determine if bolus and dry swallow showed similar pressure changes in the oropharynx using our newly developed device. A unique character of it includes that baropressure can be measured with the sensor being placed in the balloon and can assess the swallowing mechanics in terms of pressure changes in the oropharynx with less influences of direct contacts of boluses and oropharyngeal structures during swallow indirectly. Fifteen healthy subjects swallowed saliva (dry), 15 ml of water, 45 ml of water, and 15 ml of two different types of food in terms of viscosity (potage soup-type and mayonnaise-type foods). Suprahyoid muscle activity was recorded simultaneously. Three parameters, area under the curve (AUC), peak amplitude, and duration of pressure, were analyzed from each swallow. Almost all of the bolus swallowing events had biphasic baropressure responses consisting of an early phase and late phase (99%), whereas 90% of the saliva swallowing events had a single phase. AUC, peak, and duration displayed greater effects during the late phase than during the early phase. Baropressure of the early phase, but not of the late phase, significantly increased with increasing volume; however, small but significant viscosity effects on pressure were seen during both phases. Peak pressure of the late phase was preceded by maximum muscle activity, whereas that of the early phase was seen when muscle activity displayed a peak response. These findings indicated that our device with the ability to measure baropressure has the potential to provide additional parameter to assess the swallow physiology, and biphasic baropressure responses in the early and late phases could reflect functional aspects of the swallowing reflexes.

Association between swallow perception and esophageal bolus clearance in patients with globus sensation.

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Chen, Chien-Lin; Yi, Chih-Hsun; Liu, Tso-Tsai

2013-04-01

Globus sensation is common, but its pathogenesis is not yet clear. Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation. Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1. Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.

Application of dual volume reconstruction technique in embolization of intracranial aneurysms

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Xiang-hai ZHANG

2014-03-01

Full Text Available Objective　To explore the value of dual volume reconstruction technique in Guglielmi detachable coil (GDC embolization of intracranial aneurysms. Methods　Three-dimensional imaging data of 20 patients received GDC embolization of intracranial aneurysms from Jun. 2012 to Apr. 2013 were analyzed for dual volume reconstruction. The value of application of dual volume reconstruction was evaluated by the detection rate of coils bolus, degree of aneurysm occlusion, the length of aneurysm sac and aneurysm neck before and after embolization, and the characteristics and clinical value of the reconstructed images. Results 　A total of 20 coil boluses were detected by dual volume reconstruction images, and the detection rate was 100%. Among all of 20 patients, no visualization of contrast medium in the aneurysm was found in 13 patients, while contrast agent was found in the aneurysm sac in 3 patients and in the aneurysm neck in 4 patients. The length of aneurysm neck and sac was somewhat changed before and after embolization with no statistically significant difference (P>0.05. The dual volume reconstruction could reveal coil bolus, vessels, cranium and fusion images, and the aneurysms could be shown by different imaging modes according to the clinical requirement. Conclusion　Dual volume reconstruction technique can display the location of coil bolus, degree of occlusion and aneurysm size, and evaluate the embolization effect by multifarious imaging modes, providing a great deal of information for the evaluation of GDC embolization of intracranial aneurysm. DOI: 10.11855/j.issn.0577-7402.2014.02.13

Bolus obstruction by Ascaris lumbricoides

African Journals Online (AJOL)

In 67 cases conservative treatment was successful. ... bolus of worms, biliary ascariasis,3.6 pancreatitis and acute ... or chronic granulomatous peritonitis is rare.i These complica- ... obstruction admitted to the paediatric surgical wards of the.

Efficacy of a Targeted Drug Delivery on-Demand Bolus Option for Chronic Pain.

Science.gov (United States)

Bolash, Robert B; Niazi, Tariq; Kumari, Meera; Azer, Gerges; Mekhail, Nagy

2018-03-01

Intrathecal targeted drug delivery systems historically required physician office visits for dose adjustment to manage fluctuating pain. A wireless device now enables patients to supplement their basal intrathecal infusion with a programmed on-demand bolus dose. We sought to quantify the change in oral breakthrough opioid need associated with the use of an intrathecal bolus in comparison to those treated with the basal infusion alone. Demographic, dosage, bolus usage and longevity data were extracted from the historical medical record of 69 patients (18/51 bolus/nonbolus) followed continuously at our center. Medication consumption and Pain Disability Index measures were obtained at baseline and most recent follow-up. Among patients with the bolus option, only 2 (11%; confidence interval [CI] 0% to 26%) continued to require oral opiates to manage breakthrough pain compared to 29 (57%; CI 43% to 71%) without the bolus option. The Pain Disability Index score decreased by 19% in patients with the bolus option and by 25% in those with the basal infusion. Total daily intrathecal opioid intake was 34% lower in the group with the bolus device. Utilizing an intrathecal bolus to treat incident pain was a safe way to manage unpredictable breakthrough pain and may represent a cost-saving opportunity by eliminating the need for oral analgesic medications. © 2017 World Institute of Pain.

The predictive ability of six pharmacokinetic models of rocuronium developed using a single bolus: evaluation with bolus and continuous infusion regimen.

Science.gov (United States)

Sasakawa, Tomoki; Masui, Kenichi; Kazama, Tomiei; Iwasaki, Hiroshi

2016-08-01

Rocuronium concentration prediction using pharmacokinetic (PK) models would be useful for controlling rocuronium effects because neuromuscular monitoring throughout anesthesia can be difficult. This study assessed whether six different compartmental PK models developed from data obtained after bolus administration only could predict the measured plasma concentration (Cp) values of rocuronium delivered by bolus followed by continuous infusion. Rocuronium Cp values from 19 healthy subjects who received a bolus dose followed by continuous infusion in a phase III multicenter trial in Japan were used retrospectively as evaluation datasets. Six different compartmental PK models of rocuronium were used to simulate rocuronium Cp time course values, which were compared with measured Cp values. Prediction error (PE) derivatives of median absolute PE (MDAPE), median PE (MDPE), wobble, divergence absolute PE, and divergence PE were used to assess inaccuracy, bias, intra-individual variability, and time-related trends in APE and PE values. MDAPE and MDPE values were acceptable only for the Magorian and Kleijn models. The divergence PE value for the Kleijn model was lower than -10 %/h, indicating unstable prediction over time. The Szenohradszky model had the lowest divergence PE (-2.7 %/h) and wobble (5.4 %) values with negative bias (MDPE = -25.9 %). These three models were developed using the mixed-effects modeling approach. The Magorian model showed the best PE derivatives among the models assessed. A PK model developed from data obtained after single-bolus dosing can predict Cp values during bolus and continuous infusion. Thus, a mixed-effects modeling approach may be preferable in extrapolating such data.

An Adaptive Nonlinear Basal-Bolus Calculator for Patients With Type 1 Diabetes

DEFF Research Database (Denmark)

Boiroux, Dimitri; Aradóttir, Tinna Björk; Nørgaard, Kirsten

2017-01-01

size. Following meal announcements, the meal compartment and the meal time constant are estimated, otherwise insulin sensitivity is estimated. Results : We compare the performance of a conventional linear bolus calculator with the proposed bolus calculator. The proposed basal-bolus calculator......Background : Bolus calculators help patients with type 1 diabetes to mitigate the effect of meals on their blood glucose by administering a large amount of insulin at mealtime. Intraindividual changes in patients physiology and nonlinearity in insulin-glucose dynamics pose a challenge...... glucose monitor (CGM). The basal rate is determined by calculating the steady state of the model and is adjusted once a day before breakfast. The bolus size is determined by optimizing the postprandial glucose values based on an estimate of the insulin sensitivity and states, as well as the announced meal...

The influence of a solid and liquid bolus on food-stimulated gastroesophageal reflux

Energy Technology Data Exchange (ETDEWEB)

Naeser, A.; Behrens, J.K.; Vejen-Christiansen, L.; Funch-Jensen, P.; Thommesen, P. (Aarhus Kommunehospital (Denmark). GI Motility Lab. Aarhus Kommunehospital (Denmark). Dept. of Diagnostic Radiology R)

1992-02-01

Using a radiological method to demonstrate food-stimulated gastroesophageal reflux (GER), a comparative study was carried out employing a solid, already validated bolus versus a liquid one. One hundred and four consecutive patients received both a solid and a liquid bolus in randomized order. GER was observed in 37 (35.6%) patients receiving the solid bolus versus 28 (26.9%) with the liquid one. This means that the solid bolus provokes significantly more reflux (P<0.02). GER, grade II (reflux above the level of the carina), occurred equally often as a result of both types of bolus, however. The study suggests that significant, food-stimulated GER is independent of the consistency of the foodstuffs and may be detected employing a liquid bolus. This result might be used in the examination of infants for GER, using milk as a food stimulus. (orig.).

Gray and white matter volume abnormalities in monozygotic and same-gender dizygotic twins discordant for schizophrenia

DEFF Research Database (Denmark)

Hilshoff, Hilleke E.; Brans, Rachel G. H.; van Haren, Neeltje E. M.

2004-01-01

BACKGROUND: Whole brain tissue volume decreases in schizophrenia have been related to both genetic risk factors and disease-related (possibly nongenetic) factors; however, whether genetic and environmental risk factors in the brains of patients with schizophrenia are differentially reflected...... in gray or white matter volume change is not known. METHODS: Magnetic resonance imaging (1.5 T) brain scans of 11 monozygotic and 11 same-gender dizygotic twin pairs discordant for schizophrenia were acquired and compared with 11 monozygotic and 11 same-gender dizygotic healthy control twin pairs. RESULTS......: Repeated-measures volume analysis of covariance revealed decreased whole brain volume in the patients with schizophrenia as compared with their co-twins and with healthy twin pairs. Decreased white matter volume was found in discordant twin pairs compared with healthy twin pairs, particularly...

The influence of a solid and liquid bolus on food-stimulated gastroesophageal reflux

International Nuclear Information System (INIS)

Naeser, A.; Behrens, J.K.; Vejen-Christiansen, L.; Funch-Jensen, P.; Thommesen, P.; Aarhus Kommunehospital

1992-01-01

Using a radiological method to demonstrate food-stimulated gastroesophageal reflux (GER), a comparative study was carried out employing a solid, already validated bolus versus a liquid one. One hundred and four consecutive patients received both a solid and a liquid bolus in randomized order. GER was observed in 37 (35.6%) patients receiving the solid bolus versus 28 (26.9%) with the liquid one. This means that the solid bolus provokes significantly more reflux (P [de

MO-H-19A-03: Patient Specific Bolus with 3D Printing Technology for Electron Radiotherapy

International Nuclear Information System (INIS)

Zou, W; Swann, B; Siderits, R; McKenna, M; Khan, A; Yue, N; Zhang, M; Fisher, T

2014-01-01

Purpose: Bolus is widely used in electron radiotherapy to achieve desired dose distribution. 3D printing technologies provide clinicians with easy access to fabricate patient specific bolus accommodating patient body surface irregularities and tissue inhomogeneity. This study presents the design and the clinical workflow of 3D printed bolus for patient electron therapy in our clinic. Methods: Patient simulation CT images free of bolus were exported from treatment planning system (TPS) to an in-house developed software package. Bolus with known material properties was designed in the software package and then exported back to the TPS as a structure. Dose calculation was carried out to examine the coverage of the target. After satisfying dose distribution was achieved, the bolus structure was transferred in Standard Tessellation Language (STL) file format for the 3D printer to generate the machine codes for printing. Upon receiving printed bolus, a quick quality assurance was performed with patient resimulated with bolus in place to verify the bolus dosimetric property before treatment started. Results: A patient specific bolus for electron radiotherapy was designed and fabricated in Form 1 3D printer with methacrylate photopolymer resin. Satisfying dose distribution was achieved in patient with bolus setup. Treatment was successfully finished for one patient with the 3D printed bolus. Conclusion: The electron bolus fabrication with 3D printing technology was successfully implemented in clinic practice

MO-H-19A-03: Patient Specific Bolus with 3D Printing Technology for Electron Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Zou, W; Swann, B; Siderits, R; McKenna, M; Khan, A; Yue, N; Zhang, M [Rutgers University, New Brunswick, NJ (United States); Fisher, T [Memorial Medical Center, Modesto, CA (United States)

2014-06-15

Purpose: Bolus is widely used in electron radiotherapy to achieve desired dose distribution. 3D printing technologies provide clinicians with easy access to fabricate patient specific bolus accommodating patient body surface irregularities and tissue inhomogeneity. This study presents the design and the clinical workflow of 3D printed bolus for patient electron therapy in our clinic. Methods: Patient simulation CT images free of bolus were exported from treatment planning system (TPS) to an in-house developed software package. Bolus with known material properties was designed in the software package and then exported back to the TPS as a structure. Dose calculation was carried out to examine the coverage of the target. After satisfying dose distribution was achieved, the bolus structure was transferred in Standard Tessellation Language (STL) file format for the 3D printer to generate the machine codes for printing. Upon receiving printed bolus, a quick quality assurance was performed with patient resimulated with bolus in place to verify the bolus dosimetric property before treatment started. Results: A patient specific bolus for electron radiotherapy was designed and fabricated in Form 1 3D printer with methacrylate photopolymer resin. Satisfying dose distribution was achieved in patient with bolus setup. Treatment was successfully finished for one patient with the 3D printed bolus. Conclusion: The electron bolus fabrication with 3D printing technology was successfully implemented in clinic practice.

5-HTTLPR, anxiety and gender interaction moderates right amygdala volume in healthy subjects.

Science.gov (United States)

Cerasa, Antonio; Quattrone, Aldo; Piras, Fabrizio; Mangone, Graziella; Magariello, Angela; Fagioli, Sabrina; Girardi, Paolo; Muglia, Maria; Caltagirone, Carlo; Spalletta, Gianfranco

2014-10-01

Genetic variants within the serotonin transporter gene (5-HTTLPR) impact the neurobiology and risk for anxiety-related behaviours. There are also gender differences in the prevalence of anxiety-related behaviours. Although numerous studies have investigated the influence of 5-HTTLPR genotype on the neural systems involved in emotional regulation, none have investigated how these effects are modulated by gender and anxiety. We investigated this issue using two complementary region of interest-based structural neuroimaging approaches (voxel-based morphometry and Freesurfer) in 138 healthy individuals categorized into 'no anxiety' and 'subclinical anxiety' groups based on the Hamilton Rating Scale for Anxiety (HAM-A). Preliminarily, using anxiety as a continuous variable, we found a significant interaction effect of genotype by gender on anxiety. Females homozygous for the Short allele showed the highest HAM-A scores and males the lowest. In addition, a three-way significant interaction among genotype, gender and anxiety category was found for the right amygdala volume. Post hoc tests revealed that homozygous females carrying the Short variant with a subclinical anxiety condition had larger volume. The reported interaction effects demonstrate that gender strongly modulates the relationship between 5-HTTLPR genotype and subclinical expression of anxiety acting on amygdala, one region of the emotional neural network specifically involved in the anxiety-like behaviours. © The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain.

Science.gov (United States)

Hoekzema, Elseline; Schagen, Sebastian E E; Kreukels, Baudewijntje P C; Veltman, Dick J; Cohen-Kettenis, Peggy T; Delemarre-van de Waal, Henriette; Bakker, Julie

2015-05-01

The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural gray matter (GM) volumes in 55 female-to-male and 38 male-to-female adolescents, 44 boys and 52 girls without GD and applied both univariate and multivariate analyses. In girls, more GM volume was observed in the left superior medial frontal cortex, while boys had more volume in the bilateral superior posterior hemispheres of the cerebellum and the hypothalamus. Regarding the GD groups, at whole-brain level they differed only from individuals sharing their gender identity but not from their natal sex. Accordingly, using multivariate pattern recognition analyses, the GD groups could more accurately be automatically discriminated from individuals sharing their gender identity than those sharing their natal sex based on spatially distributed GM patterns. However, region of interest analyses indicated less GM volume in the right cerebellum and more volume in the medial frontal cortex in female-to-males in comparison to girls without GD, while male-to-females had less volume in the bilateral cerebellum and hypothalamus than natal boys. Deviations from the natal sex within sexually dimorphic structures were also observed in the untreated subsamples. Our findings thus indicate that GM distribution and regional volumes in GD adolescents are largely in accordance with their respective natal sex. However, there are subtle deviations from the natal sex in sexually dimorphic structures, which can represent signs of a partial sex-atypical differentiation of the brain. Copyright © 2015 Elsevier Ltd. All rights reserved.

Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial.

Science.gov (United States)

Mungroop, Timothy H; van Samkar, Ganapathy; Geerts, Bart F; van Dieren, Susan; Besselink, Marc G; Veelo, Denise P; Lirk, Philipp

2017-01-01

Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32). In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. Netherlands Trial Register NTR4948.

Assessment of myocardial perfusion with MRI using a modified dual bolus method

International Nuclear Information System (INIS)

Husso, M; Sipola, P; Manninen, H; Vainio, P; Kuittinen, T; Hartikainen, J; Saarakkala, S; Töyräs, J; Kuikka, J

2014-01-01

Quantification of regional myocardial blood flow (rMBF) with first-pass magnetic resonance imaging (FP-MRI) requires two contrast agent injections (dual bolus technique), inducing error in the determined rMBF if the injections differ. We hypothesize that using input and residue curves of the same injection would be more reliable. We aim to introduce and evaluate a novel method to correct the high concentration arterial input function (AIF) for determination of rMBF. Sixteen patients with non-Hodgkin's lymphoma were examined before and after chemotherapy. The input function was solved by correcting initial high concentration AIF using the ratio of low and high contrast AIF areas, normalized by corresponding heart rates (modified dual bolus method). For comparison, the scaled low contrast AIF was used as an input function (dual bolus method). Unidirectional transfer coefficient K trans  was calculated using both methods. K trans -values determined with the dual bolus (0.81 ± 0.32 ml g −1  min −1 ) and modified dual bolus (0.77 ± 0.42 ml g −1  min −1 ) methods were in agreement (p = 0.21). Mean K trans -values increased from 0.76 ± 0.43 to 0.89 ± 0.55 ml g −1  min −1  after chemotherapy (p = 0.17). The modified dual bolus technique agrees with the dual bolus technique (R2 = 0.899) when the low and high contrast injections are similar. However, when this is not the case, the modified dual bolus technique may be more reliable. (paper)

Assessment of bolus transit with intraluminal impedance measurement in patients with esophageal motility disorders.

Science.gov (United States)

Bogte, A; Bredenoord, A J; Oors, J; Siersema, P D; Smout, A J P M

2015-10-01

The clinical management of patients with non-obstructive dysphagia is notoriously difficult. Esophageal impedance measurement can be used to measure esophageal bolus transit without the use of radiation exposure to patients. However, validation of measurement of bolus transit with impedance monitoring has only been performed in healthy subjects with normal motility and not in patients with dysphagia and esophageal motility disorders. The aim was, therefore, to investigate the relationship between transit of swallowed liquid boluses in healthy controls and in patients with dysphagia. Twenty healthy volunteers and 20 patients with dysphagia underwent concurrent impedance measurement and videofluoroscopy. Each subject swallowed five liquid barium boluses. The ability of detecting complete or incomplete bolus transit by means of impedance measurement was assessed, using radiographic bolus transit as the gold standard. Impedance monitoring recognized stasis and transit in 80.5% of the events correctly, with 83.9% of bolus transit being recognized and 77.2% of stasis being recognized correctly. In controls 79.8% of all swallows were scored correctly, whereas in patients 81.3% of all swallows were scored correctly. Depending on the contractility pattern, between 77.0% and 94.3% of the swallows were scored correctly. Impedance measurement can be used to assess bolus clearance patterns in healthy subjects, but can also be used to reliably assess bolus transit in patients with dysphagia and motility disorders. © 2015 John Wiley & Sons Ltd.

[Observing the density increase curve after intravenous contrast medium administration using a bolus triggering system: a method for detection cardiovascular disorders?].

Science.gov (United States)

Stückle, C A; Kickuth, R; Kirchner, E M; Liermann, D; Kirchner, J

2002-06-01

Recently bolus tracking systems were developed to improve the timing of intravenous contrast media application in helical computed tomography. We investigated the benefit of this new method as a parameter of the cardiac function. Retrospective analysis of 64 patients which incidentally underwent bolus triggered contrast enhanced helical CT and invasive investigation of the heart within one week. All examinations were performed on the CT scanner Somatom Plus 4 Volume Zoom (Siemens Corp., Forchheim, Germany) using the C.A.R.E. Bolus software. This performs repetitive low-dose test scans (e.g. for the abdomen: 140 kV, 20 mA, Tl 0.5 s) and measures the Hounsfield attenuation (increase over the baseline) in a preselected region of interest. The displayed increase of vascular density over the time after peripheral contrast media injection (75 ml lopromid (300 mg/ml), 2 ml/s) was categorised to three types: (a) rapid increase, (b) deceleration before a 100 HE threshold was reached and (c) one or more peaks. The findings of the invasive investigation of the heart were correlated to the findings of the bolus-tracking measurements. The examinations were categorized as follows: 19 type A, 34 type B, 11 type C. We found a high significant correlation between the type of the Hounsfield attenuation and systolic pressure in the left ventricle. There was no correlation between the type of the Hounsfield attenuation and the diastolic pressure in the left ventricle, the pressures related to the right ventricle or the ejection fraction. The bolus-tacking system showed a sensitivity of 53, a specificity of 82, an accuracy of 70%, a positive predictive value of 70% and a negative predictive value of 70% in detection of left heart failure. The bolus tracking system C.A.R.E.-bolus often shows atypical Hounsfield attenuation in cases of cardiac failure but is not suitable as a screening method of the cardiopulmonary function.

The comparison of bolus tracking and test bolus techniques for computed tomography thoracic angiography in healthy beagles

Directory of Open Access Journals (Sweden)

Nicolette Cassel

2013-05-01

Full Text Available Computed tomography thoracic angiography studies were performed on five adult beagles using the bolus tracking (BT technique and the test bolus (TB technique, which were performed at least two weeks apart. For the BT technique, 2 mL/kg of 300 mgI/mL iodinated contrast agent was injected intravenously. Scans were initiated when the contrast in the aorta reached 150 Hounsfield units (HU. For the TB technique, the dogs received a test dose of 15% of 2 mL/kg of 300 mgI/mL iodinated contrast agent, followed by a series of low dose sequential scans. The full dose of the contrast agent was then administered and the scans were conducted at optimal times as identified from time attenuation curves. Mean attenuation in HU was measured in the aorta (Ao and right caudal pulmonary artery (rCPA. Additional observations included the study duration, milliAmpere (mA, computed tomography dose index volume (CTDI[vol] and dose length product (DLP. The attenuation in the Ao (BT = 660 52 HU ± 138 49 HU, TB = 469 82 HU ± 199 52 HU, p = 0.13 and in the rCPA (BT = 606 34 HU ± 143 37 HU, TB = 413 72 HU ± 174.99 HU, p = 0.28 did not differ significantly between the two techniques. The BT technique was conducted in a significantly shorter time period than the TB technique (p = 0.03. The mean mA for the BT technique was significantly lower than the TB technique (p = 0.03, as was the mean CTDI(vol (p = 0.001. The mean DLP did not differ significantly between the two techniques (p = 0.17. No preference was given to either technique when evaluating the Ao or rCPA but the BT technique was shown to be shorter in duration and resulted in less DLP than the TB technique.

Barium and meat. A comparison between pharyngeal swallow of fluid and solid boluses

Energy Technology Data Exchange (ETDEWEB)

Ekberg, O.; Liedberg, B.; Oewall, B.

The influence of bolus consistency on pharyngeal swallow was radiologically studied in 24 individuals by comparing liquid barium and solid meat after chewing. Pharyngeal function was apparently performed synchronously and symmetrically on both boluses. No definite conclusion about the influence on epiglottic mobility, closure of the laryngeal vestibule and relaxation of the circopharyngeal muscle could be drawn from this study. There was no difference in the elevation of the pharynx and larynx. The transit time for a solid bolus was shorter compared with that of a fluid bous. The transit time for the apex of the bolus was shorter than for the tail. A more marked elevation of the pharynx and larynx was followed by a shorter transit time. The width of the pharyngo-esophageal segment was larger in the transverse than in the sagittal diameter during the passage of the bolus and larger on solid compared with fluid swallow. Our results reflect the ability of pharyngeal swallow to be executed with precision and with few alterations due to variable bolus consistency.

Sensation of stasis is poorly correlated with impaired esophageal bolus transport

NARCIS (Netherlands)

Bogte, A.; Bredenoord, A. J.; Oors, J.; Siersema, P. D.; Smout, A. J. P. M.

2014-01-01

It is common belief that symptoms of patients with non-obstructive dysphagia are the result of impaired bolus clearance in the esophagus, usually caused by esophageal motility disorders. We therefore investigated the relationship between transit of swallowed boluses and the symptom dysphagia. Twenty

Commentary on "Performance of a glucose meter with a built-in automated bolus calculator versus manual bolus calculation in insulin-using subjects".

Science.gov (United States)

Rossetti, Paolo; Vehí, Josep; Revert, Ana; Calm, Remei; Bondia, Jorge

2012-03-01

Since the early 2000s, there has been an exponentially increasing development of new diabetes-applied technology, such as continuous glucose monitoring, bolus calculators, and "smart" pumps, with the expectation of partially overcoming clinical inertia and low patient compliance. However, its long-term efficacy in glucose control has not been unequivocally proven. In this issue of Journal of Diabetes Science and Technology, Sussman and colleagues evaluated a tool for the calculation of the prandial insulin dose. A total of 205 insulin-treated patients were asked to compute a bolus dose in two simulated conditions either manually or with the bolus calculator built into the FreeStyle InsuLinx meter, revealing the high frequency of wrong calculations when performed manually. Although the clinical impact of this study is limited, it highlights the potential implications of low diabetesrelated numeracy in poor glycemic control. Educational programs aiming to increase patients' empowerment and caregivers' knowledge are needed in order to get full benefit of the technology. © 2012 Diabetes Technology Society.

The usefulness of esophagogram with marchmallow bolus in patients with esophageal related symptoms

Energy Technology Data Exchange (ETDEWEB)

Yoon, Sang Wook; Kim, Ki Whang; Park, Hyo Jin; Kim, Eun Kyung; Yu, Jeong Sik; Seo, Jung Kun; Kwon, Ryang; Shin, Hyung Cheol [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1996-03-01

To evaluate the usefulness of the esophagogram using marshmallow bolus in the evaluation of the causes of variable esophageal-related symptoms. Esophagograms using marshmallow bolus were performed on 44 patients with esophageal-related symptoms and on ten normal volunteers. Videofluoroscopic studies were also made. Patients were classified into three groups according to their esophageal-related symptoms ; those with dysphagia, those with globus symptom, and those with chest pain. Abnormal findings on an esophagogram with marshmallow were graded in to three categories ; mild, moderate, and severe. Provocation of the same symptom was also evaluated. Esophageal monometric studies were performed on 16 patients and those results were compared with the results obtained from the esophagogram using marshmallow bolus. The provocation rate of the some symptom was 33% in the first group, 47% in the second, and 24% in the third. The provocation rate was highest in the second group. The provocation rate was also higher in patients with a severe degree of abnormality on an esophagogram using marshmallow bolus. Where there were abnormal findings, an esophagogram using marshmallow bolus showed a higher abnormality rate than did a conventional esophagogram. In cases showing abnormal finding son the esophageal monometric study, an esophagogram using marshmallow bolus showed a higher provocation rate and more severe abnormality than in cases showing normal findings on manometric study. An esophagogram using marshmallow bolus will a useful radiologic screening modality for the evaluation of patients with esophageal-related symptoms.

The usefulness of esophagogram with marchmallow bolus in patients with esophageal related symptoms

International Nuclear Information System (INIS)

Yoon, Sang Wook; Kim, Ki Whang; Park, Hyo Jin; Kim, Eun Kyung; Yu, Jeong Sik; Seo, Jung Kun; Kwon, Ryang; Shin, Hyung Cheol

1996-01-01

To evaluate the usefulness of the esophagogram using marshmallow bolus in the evaluation of the causes of variable esophageal-related symptoms. Esophagograms using marshmallow bolus were performed on 44 patients with esophageal-related symptoms and on ten normal volunteers. Videofluoroscopic studies were also made. Patients were classified into three groups according to their esophageal-related symptoms ; those with dysphagia, those with globus symptom, and those with chest pain. Abnormal findings on an esophagogram with marshmallow were graded in to three categories ; mild, moderate, and severe. Provocation of the same symptom was also evaluated. Esophageal monometric studies were performed on 16 patients and those results were compared with the results obtained from the esophagogram using marshmallow bolus. The provocation rate of the some symptom was 33% in the first group, 47% in the second, and 24% in the third. The provocation rate was highest in the second group. The provocation rate was also higher in patients with a severe degree of abnormality on an esophagogram using marshmallow bolus. Where there were abnormal findings, an esophagogram using marshmallow bolus showed a higher abnormality rate than did a conventional esophagogram. In cases showing abnormal finding son the esophageal monometric study, an esophagogram using marshmallow bolus showed a higher provocation rate and more severe abnormality than in cases showing normal findings on manometric study. An esophagogram using marshmallow bolus will a useful radiologic screening modality for the evaluation of patients with esophageal-related symptoms

Feasibility of low contrast media volume in CT angiography of the aorta

International Nuclear Information System (INIS)

Seehofnerová, Anna; Kok, Madeleine; Mihl, Casper; Douwes, Dave; Sailer, Anni; Nijssen, Estelle; Haan, Michiel J.W. de; Wildberger, Joachim E.; Das, Marco

2015-01-01

Using smaller volumes of contrast media (CM) in CT angiography (CTA) is desirable in terms of cost reduction and prevention of contrast-induced nephropathy (CIN). The purpose was to evaluate the feasibility of low CM volume in CTA of the aorta. 77 patients referred for CTA of the aorta were scanned using a standard MDCT protocol at 100 kV. A bolus of 50 ml CM (Iopromide 300 mg Iodine/ml) at a flow rate of 6 ml/s was applied (Iodine delivery rate IDR = 1.8 g/s; Iodine load 15 g) followed by a saline bolus of 40 ml at the same flow rate. Scan delay was determined by the test bolus method. Subjective image quality was assessed and contrast enhancement was measured at 10 anatomical levels of the aorta. Diagnostic quality images were obtained for all patients, reaching a mean overall contrast enhancement of 324 ± 28 HU. Mean attenuation was 350 ± 60 HU at the thoracic aorta and 315 ± 83 HU at the abdominal aorta. A straightforward low volume CM protocol proved to be technically feasible and led to CTA examinations reaching diagnostic image quality of the aorta at 100 kV. Based on these findings, the use of a relatively small CM bolus can be incorporated into routine clinical imaging

Assessment of injection bolus in first-pass radionuclide angiography. Evaluation of injection site and needle size

International Nuclear Information System (INIS)

Tonami, Syuichi; Inagaki, Syoichi; Yasui, Masakazu; Sugishita, Kouki; Yoshita, Hisashi; Nakamura, Mamoru; Kuranishi, Makoto

1996-01-01

First-pass radionuclide angiography (FPRNA) using a multi-crystal gamma camera can correctly provide many quantitative and qualitative indices of left ventricular function as well as anatomic information. A compact injection bolus of radiotracer is, however, essential to the first-pass study since the temporal separation of cardiac chambers is required for the first-pass acquisition. To examine which factors affect the quality of an injection bolus, 327 patients who had FPRNA in the anterior projection were randomized for injection site of radiotracer (right or left external jugular veins, and right antecubital vein) and needle size (19- or 21-gauge). The injected bolus was assessed from the full width at half maximum (FWHM) of the bolus time-activity curve in the superior vena cava. As to injection site using a 19-gauge needle, an attemption through right external jugular vein (EJV) revealed the shortest FWHM of an injection bolus, followed by left EJV and right antecubital vein (AV). In right EJV 91% of injected bolus FWHM was less than 1.5 sec, which was significantly higher (p<0.001) than those of the other sites (left EJV: 70%. right AV: 65%). Approximately 7% of injection from left EJV and right AV, showed a split bolus of radiotracer. However, no split bolus was observed from right EJV. There was no significant difference in FWHM of an injection bolus between 19- and 21-gauge needle from EJV. Our present study demonstrated that the quality of an injection bolus from left EJV and AV was affected by RVEF in a case of low right ventricular function. In conclusion, right EJV is the first choice of injection site to obtain a compact bolus of radiotracer for the first-pass cardiac study. A 21-gauge needle can also be inserted from the external jugular vein to perform a good bolus injection. (author)

Assessment of injection bolus in first-pass radionuclide angiography. Evaluation of injection site and needle size

Energy Technology Data Exchange (ETDEWEB)

Tonami, Syuichi; Inagaki, Syoichi; Yasui, Masakazu; Sugishita, Kouki; Yoshita, Hisashi; Nakamura, Mamoru; Kuranishi, Makoto [Toyama Medical and Pharmaceutical Univ. (Japan). Hospital

1996-09-01

First-pass radionuclide angiography (FPRNA) using a multi-crystal gamma camera can correctly provide many quantitative and qualitative indices of left ventricular function as well as anatomic information. A compact injection bolus of radiotracer is, however, essential to the first-pass study since the temporal separation of cardiac chambers is required for the first-pass acquisition. To examine which factors affect the quality of an injection bolus, 327 patients who had FPRNA in the anterior projection were randomized for injection site of radiotracer (right or left external jugular veins, and right antecubital vein) and needle size (19- or 21-gauge). The injected bolus was assessed from the full width at half maximum (FWHM) of the bolus time-activity curve in the superior vena cava. As to injection site using a 19-gauge needle, an attemption through right external jugular vein (EJV) revealed the shortest FWHM of an injection bolus, followed by left EJV and right antecubital vein (AV). In right EJV 91% of injected bolus FWHM was less than 1.5 sec, which was significantly higher (p<0.001) than those of the other sites (left EJV: 70%. right AV: 65%). Approximately 7% of injection from left EJV and right AV, showed a split bolus of radiotracer. However, no split bolus was observed from right EJV. There was no significant difference in FWHM of an injection bolus between 19- and 21-gauge needle from EJV. Our present study demonstrated that the quality of an injection bolus from left EJV and AV was affected by RVEF in a case of low right ventricular function. In conclusion, right EJV is the first choice of injection site to obtain a compact bolus of radiotracer for the first-pass cardiac study. A 21-gauge needle can also be inserted from the external jugular vein to perform a good bolus injection. (author)

The use of Coca-Cola in the management of bolus obstruction in benign oesophageal stricture.

Science.gov (United States)

Karanjia, N. D.; Rees, M.

1993-01-01

Oesophageal stricture is a complication of oesophageal reflux and may itself be complicated by bolus obstruction. We reviewed the records of patients presenting with dysphagia and who were found to have benign oesophageal strictures. We studied the outcome of bolus obstruction in 13 episodes affecting eight patients. In six episodes Coca-Cola was administered on the day before endoscopy, and in all these patients the bolus had cleared. In seven episodes nothing was administered before endoscopy, and in all seven a bolus was evident at endoscopy. In five of these seven the bolus was removed piecemeal and in each of these instances the endoscope had to be passed between two and five times. In the remaining two instances the procedure was abandoned and the patients returned to the ward for the administration of Coca-Cola. At subsequent endoscopy these patients were found to be clear of any bolus. These results suggest that the administration of Coca-Cola (or other aerated drinks) may clear a bolus in the acutely obstructed oesophagus. PMID:8476194

Oral declines and mastication deficiencies cause alteration of food bolus properties.

Science.gov (United States)

Peyron, M-A; Santé-Lhoutellier, V; François, O; Hennequin, M

2018-02-21

In the elderly, masticatory function often presents failure in certain oral tasks due to impairment such as decline in muscular force, jaw or tongue motility, neuro-muscular coordination, tooth damage, malocclusion and saliva production. Great disparity is observed in the various and potentially cumulative oral declines that occur with ageing. Such difficulties may have an impact on food consumption and nutritional status. To obtain better understanding of the consequences of several oral deficiencies, a series of swallowable boluses were prepared in vitro with the AM 2 masticator apparatus with normal and deficient programming. Physiological normal mastication (NM) was simulated using in vivo data from healthy subjects. Chewing deficiencies were reproduced by alteration of NM programming to perform different levels and combinations of force loss, lack of saliva and decrease in the motility of oral elements. Poultry meatballs were used as test-food. Particle size distribution in the food bolus was measured by sieving and rheological features (hardness, cohesiveness and elasticity) were assessed with a TPA test. Compared to the NM outcome, significant and gradual deterioration of the food bolus was observed and associated with alteration in force, saliva and motility. Combinations of several failures led to greater or cumulative deficiencies in swallowable bolus properties. For the elderly presenting a high prevalence of various oral injuries, tailoring textured food cannot be ignored as a solution for remedying deficiencies and favoring the formation of a safe-swallowable bolus, which is an essential vector of nutrients. Knowing the impacts of oral injuries on the food bolus is obviously a requisite for developing diet strategies, including nutritional items for specific populations.

Endoleak detection using single-acquisition split-bolus dual-energy computer tomography (DECT)

Energy Technology Data Exchange (ETDEWEB)

Javor, D.; Wressnegger, A.; Unterhumer, S.; Kollndorfer, K.; Nolz, R.; Beitzke, D.; Loewe, C. [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

2017-04-15

To assess a single-phase, dual-energy computed tomography (DECT) with a split-bolus technique and reconstruction of virtual non-enhanced images for the detection of endoleaks after endovascular aneurysm repair (EVAR). Fifty patients referred for routine follow-up post-EVAR CT and a history of at least one post-EVAR follow-up CT examination using our standard biphasic (arterial and venous phase) routine protocol (which was used as the reference standard) were included in this prospective trial. An in-patient comparison and an analysis of the split-bolus protocol and the previously used double-phase protocol were performed with regard to differences in diagnostic accuracy, radiation dose, and image quality. The analysis showed a significant reduction of radiation dose of up to 42 %, using the single-acquisition split-bolus protocol, while maintaining a comparable diagnostic accuracy (primary endoleak detection rate of 96 %). Image quality between the two protocols was comparable and only slightly inferior for the split-bolus scan (2.5 vs. 2.4). Using the single-acquisition, split-bolus approach allows for a significant dose reduction while maintaining high image quality, resulting in effective endoleak identification. (orig.)

Rapid contrast infusion of bolus injection for i.v. urography

International Nuclear Information System (INIS)

Kaltenborn, H.; Klose, P.; Klose, K.; Schmiedel, E.

1993-01-01

The rate of contrast injection during i.v. urography may vary considerably (bolus injection or drip infusion). The effect of 5 rates of injection (6, 12, 18, 36 and 72 ml/min) on the contrast density in the renal collecting system was examined over a period of 30 minutes. Measurements showed an inter-individual difference of more than 200% in each group. The intra-individual variations for different rates of injection were very slight; individual concentration in the kidney for a given dose depends only slightly on the rate of injection. There is no statistically significant improvement in contrast values as a result of a bolus injection. The reduced incidence of side effects justifies the use of bolus injections but pressure injections are unnecessary from a diagnostic point view. (orig.) [de

A Bolus Calculator Based on Continuous-Discrete Unscented Kalman Filtering for Type 1 Diabetics

DEFF Research Database (Denmark)

Boiroux, Dimitri; Aradóttir, Tinna Björk; Hagdrup, Morten

2015-01-01

both reduces the risk of hypoglycemia in case of an overestimated meal and the time spent in hyperglycemia if the meal size is underestimated. Faster insulin and the use of glucagon will have the potential to encourage postprandial meal bolus administration and hence will not require to accurately......In patients with type 1 diabetes, the effects of meals intake on blood glucose level are usually mitigated by administering a large amount of insulin (bolus) at mealtime or even slightly before. This strategy assumes, among other things, a prior knowledge of the meal size and the postprandial...... glucose dynamics. On the other hand, administering the meal bolus during or after mealtime could benefit from the information provided by the postprandial meal dynamics at the expense of a delayed meal bolus. The present paper investigates different bolus administration strategies (at mealtime, 15 minutes...

Three-dimensional printer-aided casting of soft, custom silicone boluses (SCSBs) for head and neck radiation therapy.

Science.gov (United States)

Chiu, Tsuicheng; Tan, Jun; Brenner, Mathew; Gu, Xuejun; Yang, Ming; Westover, Kenneth; Strom, Tobin; Sher, David; Jiang, Steve; Zhao, Bo

Custom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy, but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiation therapy. We developed a method using 3-dimensional printed parts for generating SCSBs for the treatment of HN cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on an HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of 7 HN patients with lesions at nose, cheek, eye, or ears. In vivo dose measurements with optically simulated luminescence dosimeters were performed. Total design and fabrication time from patient simulation to radiation treatment start required approximately 1 week, with fabrication constituting 1 to 2 working days depending on bolus surface area, volume, and complexity. Computed tomography and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on 7 treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3-dimensional printing technology. All treated patients tolerated SCSBs for the duration of therapy. Generation and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

21 CFR 520.1242b - Levamisole hydrochloride tablet or oblet (bolus).

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Levamisole hydrochloride tablet or oblet (bolus... § 520.1242b Levamisole hydrochloride tablet or oblet (bolus). (a) Chemical name. (-)-2,3,5,6-Tetrahydro... using in severely debilitated animals. (2) It is used in a tablet for sheep as follows: (i) Amount. 0...

Contrast agent bolus tracking with a fixed threshold or a manual fast start for coronary CT angiography

Energy Technology Data Exchange (ETDEWEB)

Stenzel, Fabian; Rief, Matthias; Zimmermann, Elke; Greupner, Johannes; Richter, Felicitas; Dewey, Marc [Charite - Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany)

2014-06-15

Comparison of bolus tracking with a fixed threshold versus a manual fast start for coronary CT angiography. We retrospectively analysed 320-row coronary CT angiography of 50 patients with suspected or known coronary artery disease. Twenty-five examinations were initiated by a bolus tracking method (group 1), 25 examinations with a manual fast surestart (group 2). Mean attenuation values in the ascending aorta were 519 ± 111 Hounsfield units (HU) in group 1 and 476 ± 65 HU in group 2 (p = 0.10). Assessable vessel lengths were 171 ± 44 mm vs 172 ± 29 mm for the right coronary artery (p = 0.91), 11 ± 4 mm vs 12 ± 4 mm for the left main (p = 0.9), 163 ± 28 mm vs 151 ± 26 mm for the left anterior descending coronary artery (p = 0.11) and 125 ± 41 mm vs 110 ± 37 mm for the left circumflex coronary artery (p = 0.18). Image quality for all coronary arteries was not significantly different between the groups (p > 0.41). The attenuation ratio between the left and right ventricle was 2.8 ± 0.7 vs 3.6 ± 1.0 (p = 0.003). Significantly less contrast agent was used in group 2 (64 ± 6 ml vs 80 ± 0 ml; p < 0.001). Bolus tracking with a fixed threshold and with a manual fast start are both suitable methods; the fast start allowed a reduction of contrast agent volumes. (orig.)

Effect of chest wall radiotherapy in different manners using tissue equivalent bolus on skin and lung of cavia cobayas

International Nuclear Information System (INIS)

Huang Wei; Qu Yaqin; Song Xiangfu; Liu Shixin; Jia Xiaojing; Guo He; Yang Lei

2009-01-01

Objective: To probe the influence of electron beam radiotherapy in different manners using different tissue equivalent boluses on skin and lung. Methods: Adult female cavia cobayas were randomly divided into four groups as control group, half-time with bolus group, half-time with bolus group and without bolus group. Acute-irradiation animal models were established using electron beam in different manners with or without 0.5 cm tissue equivalent bolus. Pathological changes in lung, hair vesicle and fibroblast cell count were analyzed 40 clays after irradiation. Results: The radiation dermatitis in the group with bolus was slighter than that of the group without bolus, but the radiation pneumonia was reverse. With bolus, the radiation dermatitis of haft-time group was slighter than that of full-time group. The injury repair of half-time group was more active than full-time group. Conclusions: The treatment of haft-time bolus could protect lung without serious skin complications. (authors)

The Consideration of Bolus Effects of Games Attached on Lesion area

International Nuclear Information System (INIS)

Park, Ju Young; Ju, Sang Kyu; Park, Young Chul; Han, Young Yi; Shin, Eun Hyuk; Park, Yong Hwan

2004-01-01

The aim of this study is to evaluate the effect of skin dose and PDD by using wounds protecting gauzes or Vaselinespread gauzes. And it was studied that the possibility to substitute custom bolus into gauzes. 4 MV photon (CL600C, varian, US), Polystyrene Phantom (30(W) X 30(L) X 30(H)) with Markus chamber(PTW, US) were used for dose measurement. This study was distinguished natural gauzes and spread over Vaseline gauzes. We gave variety to the gauze thickness at 5, 10 and 15 sheets respectively. For comparison between using bolus and not that, we had used 1.0 cm thickness bolus so that analyzed surface dose and PDD at the same conditions above mentioned. When maximum point was defined as reference point, surface dose was measured as 35% in open beam. When the gauzes were attached to surface as 5, 10 and 15 sheets, surface dose were increased as 69, 80 and 91% respectively according to thickness of gauzes. When spread over Vaseline gauzes were attached to surface as 5, 10 and 15 sheets, surface dose were increased respectively as 98, 100 and 98% according to thickness of gauzes. Also when 0.5 cm bolus and 5 sheets gauzes were composed, surface dose was measured as 98%. The gauzes that were attached to skin surface in radiation therapy had been scattering material and contributed increasing surface dose without variation of percentage depth dose. However, if we want to delivery much dose to skin surface then we have to apply many sheets of gauzes to skin surface. Although we get easy that result by bolus or spread over Vaseline gauzes, we have to revise percentage depth dose at calculation. Therefore, if we find pertinent conditions based on measured data that are considered skin dose and patient setup efficiency, to replace custom bolus with gauzes will be helpful to efficient treatment.

Precision flow-controlled Rb-82 generator for bolus or constant-infusion studies of the heart and brain

International Nuclear Information System (INIS)

Yano, Y.; Cahoon, J.L.; Budinger, T.F.

1981-01-01

A precision flow-controlled rubidium-82 generator has been constructed to deliver 76-sec Rb-82 at either fast or slow flow rates for bolus or constant-infusion studies. A stepping motor drive is interfaced to a microprocessor for pulsed control of flow rate to deliver the saline eluant solution from a large-volume (150 ml) machined pumping syringe through an alumina column that retains the 25-day Sr-82 parent. The generator system delivers 70-90% of the maximum Rb-82 activity in a 20-25 ml bolus elution of 2% NaCl. The Sr-82/Sr-85 breakthrough is 10 -7 - 10 -6 . Both yield and breakthrough are functions of column length and flow rate. Six separate Sr-82 loadings of the generator were evaluated over a period of nearly 2 yr in studies of myocardial blood perfusion and permeability changes in the blood-brain barrier. Sterility and apyrogenicity of the Rb-82 eluate were maintained during multiple elutions and long-term use of 3-4 mo for each generator loading

SU-C-213-05: Evaluation of a Composite Copper-Plastic Material for a 3D Printed Radiation Therapy Bolus

International Nuclear Information System (INIS)

Vitzthum, L; Ehler, E; Sterling, D; Reynolds, T; Higgins, P; Dusenbery, K

2015-01-01

Purpose: To evaluate a novel 3D printed bolus fabricated from a copper-plastic composite as a thin flexible, custom fitting device that can replicate doses achieved with conventional bolus techniques. Methods: Two models of bolus were created on a 3D printer using a composite copper-PLA/PHA. Firstly, boluses were constructed at thicknesses of 0.4, 0.6 and 0.8 mm. Relative dose measurements were performed under the bolus with an Attix Chamber as well as with radiochromic film. Results were compared to superficial Attix Chamber measurements in a water equivalent material to determine the dosimetric water equivalence of the copper-PLA/PHA plastic. Secondly, CT images of a RANDO phantom were used to create a custom fitting bolus across the anterolateral scalp. Surface dose with the bolus placed on the RANDO phantom was measured with radiochromic film at tangential angles with 6, 10, 10 flattening filter free (FFF) and 18 MV photon beams. Results: Mean surface doses for 6, 10, 10FFF and 18 MV were measured as a percent of Dmax for the flat bolus devices of each thickness. The 0.4 mm thickness bolus was determined to be near equivalent to 2.5 mm depth in water for all four energies. Surface doses ranged from 59–63% without bolus and 85–90% with the custom 0.4 mm copper-plastic bolus relative to the prescribed dose for an oblique tangential beam arrangement on the RANDO phantom. Conclusion: Sub-millimeter thickness, 3D printed composite copper-PLA/PHA bolus can provide a build-up effect equivalent to conventional bolus. At this thickness, the 3D printed bolus allows a level of flexure that may provide more patient comfort than current 3D printing materials used in bolus fabrication while still retaining the CT based custom patient shape. Funding provided by an intra-department grant of the University of Minnesota Department of Radiation Oncology

SU-C-213-05: Evaluation of a Composite Copper-Plastic Material for a 3D Printed Radiation Therapy Bolus

Energy Technology Data Exchange (ETDEWEB)

Vitzthum, L; Ehler, E; Sterling, D; Reynolds, T; Higgins, P; Dusenbery, K [University of Minnesota, Minneapolis, MN (United States)

2015-06-15

Purpose: To evaluate a novel 3D printed bolus fabricated from a copper-plastic composite as a thin flexible, custom fitting device that can replicate doses achieved with conventional bolus techniques. Methods: Two models of bolus were created on a 3D printer using a composite copper-PLA/PHA. Firstly, boluses were constructed at thicknesses of 0.4, 0.6 and 0.8 mm. Relative dose measurements were performed under the bolus with an Attix Chamber as well as with radiochromic film. Results were compared to superficial Attix Chamber measurements in a water equivalent material to determine the dosimetric water equivalence of the copper-PLA/PHA plastic. Secondly, CT images of a RANDO phantom were used to create a custom fitting bolus across the anterolateral scalp. Surface dose with the bolus placed on the RANDO phantom was measured with radiochromic film at tangential angles with 6, 10, 10 flattening filter free (FFF) and 18 MV photon beams. Results: Mean surface doses for 6, 10, 10FFF and 18 MV were measured as a percent of Dmax for the flat bolus devices of each thickness. The 0.4 mm thickness bolus was determined to be near equivalent to 2.5 mm depth in water for all four energies. Surface doses ranged from 59–63% without bolus and 85–90% with the custom 0.4 mm copper-plastic bolus relative to the prescribed dose for an oblique tangential beam arrangement on the RANDO phantom. Conclusion: Sub-millimeter thickness, 3D printed composite copper-PLA/PHA bolus can provide a build-up effect equivalent to conventional bolus. At this thickness, the 3D printed bolus allows a level of flexure that may provide more patient comfort than current 3D printing materials used in bolus fabrication while still retaining the CT based custom patient shape. Funding provided by an intra-department grant of the University of Minnesota Department of Radiation Oncology.

SU-F-T-517: Determining the Tissue Equivalence of a Brass Mesh Bolus in a Reconstructed Chest Wall Irradiation

Energy Technology Data Exchange (ETDEWEB)

Shekel, E; Epstein, D; Levin, D [Dept of radiotherapy, Assuta Medical Centers, Tel Aviv (Israel)

2016-06-15

Purpose: To determine the tissue equivalence of a brass mesh bolus (RPD) in the setting of a reconstructed chest wall irradiation Methods: We measured breast skin dose delivered by a tangential field plan on an anthropomorphic phantom using Mosfet and nanoDot (Landauer) dosimeters in five different locations on the breast. We also measured skin dose using no bolus, 5mm and 10 mm superflab bolus. In the Eclipse treatment planning system (Varian, Palo Alto, CA) we calculated skin dose for different bolus thicknesses, ranging from 0 to 10 mm, in order to evaluate which calculation best matches the brass mesh measurements, as the brass mesh cannot be simulated due to artefacts.Finally, we measured depth dose behavior with the brass mesh bolus to verify that the bolus does not affect the dose to the breast itself beyond the build-up region. Results: Mosfet and nanoDot measurements were consistent with each other.As expected, skin dose measurements with no bolus had the least agreement with Eclipse calculation, while measurements for 5 and 10 mm agreed well with the calculation despite the difficulty in conforming superflab bolus to the breast contour. For the brass mesh the best agreement was for 3 mm bolus Eclipse calculation. For Mosfets, the average measurement was 90.8% of the expected dose, and for nanoDots 88.33% compared to 83.34%, 88.64% and 93.94% (2,3 and 5 mm bolus calculation respectively).The brass mesh bolus increased skin dose by approximately 25% but there was no dose increase beyond the build-up region. Conclusion: Brass mesh bolus is most equivalent to a 3 mm bolus, and does not affect the dose beyond the build-up region. The brass mesh cannot be directly calculated in Eclipse, hence a 3mm bolus calculation is a good reflection of the dose response to the brass mesh bolus.

Effects of a sour bolus on the intramuscular electromyographic (EMG) activity of muscles in the submental region.

Science.gov (United States)

Palmer, Phyllis M; McCulloch, Timothy M; Jaffe, Debra; Neel, Amy T

2005-01-01

A sour bolus has been used as a modality in the treatment of oropharyngeal dysphagia based on the hypothesis that this stimulus provides an effective preswallow sensory input that lowers the threshold required to trigger a pharyngeal swallow. The result is a more immediate swallow onset time. Additionally, the sour bolus may invigorate the oral muscles resulting in stronger contractions during the swallow. The purpose of this investigation was to compare the intramuscular electromyographic activity of the mylohyoid, geniohyoid, and anterior belly of the digastric muscles during sour and water boluses with regard to duration, strength, and timing of muscle activation. Muscle duration, swallow onset time, and pattern of muscle activation did not differ for the two bolus types. Muscle activation time was more tightly approximated across the onsets of the three muscles when a sour bolus was used. A sour bolus also resulted in a stronger muscle contraction as evidenced by greater electromyographic activity. These data support the use of a sour bolus as part of a treatment paradigm.

Soft-robotic esophageal swallowing as a clinically-inspired bolus rheometry technique

International Nuclear Information System (INIS)

Dirven, Steven; Allen, Jacqueline; Xu, Weiliang; Cheng, Leo K

2017-01-01

To investigate the impact of viscosity and peristaltic transport parameters on manometric pressure signatures, a reproducible swallowing process is required. Due to inter- and intra-subject variability from swallow to swallow, the human body does not represent an optimal mechanism for such an investigation. A smooth and continuous swallowing soft-robot has been developed to produce biomimetic swallowing trajectories, and is proposed to operate as a bench-top bolus rheometric investigation method. The method compares conventional viscometry and pressure signature findings from robotic swallowing experiments. The robotic aspect of experimentation involved 450 biomimetic swallows (10 repetitions of 45 unique experiments). The method examined swallowing transport in three dimensions: bolus formulation, peristaltic wavelength, and peristaltic velocity, each of which are known to contribute to safe and effective swallowing in vivo . It is found that the pressure gradients and magnitudes are commensurate with clinical reports on biological swallowing, on the order of 100 mmHg peak, however, the relationship between viscosity and pressure signatures is less clear. Bolus transport cannot be predicted as a function of bolus viscosity alone. Traditional viscometric data at 50 s −1 , as used in clinical practice, may not be a strong indicator of swallow effort, safety, or efficacy in vivo . (paper)

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain.

OpenAIRE

Hoekzema, Elseline; Schagen, Sebastian E. E.; Kreukels, Baudewijntje P. C.; Veltman, Dick J.; Cohen-Kettenis, Peggy T.; Delemarre-van de Waal, Henriette; Bakker, Julie

2015-01-01

The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural gray matter (GM) volumes in 55 female-to-male and 38 male-to-female adolescents, 44 boys and 52 girls without GD and applied both univariate and multivariate analyses. In girls, more GM volume was o...

EFFECT OF A BITTER BOLUS ON ORAL, PHARYNGEAL AND ESOPHAGEAL TRANSIT OF HEALTHY SUBJECTS

Directory of Open Access Journals (Sweden)

Leda Maria Tavares ALVES

2013-03-01

Full Text Available Context During swallowing, boluses stimulate sensory receptors of the oral, pharyngeal, laryngeal, and esophageal regions. Sweet and tasteless foods are more acceptable for swallowing than bitter foods. A bitter bolus is unpleasant for most subjects. Our hypothesis was that the ingestion of a bitter bolus might alter the oral behavior, pharyngeal and esophageal transit when compared to a sweet bolus. Objective To evaluate whether the bitter taste of a liquid bolus causes alteration on oral, pharyngeal and/or esophageal transit in normal subjects in comparison with sweet bolus.' Method Scintigraphic evaluation of oral, pharyngeal and esophageal transit was performed in 43 asymptomatic subjects, 22 women and 21 men, ages 23-71 years, without problems with the ingestion of liquid and solid foods, and without digestive, cardiac or neurologic diseases. Each subject swallowed in random sequence and at room temperature 5 mL of a liquid bolus with bitter taste, prepared with 50 mL of water with 2 g of leaves of Peumus boldus, heated until boiling (boldus tea, and 5 mL of a liquid bolus with sweet taste, prepared with 50 mL of water with 3 g of sucrose, both labeled with 37 MBq of technetium phytate (Tc99m. Results There was no difference between the bitter bolus and the sweet bolus in mouth, pharynx and esophageal transit and clearance duration and in the amount of residues. Conclusion A bitter bolus, considered an unpleasant bolus, does not alter the duration of oral, pharyngeal and esophageal phases of swallowing, when compared with a sweet bolus, considered a pleasant bolus. Contexto Durante a deglutição o bolo estimula os receptores sensoriais da boca, faringe, laringe e esôfago. Os alimentos doces e sem gosto são mais aceitáveis para a deglutição do que os alimentos amargos, que tem gosto desagradável para a maioria dos indivíduos. A hipótese destes autores era que a ingestão de um bolo amargo pode alterar o trânsito oral

Grey matter volume differences associated with gender in children with attention-deficit/hyperactivity disorder: A voxel-based morphometry study

Directory of Open Access Journals (Sweden)

Thomas Villemonteix

2015-08-01

Full Text Available Female participants have been underrepresented in previous structural magnetic resonance imaging reports on attention-deficit/hyperactivity disorder (ADHD. In this study, we used optimized voxel-based morphometry to examine grey matter volumes in a sample of 33 never-medicated children with combined-type ADHD and 27 typically developing (TD children. We found a gender-by-diagnosis interaction effect in the ventral anterior cingulate cortex (ACC, whereby boys with ADHD exhibited reduced volumes compared with TD boys, while girls with ADHD showed increased volumes when compared with TD girls. Considering the key role played by the ventral ACC in emotional regulation, we discuss the potential contribution of these alterations to gender-specific symptoms’ profiles in ADHD.

The Interactive Effect of Diabetes Family Conflict and Depression on Insulin Bolusing Behaviors for Youth.

Science.gov (United States)

Maliszewski, Genevieve; Patton, Susana R; Midyett, L Kurt; Clements, Mark A

2017-05-01

Adherence to type 1 diabetes management declines as children enter adolescence. For youth, psychosocial variables including mood and interpersonal relationships play a large role in diabetes maintenance. The current study assessed the unique and interactive roles diabetes family conflict and depression have on insulin bolusing behaviors for youth ages 10-16 years. Ninety-one youth-parent dyads completed a survey assessing family conflict and depression. Mean daily blood glucose levels, mealtime insulin bolus scores ( BOLUS), and glycated hemoglobin (HbA1c) were collected from the medical record as outcome variables. Parent-reported diabetes-related family conflict and youths' endorsed depression both significantly predicted insulin bolusing behavior, R 2 = .13, F(2, 88) = 6.66, P family conflict and youth depression played a significant role in youths' bolusing behaviors, above and beyond that which was predicted by conflict and depression separately, R 2 = .18, F change (1, 87) = 4.63, P family conflict, while there was no change in BOLUS scores among depressed youth living in families reporting less conflict. Findings underscore the importance of screening for depression and family conflict in youth experiencing or at risk for poor adherence to mealtime insulin and higher HbA1c levels.

Pre-pharyngeal swallow effects of recurrent laryngeal nerve lesion on bolus shape and airway protection in an infant pig model

Science.gov (United States)

Gould, Francois D. H.; Yglesias, B.; Ohlemacher, J.; German, R. Z.

2016-01-01

Recurrent laryngeal nerve (RLN) damage in infants leads to increased dysphagia and aspiration pneumonia. Recent work has shown that intra oral transport and swallow kinematics change following RLN lesion, suggesting potential changes in bolus formation prior to the swallow. In this study we used geometric morphometrics to understand the effect of bolus shape on penetration and aspiration in infants with and without RLN lesion. We hypothesized 1) that geometric bolus properties are related to airway protection outcomes and 2) that in infants with RLN lesion, the relationship between geometric bolus properties and dysphagia is changed. In five infant pigs, dysphagia in 188 swallows was assessed using the Infant Mammalian Penetration Aspiration Score (IMPAS). Using images from high-speed VFSS, bolus shape, bolus area, and tongue outline were quantified digitally. Bolus shape was analyzed using elliptical Fourier analysis, and tongue outline using polynomial curve fitting. Despite large inter-individual differences, significant within individual effects of bolus shape and bolus area on airway protection exist. The relationship between penetration-aspiration score and both bolus area and shape changed post lesion. Tongue shape differed between pre and post lesion swallows, and between swallows with different IMPAS scores. Bolus shape and area affect airway protection outcomes. RLN lesion changes that relationship, indicating that proper bolus formation and control by the tongue requires intact laryngeal sensation. The impact of RLN lesion on dysphagia is pervasive. PMID:27873091

A Study on the Necessary Number of Bolus Treatments in Radiotherapy after Modified Radical Mastectomy

International Nuclear Information System (INIS)

Hong, Chae Seon; Kim, Jong Sik; Kim, Young Kon; Park, Young Hwan

2006-01-01

Post-mastectomy radiotherapy (PMR) is known to decrease loco-regional recurrence. Adequate skin and dermal dose are achieved by adding bolus. The more difficult clinical issue is determining the necessary number of bolus treatment, given the limits of normal skin tolerance. The aim of this study is to evaluate the necessary number of bolus treatment after PMR in patients with breast cancer. Four female breast cancer patients were included in the study. The median age was 53 years(range, 38-74), tumor were left sided in 2 patients and right sided in 2 patients. All patients were treated with postoperative radiotherapy after MRM. Radiotherapy was delivered to the chest wall (C.W) and supraclavicular lymph nodes (SCL) using 4 MV X-ray. The total dose was 50 Gy, in 2 Gy fractions (with 5 times a week). CT was performed for treatment planning, treatment planning was performed using A DAC-Pinnacles 3 (Phillips, USA) for all patients without and with bolus. Bolus treatment plans were generated using image tool (0.5 cm of thickness and 6 cm of width). Dose distribution was analyzed and the increased skin dose rate in the build-up region was computed and the skin dose using TLD-100 chips (Harshaw, USA) was measured. No significant difference was found in dose distribution without and with bolus; C.W coverage was 95-100% of the prescribed dose in both. But, there was remarkable difference in the skin dose to the scar. The skin dose to the scar without and with bolus were 100-105% and 50-75%. The increased skin dose rates in the build-up region for Pt. 1, Pt. 2. Pt. 3 and Pt. 4 were 23.3%, 35.6%, 34.9%, and 41.7%. The results of measured skin dose using TLD-100 chips in the cases without and with bolus were 209.3 cGy and 161.1 cGy, 200 cGy and 150.2 cGy, 211.4 cGy and 160.5 cGy, 198.6 cGy and 155.5 cGy for Pt. 1, Pt. 2, Pt. 3, and Pt. 4. It was concludes through this analysis that the adequate number of bolus treatments is 50-60% of the treatment program. Further, clinical

Radiotherapy in differentiated thyroid cancer: Optimal dose distribution using a wax bolus

International Nuclear Information System (INIS)

Mayer, R.; Stucklschweiger, G.; Oechs, A.; Pakish, B.; Hackl, A.; Preidler, K.; Szola, D.

1994-01-01

The study includes 53 patients with differentiated thyroid cancer, who underwent surgical and radioiodine therapy as well as hormone therapy. Postoperative radiotherapy was performed in all patients in 'mini-mantle-technique' with parallel opposed fields, followed by an anterior boost-field with electrons up to 60-64 Gy, using a wax bolus for optimal dose distribution in the target volume sparing out the spinal cord as much as possible. The dose to the spinal cord did not exceed 44 Gy in any case. The study shows that radiotherapy with doses up to 60-64 Gy plays an important role in postsurgical therapeutic management. Therefore nonradical surgery is a less important prognostic factor for survival and local recurrence in patients with differentiated thyroid cancer than histological diagnosis in combination with age and lymph node involvement

Custom bolus of hydrogel: dosimetric characterization, clinical use and placement uncertainties; Bolus de compensación personalizado de hidrogel: Caracterización radiológica, uso clínico e incertidumbre de colocación

Energy Technology Data Exchange (ETDEWEB)

Pérez-García, H.; Antón, D.; Miguel, D.; Ángel del Castillo, D.; Alonso, D.; De Frutos, J.; Pérez, C.

2017-11-01

When using electron beams over irregular surfaces it shows remarkable dose heterogeneity in target tissue, the use of a hydrogel bolus by Varihesive® ConvaTec as a custom bolus is proposed to compensate this effect. Radiological characterization is carried out comparing hydrogel with water by a CT study and by measuring percentage depth dose for electron beams. The dosimetric impact due to the uncertainty of bolus placement is quantitatively evaluated and it is concluded that the use of hydrogel is an acceptable solution as compensation bolus with radiological properties similar to water. [Spanish] La incidencia de un campo de electrones en una superficie irregular produce distribuciones heterogéneas de dosis. En este trabajo se propone el uso de un bolus personalizado de hidrogel Varihesive® de ConvaTec para compensar dichas irregularidades. El hidrogel se caracteriza radiológicamente comparándolo con agua mediante una adquisición TC y se obtiene el porcentaje de dosis en profundidad para campos de electrones. Se evalúa cuantitativamente el impacto dosimétrico debido a la incertidumbre de colocación y se concluye que el uso de hidrogel resulta una solución aceptable como bolus de compensación con propiedades radiológicas similares al agua.

Endoscopic evaluation of food bolus formation and its relationship with the number of chewing cycles.

Science.gov (United States)

Fukatsu, H; Nohara, K; Kotani, Y; Tanaka, N; Matsuno, K; Sakai, T

2015-08-01

It is known that solid food is transported to the pharynx actively in parallel to it being crushed by chewing and mixed with saliva in the oral cavity. Therefore, food bolus formation should be considered to take place from the oral cavity to the pharynx. In previous studies, the chewed food was evaluated after the food had been removed from the oral cavity. However, it has been pointed out that spitting food out of the oral cavity interferes with natural food bolus formation. Therefore, we observed food boluses immediately before swallowing using an endoscope to establish a method to evaluate the food bolus-forming function, and simultaneously performed endoscopic evaluation of food bolus formation and its relationship with the number of chewing cycles. The subject was inserted the endoscope nasally and instructed to eat two coloured samples of boiled rice simultaneously in two ingestion conditions ('as usual' and 'chewing well'). The condition of the food bolus was graded into three categories for each item of grinding, mixing and aggregation and scored 2, 1 and 0. The score of aggregation was high under both ingestion conditions. The scores of grinding and mixing tended to be higher in subjects with a high number of chewing cycles, and the score of aggregation was high regardless of the number of chewing cycles. It was suggested that food has to be aggregated, even though the number of chewing cycles is low and the food is not ground or mixed for a food bolus to reach the swallowing threshold. © 2015 John Wiley & Sons Ltd.

Use of a marshmallow bolus for evaluating lower esophageal mucosal rings.

Science.gov (United States)

Ott, D J; Kelley, T F; Chen, M Y; Gelfand, D W; Wu, W C

1991-07-01

Sixty-three patients (35 women, 28 men; mean age 55 yr) with lower esophageal mucosal ring shown radiographically were examined with a semi-solid bolus consisting of a portion of a standard marshmallow. The most common symptom was dysphagia, present in 46 (73%) patients. Impaction of the marshmallow bolus by the ring occurred in 40 (63%) of the 63 patients, and produced symptoms in 27 (68%) of these 40 patients. Nine (14%) rings were detected radiographically only with a solid bolus; eight of these patients had dysphagia and seven rings were 20 mm or less in caliber. Impaction related to ring caliber, and was found in all 17 (100%) rings that were 13 mm or less in diameter, in 17/24 (71%) 14- to 19-mm rings, and in 6/22 (27%) rings 20 mm or more in caliber. Endoscopy in 23 patients detected 16 (70%) rings, and also depended on ring caliber: less than or equal to 13 mm, 6/6 (100%); 14-19 mm, 5/9 (56%); greater than or equal to 20 mm, 5/8 (63%). Marshmallow impaction occurred in 17 (74%) of 23 patients who had endoscopy; three of the 23 patients had normal endoscopy. In conclusion, radiographic examination supplemented by the use of a marshmallow bolus best detects lower esophageal mucosal ring.

The impact of mastication, salivation and food bolus formation on salt release during bread consumption.

Science.gov (United States)

Tournier, Carole; Grass, Manon; Septier, Chantal; Bertrand, Dominique; Salles, Christian

2014-11-01

Health authorities recommend higher fibre and lower salt content in bread products. However, these basic ingredients of bread composition are multifunctional, and important changes in their content influence the texture, flavour and acceptability of the product. This study was designed to investigate the link between oral processing, bolus formation and sodium release during the consumption of four different breads that varied in composition and structure. Chewing behaviour was determined by surface electromyography, and salivation was quantified from the water content of the boluses collected. The kinetics of bread degradation during food bolus formation was characterised by measuring the bolus heterogeneity by texture image analysis, and sodium release into the saliva was quantified. Mastication and salivation varied between products and between subjects, thus highlighting different bolus formation strategies. In vivo salt release was mainly explained by mastication parameters. The initial slope of sodium release increased when the chewing muscles' activity increased, and the maximum sodium concentration was reached later when more masticatory cycles were required to reach the swallowing point.

Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study

International Nuclear Information System (INIS)

Cain, Peter A; Ahl, Ragnhild; Hedstrom, Erik; Ugander, Martin; Allansdotter-Johnsson, Ase; Friberg, Peter; Arheden, Hakan

2009-01-01

Knowledge about age-specific normal values for left ventricular mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) by cardiac magnetic resonance imaging (CMR) is of importance to differentiate between health and disease and to assess the severity of disease. The aims of the study were to determine age and gender specific normal reference values and to explore the normal physiological variation of these parameters from adolescence to late adulthood, in a cross sectional study. Gradient echo CMR was performed at 1.5 T in 96 healthy volunteers (11–81 years, 50 male). Gender-specific analysis of parameters was undertaken in both absolute values and adjusted for body surface area (BSA). Age and gender specific normal ranges for LV volumes, mass and function are presented from the second through the eighth decade of life. LVM, ESV and EDV rose during adolescence and declined in adulthood. SV and EF decreased with age. Compared to adult females, adult males had higher BSA-adjusted values of EDV (p = 0.006) and ESV (p < 0.001), similar SV (p = 0.51) and lower EF (p = 0.014). No gender differences were seen in the youngest, 11–15 year, age range. LV volumes, mass and function vary over a broad age range in healthy individuals. LV volumes and mass both rise in adolescence and decline with age. EF showed a rapid decline in adolescence compared to changes throughout adulthood. These findings demonstrate the need for age and gender specific normal ranges for clinical use

Split-bolus CT-urography using dual-energy CT: Feasibility, image quality and dose reduction

Energy Technology Data Exchange (ETDEWEB)

Takeuchi, Mitsuru, E-mail: m2rbimn@gmail.com [Nagoya City University Graduate School of Medical Sciences, Department of Radiology, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 (Japan); Kawai, Tatsuya; Ito, Masato; Ogawa, Masaki [Nagoya City University Graduate School of Medical Sciences, Department of Radiology, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 (Japan); Ohashi, Kazuya [Nagoya City University Hospital, Department of Radiology, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 (Japan); Hara, Masaki; Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 (Japan)

2012-11-15

Purpose: To prospectively evaluate the feasibility of dual-energy (DE) split-bolus CT-urography (CTU) and the quality of virtual non-enhanced images (VNEI) and DE combined nephrographic-excretory phase images (CNEPI), and to estimate radiation dose reduction if true non-enhanced images (TNEI) could be omitted. Patients and methods: Between August and September 2011, 30 consecutive patients with confirmed or suspected urothelial cancer or with hematuria underwent DE CT. Single-energy TNEI and DE CNEPI were obtained. VNEI was reconstructed from CNEPI. Image quality of CNEPI and VNEI was evaluated using a 5-point scale. The attenuation of urine in the bladder on TNEI and VNEI was measured. The CT dose index volume (CTDI (vol)) of the two scans was recorded. Results: The mean image quality score of CNEPI and VNEI was 4.7 and 3.3, respectively. The mean differences in urine attenuation between VNEI and TNEI were 14 {+-} 15 [SD] and -16 {+-} 29 in the anterior and posterior parts of the bladder, respectively. The mean CTDI (vol) for TNEI and CNEPI was 11.8 and 10.9 mGy, respectively. Omission of TNEI could reduce the total radiation dose by 52%. Conclusion: DE split-bolus CTU is technically feasible and can reduce radiation exposure; however, an additional TNEI scan is necessary when the VNEI quality is poor or quantitative evaluation of urine attenuation is required.

Grey matter volume differences associated with gender in children with attention-deficit/hyperactivity disorder: A voxel-based morphometry study.

Science.gov (United States)

Villemonteix, Thomas; De Brito, Stéphane A; Slama, Hichem; Kavec, Martin; Balériaux, Danielle; Metens, Thierry; Baijot, Simon; Mary, Alison; Peigneux, Philippe; Massat, Isabelle

2015-08-01

Female participants have been underrepresented in previous structural magnetic resonance imaging reports on attention-deficit/hyperactivity disorder (ADHD). In this study, we used optimized voxel-based morphometry to examine grey matter volumes in a sample of 33 never-medicated children with combined-type ADHD and 27 typically developing (TD) children. We found a gender-by-diagnosis interaction effect in the ventral anterior cingulate cortex (ACC), whereby boys with ADHD exhibited reduced volumes compared with TD boys, while girls with ADHD showed increased volumes when compared with TD girls. Considering the key role played by the ventral ACC in emotional regulation, we discuss the potential contribution of these alterations to gender-specific symptoms' profiles in ADHD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Dynamic computed tomography after bolus injection and infusion of perfluorooctylbromide (PFOB)

International Nuclear Information System (INIS)

Adam, G.; Guenther, R.W.; Goertz, H.; Schiffer, C.

1992-01-01

We investigated the enhancement of the liver, the spleen, and of induced abscesses and the abdominal vessels after administration of 3 g/kg bodyweight Perfluoroocytlbromide (PFOB) on an animal model. Twenty-one rabbits each received the contrast medium as bolus injection and as slow infusion over half an hour. CT was performed between 2 and 48 hours after contrast medium application. Peak enhancement of the liver, the spleen and the liver abscess membrane was found between 24 and 48 hours after PFOB administration, independently of the application mode. Peak enhancement of the abdominal aorta and the IVC was observed within two hours after bolus injection. In this rabbit model PFOB permits best delineation of the vessels after bolus injection within the first two hours, while CT imaging of the liver, the spleen and the liver abscess membrane is best between 24 and 48 hours after contrast medium application, independent of the injection velocity. (orig.) [de

Performance of a glucose meter with a built-in automated bolus calculator versus manual bolus calculation in insulin-using subjects.

Science.gov (United States)

Sussman, Allen; Taylor, Elizabeth J; Patel, Mona; Ward, Jeanne; Alva, Shridhara; Lawrence, Andrew; Ng, Ronald

2012-03-01

Patients consider multiple parameters in adjusting prandial insulin doses for optimal glycemic control. Difficulties in calculations can lead to incorrect doses or induce patients to administer fixed doses, rely on empirical estimates, or skip boluses. A multicenter study was conducted with 205 diabetes subjects who were on multiple daily injections of rapid/ short-acting insulin. Using the formula provided, the subjects manually calculated two prandial insulin doses based on one high and one normal glucose test result, respectively. They also determined the two doses using the FreeStyle InsuLinx Blood Glucose Monitoring System, which has a built-in, automated bolus calculator. After dose determinations, the subjects completed opinion surveys. Of the 409 insulin doses manually calculated by the subjects, 256 (63%) were incorrect. Only 23 (6%) of the same 409 dose determinations were incorrect using the meter, and these errors were due to either confirmed or potential deviations from the study instructions by the subjects when determining dose with meter. In the survey, 83% of the subjects expressed more confidence in the meter-calculated doses than the manually calculated doses. Furthermore, 87% of the subjects preferred to use the meter than manual calculation to determine prandial insulin doses. Insulin-using patients made errors in more than half of the manually calculated insulin doses. Use of the automated bolus calculator in the FreeStyle InsuLinx meter minimized errors in dose determination. The patients also expressed confidence and preference for using the meter. This may increase adherence and help optimize the use of mealtime insulin. © 2012 Diabetes Technology Society.

Gender moderates the association between dorsal medial prefrontal cortex volume and depressive symptoms in a subclinical sample.

Science.gov (United States)

Carlson, Joshua M; Depetro, Emily; Maxwell, Joshua; Harmon-Jones, Eddie; Hajcak, Greg

2015-08-30

Major depressive disorder is associated with lower medial prefrontal cortex volumes. The role that gender might play in moderating this relationship and what particular medial prefrontal cortex subregion(s) might be implicated is unclear. Magnetic resonance imaging was used to assess dorsal, ventral, and anterior cingulate regions of the medial prefrontal cortex in a normative sample of male and female adults. The Depression, Anxiety, and Stress Scale (DASS) was used to measure these three variables. Voxel-based morphometry was used to test for correlations between medial prefrontal gray matter volume and depressive traits. The dorsal medial frontal cortex was correlated with greater levels of depression, but not anxiety and stress. Gender moderates this effect: in males greater levels of depression were associated with lower dorsal medial prefrontal volumes, but in females no relationship was observed. The results indicate that even within a non-clinical sample, male participants with higher levels of depressive traits tend to have lower levels of gray matter volume in the dorsal medial prefrontal cortex. Our finding is consistent with low dorsal medial prefrontal volume contributing to the development of depression in males. Future longitudinal work is needed to substantiate this possibility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

TU-H-CAMPUS-TeP1-05: Fast Processed 3D Printing-Aided Urethane Resin (PUR) Bolus in Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Zhao, B; Chiu, T; Gu, X; Lee, H; Nedzi, L; Jiang, S [UT Southwestern Medical Center, Dallas, TX (United States)

2016-06-15

Purpose: 3D printed custom bolus is regularly used in radiation therapy clinic as a compensator. However, usual method of bolus printing with 100% filling is very time-consuming. The purpose of this study is to evaluate the feasibility and benefit of 3D printed bolus filled with UR. Methods: Two boluses were designed on nose (9e electrons) and ear (6× photons) for a head phantom in treatment planning system (TPS) to achieve dose coverage to the skin. The bolus structures (56–167cc) were converted to STereoLithographic (STL) model using an in-house developed algorithm and sent to a commercial fused deposition modeling (FDM) printer. Only shells were printed with polylactic acid (PLA) material. Liquid UR was then placed in a vacuum pump and slowly poured into the hollow bolus from its top opening. Liquid UR hardened in around half an hour. The phantom was rescanned with custom boluses attached and the dosimetry was compared with original design in TPS. Basic CT and dose properties were investigated. GaF films were irradiated to measure dose profile and output of several open photon and electron beams under solid water and UR slabs of same thicknesses. Results: CT number was 11.2±7.3 and 65.4±7.8, respectively for solid water(∼1.04g/cc) and UR(∼1.08g/cc). The output measurement at dmax for 6× was within 2% for the two materials. The relative dose profiles of the two materials above dmax show 94–99% Gamma analysis passing rates for both photons and electrons. Dose distributions with 3D PUR boluses maintained great coverage on the intended skin regions and resembled that with computer generated boluses. Manufacturing 3D PUR boluses was 3–4 times faster than 100% printed boluses. The efficiency significantly improves for larger boluses. Conclusion: The study suggests UR has similar dose responses as solid water. Making custom bolus with UR greatly increases clinical workflow efficiency.

TU-H-CAMPUS-TeP1-05: Fast Processed 3D Printing-Aided Urethane Resin (PUR) Bolus in Radiation Therapy

International Nuclear Information System (INIS)

Zhao, B; Chiu, T; Gu, X; Lee, H; Nedzi, L; Jiang, S

2016-01-01

Purpose: 3D printed custom bolus is regularly used in radiation therapy clinic as a compensator. However, usual method of bolus printing with 100% filling is very time-consuming. The purpose of this study is to evaluate the feasibility and benefit of 3D printed bolus filled with UR. Methods: Two boluses were designed on nose (9e electrons) and ear (6× photons) for a head phantom in treatment planning system (TPS) to achieve dose coverage to the skin. The bolus structures (56–167cc) were converted to STereoLithographic (STL) model using an in-house developed algorithm and sent to a commercial fused deposition modeling (FDM) printer. Only shells were printed with polylactic acid (PLA) material. Liquid UR was then placed in a vacuum pump and slowly poured into the hollow bolus from its top opening. Liquid UR hardened in around half an hour. The phantom was rescanned with custom boluses attached and the dosimetry was compared with original design in TPS. Basic CT and dose properties were investigated. GaF films were irradiated to measure dose profile and output of several open photon and electron beams under solid water and UR slabs of same thicknesses. Results: CT number was 11.2±7.3 and 65.4±7.8, respectively for solid water(∼1.04g/cc) and UR(∼1.08g/cc). The output measurement at dmax for 6× was within 2% for the two materials. The relative dose profiles of the two materials above dmax show 94–99% Gamma analysis passing rates for both photons and electrons. Dose distributions with 3D PUR boluses maintained great coverage on the intended skin regions and resembled that with computer generated boluses. Manufacturing 3D PUR boluses was 3–4 times faster than 100% printed boluses. The efficiency significantly improves for larger boluses. Conclusion: The study suggests UR has similar dose responses as solid water. Making custom bolus with UR greatly increases clinical workflow efficiency.

Automatic Bolus Tracking Versus Fixed Time-Delay Technique in Biphasic Multidetector Computed Tomography of the Abdomen

International Nuclear Information System (INIS)

Adibi, Atoosa; Shahbazi, Ali

2014-01-01

Bolus tracking can individualize time delay for the start of scans in spiral computed tomography (CT). We compared automatic bolus tracking method with fixed time-delay technique in biphasic contrast enhancement during multidetector CT of abdomen. Adult patients referred for spiral CT of the abdomen were randomized into two groups; in group 1, the arterial and portal phases of spiral scans were started 25 s and 55 s after the start of contrast material administration; in group 2, using the automatic bolus tracking software, repetitive monitoring scans were performed within the lumen of the descending aorta as the region of interest with the threshold of starting the diagnostic scans as 60 HU. The contrast enhancement of the aorta, liver, and spleen were compared between the groups. Forty-eight patients (23 males, 25 females, mean age=56.4±13.5 years) were included. The contrast enhancement of the aorta, liver, and spleen at the arterial phase was similar between the two groups (P>0.05). Regarding the portal phase, the aorta and spleen were more enhanced in the bolus-tracking group (P<0.001). The bolus tracking provided more homogeneous contrast enhancement among different patients than the fixed time-delay technique in the liver at portal phase, but not at the arterial phase. The automatic bolus-tracking method, results in higher contrast enhancement of the aorta and spleen at the portal phase, but has no effect on liver enhancement. However, bolus tracking is associated with reduced variability for liver enhancement among different patients

Age, gender, and interracial variability of normal lacrimal gland volume using MRI.

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Bukhari, Amal A; Basheer, Naushad A; Joharjy, Heba I

2014-01-01

Aimed to evaluate normal volume of the lacrimal gland in patients of different age groups and race. All MRI studies of the brain that were done between June 2012 and April 2013 were examined. Lacrimal glands were identified using fat-saturated fluid-attenuated inversion recovery (FLAIR) images, and the volumes were calculated using TeraRecon iNtuition viewer. Volumes for the right and left lacrimal glands were recorded for persons of different age groups and race, and the results were compared with those of a randomly selected group of patients who had undergone the same calculation method using CT of the brain, orbit, or paranasal sinuses. The authors included 998 lacrimal glands of 499 patients. The mean volumes for the right and left lacrimal glands were 0.770 and 0.684 cm, respectively. Lacrimal glands were larger in women; the largest volumes were observed during the second decade of life. Mean volumes also varied with race: 0.840 cm in Asians, 0.790 cm in Africans, 0.760 cm in Indians, and 0.710 cm in Middle Easterners. The consultant neuroradiologist and the intern showed excellent agreement for measurements of lacrimal gland volume. No significant difference was observed between lacrimal gland measurements method on MRI and CT. Lacrimal gland volume varies according to age, gender, race, and laterality. Measurements with MRI using fat-saturated FLAIR images and TeraRecon iNtuition viewer software are reliable, accurate, and can be used by junior staff with less radiation exposure to patients.

Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study

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Allansdotter-Johnsson Ase

2009-01-01

Full Text Available Abstract Background Knowledge about age-specific normal values for left ventricular mass (LVM, end-diastolic volume (EDV, end-systolic volume (ESV, stroke volume (SV and ejection fraction (EF by cardiac magnetic resonance imaging (CMR is of importance to differentiate between health and disease and to assess the severity of disease. The aims of the study were to determine age and gender specific normal reference values and to explore the normal physiological variation of these parameters from adolescence to late adulthood, in a cross sectional study. Methods Gradient echo CMR was performed at 1.5 T in 96 healthy volunteers (11–81 years, 50 male. Gender-specific analysis of parameters was undertaken in both absolute values and adjusted for body surface area (BSA. Results Age and gender specific normal ranges for LV volumes, mass and function are presented from the second through the eighth decade of life. LVM, ESV and EDV rose during adolescence and declined in adulthood. SV and EF decreased with age. Compared to adult females, adult males had higher BSA-adjusted values of EDV (p = 0.006 and ESV (p Conclusion LV volumes, mass and function vary over a broad age range in healthy individuals. LV volumes and mass both rise in adolescence and decline with age. EF showed a rapid decline in adolescence compared to changes throughout adulthood. These findings demonstrate the need for age and gender specific normal ranges for clinical use.

Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers.

Science.gov (United States)

Schantz, Daryl I; Dragulescu, Andreea; Memauri, Brett; Grotenhuis, Heynric B; Seed, Mike; Grosse-Wortmann, Lars

2016-10-01

Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (PHydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a "variable" that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient.

Micropropagation of Gerbera (Gerbera jamesonii Bolus).

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Minerva, Ghani; Kumar, Surinder

2013-01-01

Gerbera (Gerbera jamesonii Bolus) is one of the most popular ornamental flowers worldwide and used both as cut flower and potted plant. Some of them show excellent agronomic characters such as color, floral diameter, stem length, and vigor, which make this plant of commercial importance. Conventionally, multiplication is done through seeds or rhizome cuttings. Rapid multiplication of elite cultivars of Gerbera, with improved agronomic traits, has been achieved by using both direct and indirect tissue culture methods. Direct shoot regeneration was accomplished from stem apices on MS medium supplemented with 1 mg/L 6-benzyladenine (BA) and 1 mg/L kinetin. Indirect shoot induction succeeded from callus differentiation has been achieved on MS medium containing 2 mg/L 2,4-dichlorophenoxyacetic acid, 0.5 mg/L indole-3-acetic acid, and 2 mg/L BA. The in vitro shoots, 4-5 cm long, were rooted by quick dipping the shoot bases for 3-5 s in 2,000 mg/L indole-3-butyric acid solution followed by transfer to the pots containing farmyard manure, soil, and sand (1:1:1 by volume). Initially, in vitro plantlets were covered with glass jars to maintain a high relative humidity (85-90%). As soon as new shoot growth begins, relative humidity is decreased by exposing them to the open environmental conditions prior transferring to the glasshouse. Indirect shoot regeneration increased the frequency of somaclonal variations. The selected somaclones were used in developing new and novel cultivars.

Comparison of Insulin Detemir and Insulin Glargine for Hospitalized Patients on a Basal-Bolus Protocol

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Sondra Davis

2017-04-01

Full Text Available BACKGROUND: The primary purpose of this study is to determine whether insulin detemir is equivalent to insulin glargine in controlling hyperglycemia for the adult hospitalized patient on a basal-bolus treatment regimen. METHODS: A retrospective study was conducted at two acute care hospitals within the same health system. Patients from both facilities who were initiated on a basal-bolus subcutaneous insulin regimen were included in the study. The basal-bolus regimen consisted of three components: basal, bolus, and corrective insulin with only the data from the first seven days analyzed. Once the basal-bolus protocol was initiated, all previous glycemic agents were discontinued. The target glycemic goal of the study was 100–180 mg/dL. RESULTS: In both groups, 50% of the patients had achieved the target glycemic control goal (100–180 mg/dL by day 2 (p = 0.3. However, on the seventh or last day of basal-bolus treatment, whichever came first, 36.36% of patients receiving insulin detemir (n = 88 achieved the blood glucose reading goal compared to 52.00% in patients receiving insulin glargine (n = 100 (p = 0.03. This corresponded to an adjusted odds ratio of 2.12 (1.08 to 4.15, p = 0.03. The adjusting variables were provider type, whether the patient was hospitalized within 30 days prior and diagnosis of stroke. The mean blood glucose readings for the insulin glargine and the insulin detemir groups while on basal-bolus therapy were 200 mg/dL and 215 mg/dL, respectively (p = 0.05. The total number of blood glucose readings less than 70 mg/dL and less than 45 mg/dL was very low and there were no differences in number of episodes with hypoglycemia between the two groups. CONCLUSION: There was not a statistical difference between the two groups at 2 days, however there was on the seventh day or the last day of basal-bolus treatment. There were nonsignificant hypoglycemia events between basal insulin groups and the results for the last or seventh day

Reproducibility of 5-HT2A receptor measurements and sample size estimations with [18F]altanserin PET using a bolus/infusion approach

International Nuclear Information System (INIS)

Haugboel, Steven; Pinborg, Lars H.; Arfan, Haroon M.; Froekjaer, Vibe M.; Svarer, Claus; Knudsen, Gitte M.; Madsen, Jacob; Dyrby, Tim B.

2007-01-01

To determine the reproducibility of measurements of brain 5-HT 2A receptors with an [ 18 F]altanserin PET bolus/infusion approach. Further, to estimate the sample size needed to detect regional differences between two groups and, finally, to evaluate how partial volume correction affects reproducibility and the required sample size. For assessment of the variability, six subjects were investigated with [ 18 F]altanserin PET twice, at an interval of less than 2 weeks. The sample size required to detect a 20% difference was estimated from [ 18 F]altanserin PET studies in 84 healthy subjects. Regions of interest were automatically delineated on co-registered MR and PET images. In cortical brain regions with a high density of 5-HT 2A receptors, the outcome parameter (binding potential, BP 1 ) showed high reproducibility, with a median difference between the two group measurements of 6% (range 5-12%), whereas in regions with a low receptor density, BP 1 reproducibility was lower, with a median difference of 17% (range 11-39%). Partial volume correction reduced the variability in the sample considerably. The sample size required to detect a 20% difference in brain regions with high receptor density is approximately 27, whereas for low receptor binding regions the required sample size is substantially higher. This study demonstrates that [ 18 F]altanserin PET with a bolus/infusion design has very low variability, particularly in larger brain regions with high 5-HT 2A receptor density. Moreover, partial volume correction considerably reduces the sample size required to detect regional changes between groups. (orig.)

Development of test bolus tracking method and usefulness in coronary CT angiography

International Nuclear Information System (INIS)

Yamaguchi, Takayoshi; Takahashi, Daichi

2009-01-01

The test bolus tracking (TBT) method is a new injection method of contrast medium that we developed. The TBT method is an injection technique that continuously performs the test bolus injection and the main bolus injection, such that the best acquisition of scan timing and the improvement of examination efficiency can be expected. We compared the TBT method and the test injection method by coronary CT angiography. The results demonstrated that the contrast enhancement of the coronary arteries was high and the variation of the CT value was also small in the TBT method. When the scan timing expected by the TI method and the TBT method were compared, it was different of two seconds or more by the case with 43%. However, the variation of CT value was small for the TBT method in these cases. Therefore, the TBT method is a very useful method for coronary CT angiography (CCTA). (author)

Development of a universal dual-bolus injection scheme for the quantitative assessment of myocardial perfusion cardiovascular magnetic resonance

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Alfakih Khaled

2011-05-01

Full Text Available Abstract Background The dual-bolus protocol enables accurate quantification of myocardial blood flow (MBF by first-pass perfusion cardiovascular magnetic resonance (CMR. However, despite the advantages and increasing demand for the dual-bolus method for accurate quantification of MBF, thus far, it has not been widely used in the field of quantitative perfusion CMR. The main reasons for this are that the setup for the dual-bolus method is complex and requires a state-of-the-art injector and there is also a lack of post processing software. As a solution to one of these problems, we have devised a universal dual-bolus injection scheme for use in a clinical setting. The purpose of this study is to show the setup and feasibility of the universal dual-bolus injection scheme. Methods The universal dual-bolus injection scheme was tested using multiple combinations of different contrast agents, contrast agent dose, power injectors, perfusion sequences, and CMR scanners. This included 3 different contrast agents (Gd-DO3A-butrol, Gd-DTPA and Gd-DOTA, 4 different doses (0.025 mmol/kg, 0.05 mmol/kg, 0.075 mmol/kg and 0.1 mmol/kg, 2 different types of injectors (with and without "pause" function, 5 different sequences (turbo field echo (TFE, balanced TFE, k-space and time (k-t accelerated TFE, k-t accelerated balanced TFE, turbo fast low-angle shot and 3 different CMR scanners from 2 different manufacturers. The relation between the time width of dilute contrast agent bolus curve and cardiac output was obtained to determine the optimal predefined pause duration between dilute and neat contrast agent injection. Results 161 dual-bolus perfusion scans were performed. Three non-injector-related technical errors were observed (1.9%. No injector-related errors were observed. The dual-bolus scheme worked well in all the combinations of parameters if the optimal predefined pause was used. Linear regression analysis showed that the optimal duration for the predefined

Efficacy study of Styplon Vet Bolus as supportive therapy in management of hemorrhagic conditions of ruminants

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B R Ravikumar

Full Text Available On-field trial was conducted in dairy animals to evaluate efficacy of Styplon Vet Bolus (M/s Himalaya Drug Company, Banglore, India as supportive therapy in management of hemorrhagic conditions (Hematuria, hemoagalectia, bleeding wounds, uterine bleeding and epistaxis of ruminants. Styplon Vet 1-2 boli twice daily was administered to cows and buffaloes, and ½ bolus twice daily for sheep till they recover clinically. The results indicated that Styplon Vet Bolus is a safe and effective styptic in ruminants. [Vet World 2009; 2(12.000: 470-471

21 CFR 520.1802b - Piperazine-carbon disulfide complex boluses.

Science.gov (United States)

2010-04-01

...) per 500 pounds body weight; removal of large strongyles, pinworms, and bots, 1 bolus per 250 pounds...), large strongyles (Strongylus spp.) bots (Gastrophilus spp.), small strongyles, and pinworms (Oxyuris...

Dual-phase helical CT using bolus triggering technique: optimization of transition time

International Nuclear Information System (INIS)

Choi, Young Ho; Kim, Tae Kyoung; Park, Byung Kwan; Koh, Young Hwan; Han, Joon Koo; Choi, Byung Ihn

1999-01-01

To optimize the transition time between the triggering point in monitoring scanning and the initiation of diagnostic hepatic arterial phase (HAP) scanning in hepatic spiral CT, using a bolus triggering technique. One hundred consecutive patients with focal hepatic lesion were included in this study. Patients were randomized into two groups. Transition times of 7 and 11 seconds were used in group 1 and 2, respectively. In all patients, bolus triggered HAP spiral CT was obtained using a semi-automatic bolus tracking program after the injection of 120mL of non-ionic contrast media at a rate of 3mL/sec. When aortic enhancement reached 90 HU, diagnostic HAP scanning began after a given transition time. From images of group 1 and group 2, the degree of parenchymal enhancement of the liver and tumor-to-liver attenuation difference were measured. Also, for qualitative analysis, conspicuity of the hepatic artery and hypervascular tumor was scored and analyzed. Hepatic parenchymal enhancement on HAP was 12.07 + /-6.44 HU in group 1 and 16.03 + /-5.80 HU in group 2 (p .05). In the evaluation of conspicuity of hepatic artery, there was no statistically significant difference between the two groups (p > .05). The conspicuity of hypervascular tumors in group 2 was higher than in group 1 (p < .05). HAP spiral CT using a bolus triggering technique with a transition time of 11 seconds provides better HAP images than when the transition time is 7 seconds

Functional aspects of distal oesophageal spasm: the role of onset velocity and contraction amplitude on bolus transit

Science.gov (United States)

Pohl, Daniel; Ciolino, Jody; Roberts, Jason; Savarino, Edoardo; Freeman, Janice; Nietert, Paul J; Tutuian, Radu; Castell, Donald

2012-01-01

Background Distal oesophageal spasm (DES) is a rare and under-investigated motility abnormality. Recent studies indicate effective bolus transit in varying percentages of DES patients. Aim Explore functional aspects including contraction onset velocity and contraction amplitude cut-off values for simultaneous contractions to predict complete bolus transit Methods We re-examined data from 107 impedance-manometry recordings with a diagnosis of DES. Receiver operating characteristic (ROC) analysis was conducted, regarding effects of onset velocity on bolus transit taking into account distal oesophageal amplitude (DEA) and correcting for intra-individual repeated measures. Results Mean area under the ROC curve for saline and viscous swallows were 0.84±0.05 and 0.84±0.04, respectively. Velocity criteria of >30cm/s when DEA>100mmHg and 8cm/s when DEADEA>100mmHg and >7cm/s when DEAsensitivity of 75% and specificity of 80% to identify complete bolus transit. Using these criteria, final diagnosis changed in 44.9% of patients. Abnormal bolus transit was observed in 50.9% of newly diagnosed DES patients versus 7.5% of patients classified as normal. DES patients with DEA>100mmHg suffered twice as often from chest pain than those with DEA<100mmHg. Conclusion The proposed velocity cut-offs for diagnosing distal oesophageal spasm improve the ability to identify patients with spasm and abnormal bolus transit. PMID:22475443

Total intravenous anaesthesia by boluses or by continuous rate infusion of propofol in mute swans (Cygnus olor).

Science.gov (United States)

Müller, Kerstin; Holzapfel, Judith; Brunnberg, Leo

2011-07-01

To investigate intravenous (IV) propofol given by intermittent boluses or by continuous rate infusion (CRI) for anaesthesia in swans. Prospective randomized clinical study. Twenty mute swans (Cygnus olor) (eight immature and 12 adults) of unknown sex undergoing painless diagnostic or therapeutic procedures. Induction of anaesthesia was with 8 mg kg(-1) propofol IV. To maintain anaesthesia, ten birds (group BOLI) received propofol as boluses, whilst 10 (group CRI) received propofol as a CRI. Some physiological parameters were measured. Anaesthetic duration was 35 minutes. Groups were compared using Mann-Whitney U-test. Results are median (range). Anaesthetic induction was smooth and tracheal intubation was achieved easily in all birds. Bolus dose in group BOLI was 2.9 (1.3-4.3) mg kg(-1); interval between and number of boluses required were 4 (1-8) minutes and 6 (4-11) boluses respectively. Total dose of propofol was 19 (12.3-37.1) mg kg(-1). Awakening between boluses was very abrupt. In group CRI, propofol infusion rate was 0.85 (0.8-0.9) mg kg(-1) minute(-1), and anaesthesia was stable. Body temperature, heart and respiratory rates, oxygen saturation (by pulse oximeter) and reflexes did not differ between groups. Oxygen saturations (from pulse oximeter readings) were low in some birds. Following anaesthesia, all birds recovered within 40 minutes. In 55% of all, transient signs of central nervous system excitement occurred during recovery. 8 mg kg(-1) propofol appears an adequate induction dose for mute swans. For maintenance, a CRI of 0.85 mg kg(-1) minute(-1) produced stable anaesthesia suitable for painless clinical procedures. In contrast bolus administration, was unsatisfactory as birds awoke very suddenly, and the short intervals between bolus requirements hampered clinical procedures. Administration of additional oxygen throughout anaesthesia might reduce the incidence of low arterial haemoglobin saturation. © 2011 The Authors. Veterinary Anaesthesia and

Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging

International Nuclear Information System (INIS)

Faber, S.C.; Reiser, M.; Englmeier, K.H.

2001-01-01

Objective: To compare the cartilage thickness, volume, and articular surface areas of the knee joint between young healthy, non-athletic female and male individuals. Subjects and design. MR imaging was performed in 18 healthy subjects without local or systemic joints disease (9 female, age 22.3±2.4 years, and 9 male, age 22.2.±1.9 years), using a fat-suppressed FLASH 3D pulse sequence (TR=41 ms, TE=11 ms, FA=30 ) with sagittal orientation and a spatial resolution of 2x0.31x0.31 mm 3 . After three-dimensional reconstruction and triangulation of the knee joint cartilage plates, the cartilage thickness (mean and maximal), volume, and size of the articular surface area were quantified, independent of the original section orientation. Results and conclusions: Women displayed smaller cartilage volumes than men, the percentage difference ranging from 19.9% in the patella, to 46.6% in the medial tibia. The gender differences of the cartilage thickness were smaller, ranging from 2.0% in the femoral trochlea to 13.3% in the medial tibia for the mean thickness, and from 4.3% in the medial femoral condyle to 18.3% in the medial tibia for the maximal cartilage thickness. The differences between the cartilage surface areas were similar to those of the volumes, with values ranging from 21.0% in the femur to 33.4% in the lateral tibia. Gender differences could be reduced for cartilage volume and surface area when normalized to body weight and body weight x body height. The study demonstrates significant gender differences in cartilage volume and surface area of men and women, which need to be taken into account when retrospectively estimating articular cartilage loss in patients with symptoms of degenerative joint disease. Differences in cartilage volume are primarily due to differences in joint surface areas (epiphyseal bone size), not to differences in cartilage thickness. (orig.)

Esophagogastric junction outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit.

Science.gov (United States)

Zheng, E; Gideon, R M; Sloan, J; Katz, P O

2017-10-01

Currently, the diagnosis of esophageal motility disorders is in part based upon a hierarchical algorithm in which abnormalities of the esophagogastric junction (EGJ) is prioritized. An important metric in evaluating the EGJ is the integrated relaxation pressure (IRP). Patients who do not have achalasia but are found to have an elevated IRP are diagnosed with EGJ outflow obstruction. It has been our observation that a subset of these patients also has a second named motility disorder and may also have abnormal bolus transit. The aim of this study is to determine the frequency of abnormal body motility and or abnormal bolus movement in patients with EGJ outflow obstruction. Further, in an effort to evaluate the potential clinical value in measuring bolus transit as a complement to esophageal manometry, specifically in patients with EGJ outflow obstruction, we analyzed the presenting symptoms of these patients. A total of 807 patients with a mean age of 53 years completed esophageal function testing with impedance monitoring and high-resolution manometry between January 2012 and October 2016. There were 74 patients with achalasia who were excluded from the study. Of the remaining 733 patients, 138 (19%) had an elevated IRP and were given a diagnosis of EGJ outflow obstruction. Among these patients, 56 (40%) were diagnosed with an abnormal motility pattern to liquids (ineffective esophageal motility = 28, distal esophageal spasm = 19, Jackhammer = 6), of which 44 (76%) had abnormal bolus transit to liquids, viscous, or both. In contrast, there were 82 patients with EGJ outflow obstruction and normal esophageal motility, of which 33 (40%) had abnormal bolus transit. Patients with preserved esophageal motility and EGJ outflow obstruction were then evaluated. Of the 733 patients, 299 (40%) had intact esophageal motility. Of the 299 patients with normal esophageal motility, 56 patients had an elevated IRP, of which 16 (28%) had abnormal bolus transit. There were 243 (33

Improved target volume definition in radiosurgery of arteriovenous malformations by stereotactic correlation of MRA, MRI, blood bolus tagging, and functional MRI

International Nuclear Information System (INIS)

Schad, L.R.; Bock, M.; Baudendistel, K.; Essig, M.; Debus, J.; Knopp, M.V.; Engenhart, R.; Lorenz, W.J.

1996-01-01

The authors report the sterotactic correlation of different MRI-techniques [MR angiography (MRA), MRI, blood bolus tagging (STAR), and functional MRI] in 10 patients with cerebral arteriovenous malformations (AVM) and its application in precision radiotherapy planning. The patient's head was fixed in a stereotactic localization system. By phantom measurements different materials (steel, aluminium, titanium, plastic, wood, ceramics) used for the stereotactic system were tested for mechanical stability and geometrical MR image distortion. All metallic stereotactic rings led to a more or less dramatic geometrical distortion and signal cancellation in the MR images. The best properties - nearly no distortion and high mechanical stability - are provided by a ceramic ring. If necessary, the remaining geometrical MR image distortion can be 'corrected' by calculations based on modeling the distortion as a fourth-order 2D-polynomial. Using this method multimodality matching can be performed automatically as long as all images are acquired in the same examination and the patient is sufficiently immobilized. Precise definition of the target volume could be performed by the radiotherapist either directly in MR images or in calculated projection MR angiograms. As a result, information about the hemodynamics of the AVM was provided by a 3D-phase-contrast flow measurement and a dynamic MRA with the STAR technique leading to an improved definition of the size of the nidus, and the pattern of the venous drainage. In addition, functional MRI was performed in patients with lesions close to the primary motor cortex area leading to an improved definition of structures at risk for high-dose application in radiosurgery. (orig./MG)

Review article : intra-oesophageal impedance monitoring for the assessment of bolus transit and gastro-oesophageal reflux

NARCIS (Netherlands)

Conchillo, J. M.; Smout, A. J.

2009-01-01

Background Intra-oesophageal impedance monitoring can be used to assess the clearance of a swallowed bolus (oesophageal transit) and to detect gastro-oesophageal reflux independent of its acidity. Aim To discuss the clinical application of the impedance technique for the assessment of bolus transit

Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

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Nils Bjerregaard

2012-01-01

Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.

Dextrose boluses versus burette dextrose infusions in prevention of ...

African Journals Online (AJOL)

The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the ... and safety monitoring board (DSMB) was set up to oversee to ..... On the other hand, Namukwaya et al in a prospective study at Mulago ...

Impacts of palatal coverage on bolus formation during mastication and swallowing and subsequent adaptive changes.

Science.gov (United States)

Sato, T; Furuya, J; Tamada, Y; Kondo, H

2013-10-01

Palatal coverage is often required for elderly edentulous patients with complete dentures. The purpose of this study was to clarify impacts of palatal coverage on bolus formation and subsequent adaptive changes. Subjects were 18 healthy young dentulous adults who wore 1·5-mm-thick palatal plates. Subjects were asked to feed 12 g of bicoloured rice as usual, and the bolus formation by mastication and swallowing in the pharynx was observed using a nasal videoendoscopy. The bolus formation index (BFI), number of mastication strokes until swallowing, visual analogue scale about swallowing easiness and masticatory performance using colour-changeable gum were measured under three conditions: before placement of the palatal plate (day 0), immediately after placement (day 1) and after 7 days of wearing the plate (day 7). BFI and visual analogue scale on day 1 were significantly lower than those on day 0, but those on day 7 significantly recovered to the level of day 0. The number of mastication strokes did not change from day 0 to day 1, however, that on day 7 was significantly higher. Masticatory performance on days 1 and 7 was significantly lower than that on day 0. Although palatal coverage inhibits bolus formation during feeding, subjects increased the number of mastication strokes until swallowing threshold as they adapted to palatal coverage over time. This adaptive change was due to compensate for the lowered masticatory performance to achieve bolus formation for comfortable swallowing. © 2013 John Wiley & Sons Ltd.

MR liver imaging after bolus administration of Teslascan

International Nuclear Information System (INIS)

Costa, S.; Marti-Bonmati, L.; Delgado, F.; Torregrosa, A.

2003-01-01

Mn-DPDP (Teslascan. Amersham-Health) improves the detection of small hepatic lesions and the accuracy with which certain focal lesions can be characterized. Slow infusion (2-3 ml per minute) is the accepted European standard for its administration. Our aim was to evaluate the efficiency of bolus administration. A prospective MR evaluation at 0.5 was performed on 31 consecutive patients. A GE T1 sequence was performed on all before contrast administration. Teslascan was administered by rapid intravenous infusion (=1 ml/s), and the GE sequence was repeated and completed by an STIR sequence. Correlations between presence of cirrhosis and enhancement pattern of hepatic parenchyma, number of lesions detected before and after bolus administration, as well as lesion histology and degree of enhancement were all analyzed. Adverse clinical reactions as reported by patients were also noted. Cirrhotic liver was found in 49% of the patients. Enhancement was mainly heterogeneous with hypointense areas and heterogeneous with hypointense areas together with more greatly enhanced regenerative nodules. Enhancement of cirrhotic livers was homogeneous in a third of the cases. Non-cirrhotic patients exhibited a homogeneous hepatic mass in most cases,ith only one liver showing heterogeneous enhancement containing hypointense bands caused by necrotic debris having resulted from treated metastases. Enhancement pattern differences between cirrhotic and non-cirrhotic patients were statistically significant (p=0.001). In 20 of the 31 patients, solid focal lesions were detected. Sequences performed after bolus administration of contrast media detected more lesions than did those before administration. Combination of both post-administration sequences (T1 and STIR) detected the most lesions, with differences between it and pre-administration sequences being statistically significant (p=0.0014). There was observed a varying degree of lesion enhancement. Such variability was associated with the

Cerebral hemodynamic changes measured by gradient-echo or spin-echo bolus tracking and its correlation to changes in ICA blood flow measured by phase-mapping MRI

DEFF Research Database (Denmark)

Marstrand, J.R.; Rostrup, Egill; Garde, Ellen

2001-01-01

Changes in cerebral blood flow (CBF) induced by Acetazolamide (ACZ) were measured using dynamic susceptibility contrast MRI (DSC-MRI) with both spin echo (SE) EPI and gradient echo (GE) EPI, and related to changes in internal carotid artery (ICA) flow measured by phase-mapping. Also examined...... was the effect of repeated bolus injections. CBF, cerebral blood volume (CBV), and mean transit time (MTT) were calculated by singular value decomposition (SVD) and by deconvolution using an exponential function as kernel. The results showed no dependency on calculation method. GE-EPI measured a significant...... increase in CBF and CBV in response to ACZ, while SE-EPI measured a significant increase in CBV and MTT. CBV and MTT change measured by SE-EPI was sensitive to previous bolus injections. There was a significant linear relation between change in CBF measured by GE-EPI and change in ICA flow. In conclusion...

Causes of death after fluid bolus resuscitation: new insights from FEAST.

Science.gov (United States)

Myburgh, John; Finfer, Simon

2013-03-14

The Fluid Expansion as Supportive Therapy (FEAST study) was an extremely well conducted study that gave unexpected results. The investigators had reported that febrile children with impaired perfusion treated in low-income countries without access to intensive care are more likely to die if they receive bolus resuscitation with albumin or saline compared with no bolus resuscitation at all. In a secondary analysis of the trial, published in BMC Medicine, the authors found that increased mortality was evident in patients who presented with clinical features of severe shock in isolation or in conjunction with features of respiratory or neurological failure. The cause of excess deaths was primarily refractory shock and not fluid overload. These features are consistent with a potential cardiotoxic or ischemia-reperfusion injury following resuscitation with boluses of intravenous fluid. Although these effects may have been amplified by the absence of invasive monitoring, mechanical ventilation or vasopressors, the results provide compelling insights into the effects of intravenous fluid resuscitation and potential adverse effects that extend beyond the initial resuscitation period. These data add to the increasing body of literature about the safety and efficacy of intravenous resuscitation fluids, which may be applicable to management of other populations of critically ill patients.

A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

Directory of Open Access Journals (Sweden)

Joana Nunes

Full Text Available Abstract Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB compared to continuous epidural infusion (CEI leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 µg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2 µg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus; B - Ropivacaine 0.1% plus Sufentanil 0.2 µg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37. The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83. We found a higher caesarean delivery rate in group A (56.7%; p = 0.02. No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.

Evaluation of surface and shallow depth dose reductions using a Superflab bolus during conventional and advanced external beam radiotherapy.

Science.gov (United States)

Yoon, Jihyung; Xie, Yibo; Zhang, Rui

2018-03-01

The purpose of this study was to evaluate a methodology to reduce scatter and leakage radiations to patients' surface and shallow depths during conventional and advanced external beam radiotherapy. Superflab boluses of different thicknesses were placed on top of a stack of solid water phantoms, and the bolus effect on surface and shallow depth doses for both open and intensity-modulated radiotherapy (IMRT) beams was evaluated using thermoluminescent dosimeters and ion chamber measurements. Contralateral breast dose reduction caused by the bolus was evaluated by delivering clinical postmastectomy radiotherapy (PMRT) plans to an anthropomorphic phantom. For the solid water phantom measurements, surface dose reduction caused by the Superflab bolus was achieved only in out-of-field area and on the incident side of the beam, and the dose reduction increased with bolus thickness. The dose reduction caused by the bolus was more significant at closer distances from the beam. Most of the dose reductions occurred in the first 2-cm depth and stopped at 4-cm depth. For clinical PMRT treatment plans, surface dose reductions using a 1-cm Superflab bolus were up to 31% and 62% for volumetric-modulated arc therapy and 4-field IMRT, respectively, but there was no dose reduction for Tomotherapy. A Superflab bolus can be used to reduce surface and shallow depth doses during external beam radiotherapy when it is placed out of the beam and on the incident side of the beam. Although we only validated this dose reduction strategy for PMRT treatments, it is applicable to any external beam radiotherapy and can potentially reduce patients' risk of developing radiation-induced side effects. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

SU-F-T-325: On the Use of Bolus in Dosimetry and Dose Reduction for Pacemaker and Defibrillator

International Nuclear Information System (INIS)

Liu, W; Kenneth, R; Higgins, S; Nath, R; Zhu, D; Trumpore, S; Chen, Z

2016-01-01

Purpose: Special attention is required in planning and administering radiation therapy to patients with cardiac implantable electronic devices (CIEDs), such as pacemaker and defibrillator. The range of dose to CIEDs that can induce malfunction is very large among CIEDs. Significant defects have been reported at dose as low as 0.15Gy. Failures causing discomfort have been reported at dose as low as 0.05Gy. Therefore, accurate estimation of dose to CIED and dose reduction are both important even if the dose is expected to be less than the often-used 2Gy limit. We investigate the use of bolus in in vivo dosimetry for CIEDs. Methods: In our clinic, high-energy beams (>10MV) are not used for patients with CIED due to neutron production. Solid water phantom measurements of out-of-field dose for a 6MV beam were performed using parallel plate chamber at different depth with and without 2cm bolus covering the chamber. In vivo dosimetry at skin surface above the pacemaker was performed with and without bolus for 3 patients with pacemaker <5cm from the field edge. Results: Chamber measured dose at depth ∼1 to 1.5cm below the skin surface, where the CIED is normally located, was reduced by ∼6% – 20% with bolus. The dose reduction became smaller at deeper depth. In vivo dosimetry at skin surface also yielded ∼20% – 60% lower dose when using bolus for the 3 patients. In general, TPS calculation underestimated the dose. The dose measured with bolus is closer to the dose at the depth of the pacemaker and less affected by contaminant electrons and linac head leakage. Conclusion: In vivo CIED dose measurements should be performed with 1 to 2cm bolus covering the dosimeter on the skin above the CIED for more accurate CIED dose estimation. The use of bolus also reduces the dose delivered to CIED.

SU-F-T-325: On the Use of Bolus in Dosimetry and Dose Reduction for Pacemaker and Defibrillator

Energy Technology Data Exchange (ETDEWEB)

Liu, W; Kenneth, R; Higgins, S; Nath, R [Yale University School of Medicine, New Haven, CT (United States); Zhu, D [Saint Thomas Hospital, Murfreesboro, TN (United States); Trumpore, S [Yale-New Haven Hospital, New Haven, CT (United States); Chen, Z [Yale New Haven Hospital, New Haven, CT (United States)

2016-06-15

Purpose: Special attention is required in planning and administering radiation therapy to patients with cardiac implantable electronic devices (CIEDs), such as pacemaker and defibrillator. The range of dose to CIEDs that can induce malfunction is very large among CIEDs. Significant defects have been reported at dose as low as 0.15Gy. Failures causing discomfort have been reported at dose as low as 0.05Gy. Therefore, accurate estimation of dose to CIED and dose reduction are both important even if the dose is expected to be less than the often-used 2Gy limit. We investigate the use of bolus in in vivo dosimetry for CIEDs. Methods: In our clinic, high-energy beams (>10MV) are not used for patients with CIED due to neutron production. Solid water phantom measurements of out-of-field dose for a 6MV beam were performed using parallel plate chamber at different depth with and without 2cm bolus covering the chamber. In vivo dosimetry at skin surface above the pacemaker was performed with and without bolus for 3 patients with pacemaker <5cm from the field edge. Results: Chamber measured dose at depth ∼1 to 1.5cm below the skin surface, where the CIED is normally located, was reduced by ∼6% – 20% with bolus. The dose reduction became smaller at deeper depth. In vivo dosimetry at skin surface also yielded ∼20% – 60% lower dose when using bolus for the 3 patients. In general, TPS calculation underestimated the dose. The dose measured with bolus is closer to the dose at the depth of the pacemaker and less affected by contaminant electrons and linac head leakage. Conclusion: In vivo CIED dose measurements should be performed with 1 to 2cm bolus covering the dosimeter on the skin above the CIED for more accurate CIED dose estimation. The use of bolus also reduces the dose delivered to CIED.

Optimization of a beam shaping bolus for superficial microwave hyperthermia waveguide applicators using a finite element method

International Nuclear Information System (INIS)

Kumaradas, J Carl; Sherar, Michael D

2003-01-01

Temperature inhomogeneity in hyperthermia treatments often limits the total thermal dose that can be delivered to the tumour region. To reduce such inhomogeneities, a prototype dynamically modifiable square array of saline-filled patches which attenuate microwave energy was developed for superficial treatments that use external microwave applicators. The array was situated inside the coupling water bolus that is often used with external applicators. The prototype has been previously tested clinically with promising results. A more complete theoretical analysis of the performance of this new bolus design and improvements to its design by modelling are presented here. The analysis was performed by performing five iterative simulations of the SAR pattern produced inside a tissue structure by a waveguide applicator with a water bolus containing the dynamic patch array attached. Between iterations the patch array configuration was modified in an attempt to improve the ability of the bolus to confine heating to an 'L'-shaped tumour region. These simulations were performed using the finite element method. The steady-state temperature profile was then computed using a finite element method based simulation of heat transfer that assumed a given applicator power level and water bolus temperature. Several iterations of these heat transfer simulations were performed with varying applicator power level and water bolus temperature to improve the confinement of heating to the target region. The analysis showed that the dynamic patch array should be capable of conforming heating to an 'L'-shaped target tumour region while limiting the heating to the surrounding normal tissue to an acceptable level

Radionuclide esophageal transit of a liquid bolus: A reappraisal

International Nuclear Information System (INIS)

Holloway, R.H.; Lange, R.C.; Magyar, L.; Greene, R.; McCallum, R.W.

1984-01-01

Measurement of radionuclide esophageal transit (RT) using a liquid bolus has been suggested as a screening test for esophageal motor disorders (EMD). The authors prospectively evaluated RT in 49 patients referred for esophageal manometry. Ten subjects with normal manometry served as controls. RT was performed using two 10 ml boluses of water labeled with 250 μCi /sup 99m/Tc-sulfur colloid. Patients were studied supine and the swallow sequences framed in 1 second intervals. Transit time was measured from the time of entry to the time of exit from the esophagus. Mean transit time in normal subjects was 9.1 +- 2.1 (SD) sec. The test was abnormal if the transit time was prolonged (> 15 sec) in at least 1 of 2 swallows. RT agreed with manometry in 36/49 patients (75%), including 9/9 achalasics, 3/3 diffuse esophageal spasm, 3/7 'nutcracker esophagus' and 7/8 non-specific motor disorders (NSMD). 4/18 patients with normal manometry had abnormal RT. 9/31 patients with abnormal manometry had normal RT, including 4/7 nutcracker esophagus, 3/3 hypertrensive LES, 1/1 scleroderma and 1/8 NSMD. Sensitivity of RT was 70% and specificity 77%. The false positive rate was 15% and the false negative rate 39%. The authors conclude the following: 1) RT identifies patients with absent or impaired peristalsis; 2) There is substantial incidence of false negatives among patients with manometric disorders but normal peristalsis; and 3) Abnormal RT did occur in some patients with normal menometry. RT using a liquid bolus may not be sensitive enough as a screening test for EMD, but it may be an important adjunct to manometry

Perception of Diabetic Patients Regarding Basal Bolus Insulin Injections and Outcome of its Use

International Nuclear Information System (INIS)

Shahid, M.; Sarfraz, A.; Mahar, S. A.; Alam, M.; Shaikh, S.; Shahid, N.

2016-01-01

Objective: To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin (HbA1c) before and after 3 months of such treatment in diabetic patients. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015. Methodology: A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose (FBS), random blood glucose (RBS) and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p < 0.05. Results: Majority (n=217, 97.7 percentage) of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 ± 52.2 mg/dl, RBS was 385.5 percentage 47.61 mg/dl and HbA1c was 12.76 percentage 1.92 percentage. After 3 months of treatment, FBS improved to 117.9 ± 14.2 mg/dl, RBS was 156.7 ± 17.09 mg/dl and HbA1c was 7.72 ± 4.41 percentage (p < 0.001). Two hundred and sixteen (97.3 percentage) patients believed that basal bolus insulin was started as their diabetes worsened; 15 (70.70 percentage) thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four (87.4 percentage) had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 (70.7 percentage). One hundred and twenty seven (84.1 percentage) of the females and 51 (71.8 percentage) of the males thought that the basal bolus insulin regimen was too expensive (p=0.032). Conclusion: There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this

Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers

Energy Technology Data Exchange (ETDEWEB)

Schantz, Daryl I. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); University of Manitoba, Variety Children' s Heart Centre, Winnipeg, MB (Canada); Dragulescu, Andreea [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Memauri, Brett [University of Manitoba, Department of Radiology, St. Boniface General Hospital, Winnipeg, MB (Canada); Grotenhuis, Heynric B. [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); Wilhelmina Children' s Hospital, Utrecht (Netherlands); Seed, Mike; Grosse-Wortmann, Lars [The Hospital for Sick Children, The Labatt Family Heart Centre in the Department of Paediatrics, Toronto, ON (Canada); The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2016-10-15

Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a ''variable'' that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient. (orig.)

Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers

International Nuclear Information System (INIS)

Schantz, Daryl I.; Dragulescu, Andreea; Memauri, Brett; Grotenhuis, Heynric B.; Seed, Mike; Grosse-Wortmann, Lars

2016-01-01

Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. To evaluate the effects of volume administration on cardiac chamber volumes. Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a ''variable'' that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient. (orig.)

Ocular Dynamics of Bolus Ingestion of Eleis guineensis Sap (Palm ...

African Journals Online (AJOL)

Elaeis guineensis), and is widely consumed among the various ethnic nationalities in Nigeria. The effect of bolus ingestion of 600ml, palm wine was undertaken so as to determine its ocular dynamics in healthy volunteers. Results showed that ...

Review of adverse reactions, including anaphylaxis, in 4,260 intravenous bolus injections

International Nuclear Information System (INIS)

Kanal, E.; Applegate, G.R.; Gillen, C.P.

1990-01-01

This paper evaluates the incidence and type of adverse reactions to Gd-DTPA (Magnevist) after bolus administration in an active clinical MR setting. Between May 1988 and March 1990, 4,260 bolus intravenous injections of Gd-DTPA, 0.1 mmol/kg, were administered during clinical MR examinations. Patient tolerance and reactions were recorded in each instance. All cases of suspected local infiltration were excluded from this study. Review of this data revealed 15 instances of nausea and 12 of emesis following contrast administration. In addition, there were five or fewer cases of associated headaches, dizziness, odd tastes, seizures (with prior seizure histories) mild chest pain, palpitations, hives, or wheezing

Impaired bolus transit across the esophagogastric junction in postfundoplication dysphagia

NARCIS (Netherlands)

Scheffer, R. C. H.; Samsom, M.; Haverkamp, A.; Oors, J.; Hebbard, G. S.; Gooszen, H. G.

2005-01-01

This study assessed the effect of fundoplication on liquid and solid bolus transit across the esophagogastric junction (EGJ) in relation to EGJ dynamics and dysphagia. Twelve patients with gastro-esophageal reflux disease (GERD) were studied before and after fundoplication. Concurrent

Electrical characterization of bolus material as phantom for use in electrical impedance and computed tomography fusion imaging

Directory of Open Access Journals (Sweden)

Parvind Kaur Grewal

2014-04-01

Full Text Available Phantoms are widely used in medical imaging to predict image quality prior to clinical imaging. This paper discusses the possible use of bolus material, as a conductivity phantom, for validation and interpretation of electrical impedance tomography (EIT images. Bolus is commonly used in radiation therapy to mimic tissue. When irradiated, it has radiological characteristics similar to tissue. With increased research interest in CT/EIT fusion imaging there is a need to find a material which has both the absorption coefficient and electrical conductivity similar to biological tissues. In the present study the electrical properties, specifically resistivity, of various commercially available bolus materials were characterized by comparing their frequency response with that of in-vivo connective adipose tissue. It was determined that the resistivity of Gelatin Bolus is similar to in-vivo tissue in the frequency range 10 kHz to 1MHz and therefore has potential to be used in EIT/CT fusion imaging studies.

The Impact of Injector-Based Contrast Agent Administration on Bolus Shape and Magnetic Resonance Angiography Image Quality.

Science.gov (United States)

Jost, Gregor; Endrikat, Jan; Pietsch, Hubertus

2017-01-01

To compare injector-based contrast agent (CA) administration with hand injection in magnetic resonance angiography (MRA). Gadobutrol was administered in 6 minipigs with 3 protocols: (a) hand injection (one senior technician), (b) hand injection (6 less-experienced technicians), and (c) power injector administration. The arterial bolus shape was quantified by test bolus measurements. A head and neck MRA was performed for quantitative and qualitative comparison of signal enhancement. A significantly shorter time to peak was observed for protocol C, whereas no significant differences between protocols were found for peak height and bolus width. However, for protocol C, these parameters showed a much lower variation. The MRA revealed a significantly higher signal-to-noise ratio for injector-based administration. A superimposed strong contrast of the jugular vein was found in 50% of the hand injections. Injector-based CA administration results in a more standardized bolus shape, a higher vascular contrast, and a more robust visualization of target vessels.

The Impact of Injector-Based Contrast Agent Administration on Bolus Shape and Magnetic Resonance Angiography Image Quality

Directory of Open Access Journals (Sweden)

Gregor Jost

2017-04-01

Full Text Available Objective: To compare injector-based contrast agent (CA administration with hand injection in magnetic resonance angiography (MRA. Methods: Gadobutrol was administered in 6 minipigs with 3 protocols: (a hand injection (one senior technician, (b hand injection (6 less-experienced technicians, and (c power injector administration. The arterial bolus shape was quantified by test bolus measurements. A head and neck MRA was performed for quantitative and qualitative comparison of signal enhancement. Results: A significantly shorter time to peak was observed for protocol C, whereas no significant differences between protocols were found for peak height and bolus width. However, for protocol C, these parameters showed a much lower variation. The MRA revealed a significantly higher signal-to-noise ratio for injector-based administration. A superimposed strong contrast of the jugular vein was found in 50% of the hand injections. Conclusions: Injector-based CA administration results in a more standardized bolus shape, a higher vascular contrast, and a more robust visualization of target vessels.

A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia.

Science.gov (United States)

Nunes, Joana; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, Isabel

2016-01-01

There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

A prospective, randomized, blinded-endpoint, controlled study – continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

Directory of Open Access Journals (Sweden)

Joana Nunes

2016-09-01

Full Text Available Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB compared to continuous epidural infusion (CEI leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 μg, parturient were randomly assigned to one of three regimens: A – Ropivacaine 0.15% plus Sufentanil 0.2 μg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus; B – Ropivacaine 0.1% plus Sufentanil 0.2 μg/mL as programmed intermittent epidural bolus and C – Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37. The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83. We found a higher caesarean delivery rate in group A (56.7%; p = 0.02. No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Resumo: Justificativa: Há evidências de que a administração de um bolus epidural intermitente programado (BEIP comparada à infusão epidural contínua (IEC resulta em maior eficácia da analgesia e da satisfação materna, com redução das intervenções anestésicas. Métodos: Neste estudo, 166

Normative values for volume and fat content of the hip abductor muscles and their dependence on side, age and gender in a healthy population.

Science.gov (United States)

Marcon, Magda; Berger, Nicole; Manoliu, Andrei; Fischer, Michael A; Nanz, Daniel; Andreisek, Gustav; Ulbrich, Erika J

2016-04-01

To determine normative values for volume and fat content of the gluteus medius (GMed) and minimus (GMin) muscle in healthy volunteers and to evaluate their dependence on age, gender and leg dominance. The IRB approval was obtained for this study. 80 healthy volunteers (females, 40; males, 40; age range 20-62 years), divided into four age groups, were included. Fat- and water-signal-separated MR images of the pelvis were acquired on a 3.0 T MR with a 3-point mDIXON sequence. Normalized volume and fat-signal fraction (FSF) of the GMed (ViGMed, FSFGMed) and GMin (ViGMin, FSFGMin) muscles were determined. The overall mean volumes (normalized) and FSF ± SD: ViGMed 105.13 ± 16.30 cm(3); ViGMin 30.24 ± 5.15 cm(3); FSFGMed 8.13 ± 1.70 % and FSFGMin 9.89 ± 2.72 %. Comparing different age subgroups within each gender no significant differences were found concerning the volumes and FSFs (except FSFGMin in male subgroup aged 20-29 versus 50-62 years, P = 0.014). Comparing FSFs differences between the two genders, only in 20-29 years subgroup, FSFGMed (P =0.003) and FSFGMin (P =0.002) were greater in female. Volume differences between the two legs were not significant (P > 0.077); FSFGMed and FSFGMin (P =0.005 for both) were significantly lower in the dominant leg in female but not in male group (P = 0.454 for FSFGMed and P = 0.643 for FSFMin). No age dependency was evident for volume normative data for GMed and GMin and normative data for FSF values showed no age- or gender dependency.

Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care.

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van Paridon, Bregje M; Sheppard, Cathy; G, Garcia Guerra; Joffe, Ari R

2015-08-17

Early administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited. The Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent. Timing of interventions were determined by retrospective chart review using a study manual and case-report-form. We aimed to determine the association of intervention timing and outcome in children with sepsis. Univariate (t-test and Fisher's Exact) and multiple linear regression statistics evaluated predictors of outcomes of PICU length of stay (LOS) and ventilation days. Seventy-nine children, age median 60 (IQR 22-133) months, 40 (51%) female, 39 (49%) with severe underlying co-morbidity, 44 (56%) with septic shock, and median PRISM-III 10.5 [IQR 6.0-17.0] were enrolled. Most patients presented in an ED: 36 (46%) at an outlying hospital ED, and 21 (27%) at the Children's Hospital ED. Most infections were pneumonia with/without empyema (42, 53%), meningitis (11, 14%), or bacteremia (10, 13%). The time from presentation to acceptable antibiotic administration was a median of 115.0 [IQR 59.0-323.0] minutes; 20 (25%) of patients received their antibiotics in the first hour from presentation. Independent predictors of PICU LOS were PRISM-III, and severe underlying co-morbidity, but not time to antibiotics. In the septic shock subgroup, the volume of fluid boluses given in the first 2 hours was independently associated with longer PICU LOS (effect size 0.22 days; 95% CI 0.5, 0.38; per ml/kg). Independent predictors of ventilator days were PRISM-III score and severe underlying co-morbidity. In the septic shock subgroup, volume of fluid boluses in the first 2 hours was independently associated with more ventilator days

Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus

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Han, T.-H.; Martyn, J. A. J.

2009-01-01

Background Burn injury leads to resistance to the effects of non-depolarizing muscle relaxants. We tested the hypothesis that a larger bolus dose is as effective as priming for rapid onset of paralysis after burns. Methods Ninety adults, aged 18–59 yr with 40 (2)% [mean (se)] burn and 30 (2) days after injury, received rocuronium as a priming dose followed by bolus (0.06+0.94 mg kg−1), or single bolus of either 1.0 or 1.5 mg kg−1. Sixty-one non-burned, receiving 1.0 mg kg−1 as a primed (0.06+0.94 mg kg−1) or full bolus dose, served as controls. Acceleromyography measured the onset times. Results Priming when compared with 1.0 mg kg−1 bolus in burned patients shortened the time to first appearance of twitch depression (30 vs 45 s, P<0.05) and time to maximum twitch inhibition (135 vs 210 s, P<0.05). The onset times between priming and higher bolus dose (1.5 mg kg−1) were not different (30 vs 30 s for first twitch depression and 135 vs 135 s for maximal depression, respectively). The onset times in controls, however, were significantly (P<0.05) faster than burns both for priming and for full bolus (15 and 15 s, respectively, for first twitch depression and 75 and 75 s for maximal depression). Priming caused respiratory distress in 10% of patients in both groups. Intubating conditions in burns were significantly better with 1.5 mg kg−1 than with priming or full 1.0 mg kg−1 bolus. Conclusions A dose of 1.5 mg kg−1 not only produces an initial onset of paralysis as early as 30 s, which we speculate could be a reasonable onset time for relief of laryngospasm, but also has an onset as fast as priming with superior intubating conditions and no respiratory side-effects. PMID:19029093

Use of cornmeal bolus as an aid in obtaining cranial four-vessel angiograms.

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Weathers, R M; Lee, A

1975-01-01

In cranial angiography it has always been difficult to visualize extracranial vessels of the cervico-thoracic region, upon one radiograph, by using the same exposure factors for both regions. For this reason, we experimented and found that by applying a dry cornmeal bolus on specific areas of the neck a technically superior radiograph of these regions can be achieved. This bolus simulated added soft tissue to the cervical region. The density of the cervical region is now similar to that of the upper thoracic. As a result, factors set for one exposure will adequately penetrate both areas.

[Simultaneous determination of five effective components in Sijunzi bolus using high performance liquid chromatography-evaporation light scattering detection].

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Li, Chunying; Zhang, Xiaojun

2010-01-01

A high performance liquid chromatographic (HPLC) method was developed for the simultaneous determination of lobetyolin, pachymic acid, glycyrrhizic acid, atractylenoide III and atractylenolide I in Sijunzi bolus. The separation was performed on an HIQ SIL C18 V column (250 mm x 4.6 mm, 5 microm) with 0.5% acetic acid-methanol as the mobile phase of gradient elution at a flow rate of 1.0 mL/min. The detection was performed with an evaporation light scattering detector (ELSD) and the sample volume was 10 microL. The temperature of drift tube and heating grade of nebulizer was respectively set at 55 degrees C and 60% at 0.2 MPa of pressure. Nitrogen gas was used as carrier gas. Under the optimized conditions, there were good linear relationships between the logarithm values of mass concentration and the peak areas of lobetyolin, pachymic acid, glycyrrhizic acid, atractylenoide III and atractylenolide I in the ranges of 0.076 - 1.21, 0.048 -0.76, 0.153 - 2.45, 0.045 - 0.72 and 0.098 - 1.56 g/L, respectively. The recoveries of the five components were between 97.13% and 100.25%, the relative standard deviations (RSDs) were between 1.23% and 2.44%. This method is simple, rapid, accurate and suitable for the quality control of Sijunzi bolus.

Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial

NARCIS (Netherlands)

Mungroop, Timothy H.; van Samkar, Ganapathy; Geerts, Bart F.; van Dieren, Susan; Besselink, Marc G.; Veelo, Denise P.; Lirk, Philipp

2017-01-01

Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine

Post-mastectomy radiation therapy without usage of a bolus may be a reasonable option

International Nuclear Information System (INIS)

Nakamura, Naoki; Arahira, Satoko; Zenda, Sadamoto; Yoneyama, Kimiyasu; Mukai, Hirofumi; Onozawa, Masakatsu; Toshima, Masamichi; Motegi, Atsushi; Hirano, Yasuhiro; Hojo, Hidehiro; Kibe, Yuichi; Akimoto, Tetsuo

2017-01-01

To clarify the efficacy and toxicity of post-mastectomy radiation therapy (PMRT) without usage of a bolus, we identified 129 consecutive patients who received PMRT at the National Cancer Center Hospital East between 2003 and 2012. Seven of the 129 patients who received breast reconstruction before PMRT were excluded. All patients received PMRT of 6 MV photons, without usage of a bolus. The median follow-up duration for all eligible patients was 47.7 months (range: 4.0–123.2). Local, locoregional and isolated locoregional recurrence was found in 12 (9.8%), 14 (11%) and 5 patients (4.1%), respectively. The 3- and 5-year cumulative incidence of local recurrence, locoregional recurrence and isolated locoregional recurrence was 9.2 and 10.7%, 10.8 and 12.4%, and 4.3 and 4.3%, respectively. Although Grade 2 dermatitis was found in 11 patients (9.0%), no Grade 3–4 dermatitis was found. On univariate analysis, only a non-luminal subtype was a significant predictor for local recurrence (P < 0.001). On multivariate analysis, a non-luminal subtype remained as an independent predictor for local recurrence (P = 0.003, odds ratio: 10.9, 95% confidence interval: 2.23–53.1). In conclusion, PMRT without usage of a bolus resulted in a low rate of severe acute dermatitis without an apparent increase in local recurrence. PMRT without usage of a bolus may be reasonable, especially for patients with a luminal subtype.

The velocity of a radioactive bolus in the oesophagus evaluated by means of an image segmentation algorithm

International Nuclear Information System (INIS)

Miquelin, Charlie A; Dantas, Roberto O; Oliveira, Ricardo B; Braga, Francisco Jos H. N

2002-01-01

Classical scintigraphic evaluation of a radioactive bolus through the oesophagus is based on regions of interest and time/activity curves, which only gives information about the total time required for it to cross the organ. Instantaneous parameters can be obtained if the exact position (centroid) of the bolus is known. For that, one needs to know the co-ordinates of the centre of mass of the bolus radioactivity distribution. From this, one can obtain velocity at each time. Obtaining such a new parameter would be important, to try to determine whether the anatomical differences among the 3 thirds of the oesophagus have a functional correspondence or not. We have studied 5 normal volunteers (4 males, 1 female, 33-68 yo). Each volunteer swallowed (unique swallowing) 40 MBq of 99mTc-phytate in 10 ml water. Eighty frames (0.3 sec) were acquired in a scintillation camera. External marks were used to separate the pharynx from the oesophagus. Images were transformed into bitmap by means of a Sophy Medical processing module and analysed by means of the algorithm, which determines the co-ordinates of the centroid (horizontal and vertical) for each frame and instant velocities through the organ. Different velocities were found in typical evaluations. Curves representing the different positions of the bolus C and the correspondent different Vs were obtained. Different velocities of the bolus were detected during the pharyngeal phase, and proximal, mid and distal parts of the oesophagus. Larger studies are necessary, but it seems that the velocity of a radioactive bolus changes in the different parts of the oesophagus. It is reasonable to say that there is a functional correspondence to the anatomical differences in the organ (Au)

WE-F-16A-05: Use of 3D-Printers to Create a Tissue Equivalent 3D-Bolus for External Beam Therapy

Energy Technology Data Exchange (ETDEWEB)

Burleson, S; Baker, J; Hsia, A; Xu, Z [Stony Brook Medicine, Stony Brook, NY (United States)

2014-06-15

Purpose: The purpose of this project is to demonstrate that a non-expensive 3D-printer can be used to manufacture a 3D-bolus for external beam therapy. The printed bolus then can be modeled in our treatment planning system to ensure accurate dose delivery to the patient. Methods: We developed a simple method to manufacture a patient-specific custom 3Dbolus. The bolus is designed using Eclipse Treatment Planning System, contoured onto the patients CT images. The bolus file is exported from Eclipse to 3D-printer software, and then printed using a 3D printer. Various tests were completed to determine the properties of the printing material. Percent depth dose curves in this material were measured with electron and photon beams for comparison to other materials. In order to test the validity of the 3D printed bolus for treatment planning, a custom bolus was printed and tested on the Rando phantom using film for a dose plane comparison. We compared the dose plane measured on the film to the same dose plane exported from our treatment planning system using Film QA software. The gamma-dose distribution tool was used in our film analysis. Results: We compared point measurements throughout the dose plane and were able to achieve greater than 95% passing rate at 3% dose difference and 3 mm distance to agreement, which is our departments acceptable gamma pixel parameters. Conclusion: The printed 3D bolus has proven to be accurately modeled in our treatment planning system, it is more conformal to the patient surface and more durable than other bolus currently used (wax, superflab etc.). It is also more convenient and less costly than comparable bolus from milling machine companies.

WE-F-16A-05: Use of 3D-Printers to Create a Tissue Equivalent 3D-Bolus for External Beam Therapy

International Nuclear Information System (INIS)

Burleson, S; Baker, J; Hsia, A; Xu, Z

2014-01-01

Purpose: The purpose of this project is to demonstrate that a non-expensive 3D-printer can be used to manufacture a 3D-bolus for external beam therapy. The printed bolus then can be modeled in our treatment planning system to ensure accurate dose delivery to the patient. Methods: We developed a simple method to manufacture a patient-specific custom 3Dbolus. The bolus is designed using Eclipse Treatment Planning System, contoured onto the patients CT images. The bolus file is exported from Eclipse to 3D-printer software, and then printed using a 3D printer. Various tests were completed to determine the properties of the printing material. Percent depth dose curves in this material were measured with electron and photon beams for comparison to other materials. In order to test the validity of the 3D printed bolus for treatment planning, a custom bolus was printed and tested on the Rando phantom using film for a dose plane comparison. We compared the dose plane measured on the film to the same dose plane exported from our treatment planning system using Film QA software. The gamma-dose distribution tool was used in our film analysis. Results: We compared point measurements throughout the dose plane and were able to achieve greater than 95% passing rate at 3% dose difference and 3 mm distance to agreement, which is our departments acceptable gamma pixel parameters. Conclusion: The printed 3D bolus has proven to be accurately modeled in our treatment planning system, it is more conformal to the patient surface and more durable than other bolus currently used (wax, superflab etc.). It is also more convenient and less costly than comparable bolus from milling machine companies

Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals.

Science.gov (United States)

Cisternas, D; Scheerens, C; Omari, T; Monrroy, H; Hani, A; Leguizamo, A; Bilder, C; Ditaranto, A; Ruiz de León, A; Pérez de la Serna, J; Valdovinos, M A; Coello, R; Abrahao, L; Remes-Troche, J; Meixueiro, A; Zavala, M A; Marin, I; Serra, J

2017-09-01

Previous studies have not been able to correlate manometry findings with bolus perception. The aim of this study was to evaluate correlation of different variables, including traditional manometric variables (at diagnostic and extreme thresholds), esophageal shortening, bolus transit, automated impedance manometry (AIM) metrics and mood with bolus passage perception in a large cohort of asymptomatic individuals. High resolution manometry (HRM) was performed in healthy individuals from nine centers. Perception was evaluated using a 5-point Likert scale. Anxiety was evaluated using Hospitalized Anxiety and Depression scale (HAD). Subgroup analysis was also performed classifying studies into normal, hypotensive, vigorous, and obstructive patterns. One hundred fifteen studies were analyzed (69 using HRM and 46 using high resolution impedance manometry (HRIM); 3.5% swallows in 9.6% of volunteers were perceived. There was no correlation of any of the traditional HRM variables, esophageal shortening, AIM metrics nor bolus transit with perception scores. There was no HRM variable showing difference in perception when comparing normal vs extreme values (percentile 1 or 99). Anxiety but not depression was correlated with perception. Among hypotensive pattern, anxiety was a strong predictor of variance in perception (R 2 up to .70). Bolus perception is less common than abnormal motility among healthy individuals. Neither esophageal motor function nor bolus dynamics evaluated with several techniques seems to explain differences in bolus perception. Different mechanisms seem to be relevant in different manometric patterns. Anxiety is a significant predictor of bolus perception in the context of hypotensive motility. © 2017 John Wiley & Sons Ltd.

Evaluation of the esophagus with a marshmallow bolus: clarifying the cause of dysphagia.

Science.gov (United States)

Ott, D J; Kelley, T F; Chen, M Y; Gelfand, D W

1991-01-01

We reviewed the radiographic examinations of the esophagus and medical records in 117 patients (55 women and 62 men; mean age, 52 years) in which a marshmallow bolus was also given. A one-third to one-half piece of a standard marshmallow was used with a mean size of 23 mm (+/- 4.5 mm SD) measured in vivo. In 62 patients with no intrinsic structural narrowing of the esophagus, impaction occurred in only seven (11%). Four of these patients had an esophageal motility disorder, and three had a previous Nissen fundoplication. The remaining 55 patients had lower esophageal mucosal rings (47) or peptic strictures (8). Marshmallow impaction was seen in 27 of 47 rings (57%) and was inversely related to ring size, and in six of eight strictures (75%). Also, impaction was related to the ratio of bolus size to ring caliber, and invariably occurred when this ratio was greater than 1.5. Dysphagia was the presenting complaint in 76 (65%) patients, but was found equally in those without intrinsic narrowing and in those with ring or stricture. However, dysphagia was reproduced by the marshmallow bolus only in patients with esophageal narrowing or abnormal motility.

Replacement of oxytocin bolus administration by infusion: influences on postpartum outcome.

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Löytved-Hardegg, Julia J; Brunner, Mirjam; Ries, Jean-Jacques; von Felten, Stefanie; Heugel, Christina; Lapaire, Olav; Voekt, Cora; Hösli, Irene

2016-06-01

Postpartum haemorrhage (PPH) represents a leading cause of maternal morbidity and mortality. Giving oxytocin after birth reduces the risk for PPH. It has never been tested whether different methods of oxytocin administration affect the maternal outcome. This study aims to compare the infusion versus the bolus application of oxytocin after singleton vaginal delivery. This retrospective monocentre study compares the incidence of clinically relevant postpartum complications in women receiving 5 IE of oxytocin as a bolus or as a 100 ml-infusion over 5 min, given immediately after birth. Included were women delivering singletons vaginally at term. We used propensity score weighting to compare outcomes between women receiving bolus and infusion and to minimize the selection bias in this retrospective cohort. 1765 patients were included. Patient characteristics were balanced. We found no significant differences for the combined overall postpartum adverse outcome (the incidence of PPH, manual removal of the placenta and/or curettage). For the single outcomes, we observed a significantly higher frequency of manual removal of the placenta (Odds ratio 1.47, 95 % CI 1.02-2.13) and a slightly higher but clinically not relevant estimated blood loss (Relative effect 1.05, 95 % CI 1.01-1.10) in the infusion group. The data show a tendency towards more complications in the infusion group. It is related to a more frequent need for manual removal of the placenta.

Continuous indomethacin infusion may be less effective than bolus infusions for ductal closure in very low birth weight infants

NARCIS (Netherlands)

de Vries, NKS; Jagroep, FK; Jaarsma, AS; Elzenga, NJ; Bos, AF

The effectiveness of continuous indomethacin (INDO) infusion versus bolus infusions for closure of patent ductus arteriosus (PDA) was investigated. The study design was an open-label case series (continuous INDO) with historic controls matched for gestational age (bolus INDO). Ductal closure rates

Implementation of a split-bolus single-pass CT protocol at a UK major trauma centre to reduce excess radiation dose in trauma pan-CT

International Nuclear Information System (INIS)

Leung, V.; Sastry, A.; Woo, T.D.; Jones, H.R.

2015-01-01

Aim: To quantify the dose reduction and ensure that the use of a split-bolus protocol provided sufficient vascular enhancement. Materials and methods: Between 1 January 2014 and 31 May 2014, both split bolus and traditional two-phase scans were performed on a single CT scanner (SOMATOM Definition AS+, Siemens Healthcare) using a two-pump injector (Medrad Stellant). Both protocols used Siemens' proprietary tube current and tube voltage modulation techniques (CARE dose and CARE kV). The protocols were compared retrospectively to assess the dose–length product (DLP), aortic radiodensity at the level of the coeliac axis and radiodensity of the portal vein. Results: There were 151 trauma CT examinations during this period. Seventy-eight used the split-bolus protocol. Seventy-one had traditional two-phase imaging. One patient was excluded as they were under the age of 18 years. The radiodensity measurements for the portal vein were significantly higher (p<0.001) in the split-bolus protocol. The mean aortic enhancement in both protocols exceeded 250 HU, although the traditional two-phase protocol gave greater arterial enhancement (p<0.001) than the split-bolus protocol. The split-bolus protocol had a significantly lower (p<0.001) DLP with 43.5% reduction in the mean DLP compared to the traditional protocol. Conclusion: Split-bolus CT imaging offers significant dose reduction for this relatively young population while retaining both arterial and venous enhancement. -- Highlights: •We implemented a split bolus pan-CT protocol for trauma CT. •We compared the radiation dose and vascular enhancement of the split bolus protocol to a traditional two phase protocol. •The split bolus protocol had a 43.5% reduction in mean DLP

Comparison of Bolus Phenylephrine, Ephedrine and Mephentermine for Maintenance of Arterial Pressure during Spinal Anesth

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B Bhattarai

2010-03-01

Full Text Available INTRODUCTION: Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine. METHODS: The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. Group P received bolus of Phenylephrine 25 microgram, where as group E received Ephedrine 5mg and Group M received Mephentermine 6mg. RESULTS: It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine. Neonatal APGAR score were similar in all three groups. CONCLUSIONS: All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration. Keywords: APGAR, ephedrine, hypotension, mephentermine, phenylephrine, spinal anesthesia.

"The relationship between pharmacokinetic variables and pharmacodynamic profiles of bolus versus continuous infusion of furosemide in critically ill patients"

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"Mojtaba Mojtahedzadeh

2005-05-01

Full Text Available In this investigation, the pharmacokinetic variables of continuous infusion and intermittent bolus injection of furosemide and the possible relationship between its pharmacokinetic characteristics and pharmacodynamic profile among intensive care unit (ICU patients were studied. In this prospective, randomized, clinical trial, twelve patients received IV bolus of 20 mg of the drug during 3 hours period and, the drug dose was doubled, when the urine output was less than 1 ml/kg/h (group 1. The other nine patients received a continuous intravenous furosemide infusion at the rate of 0.1 mg/kg/h (group 2. The amount of furosemide in serum was measured by high performance liquid chromatography (HPLC. Results showed a positive correlation between plasma clearance of furosemide and its diuretic activity (P=0.01. The pharmacokinetic parameters such as Vd (l, CL (ml/min, Ke (min-1 and t½ (min in continuous infusion patients were not significantly differed from the bolus patients (P-values 0.5, 0.9, 0.9,0.9, respectively. Nevertheless the observed plasma clearance of drug in the continuous infusion group was clinically higher than bolus injection group and as a result the cumulative urine output per hour per mg of furosemide in a continuous infusion was observed to be higher than bolus(P=0.2. Changes in serum sodium and potassium were similar for both groups, but bolus injection patients were associated with higher potassium depletion (P=0.001. Therefore, continuous infusion seems to be better means of diuretic therapy in critically ill patients.

Rapid Bolus Administration Does not Increase The Extravasation Rate of Albumin: A Randomized Controlled Trial in The Endotoxemic Pig.

Science.gov (United States)

von Seth, Magnus; Lipcsey, Miklós; Engström, Peter; Larsson, Anders; Hillered, Lars; Maripuu, Enn; Widström, Charles; Sjölin, Jan

2017-04-01

Some experimental data suggest that rapid bolus administration of albumin causes less plasma-expanding effects than slow, continuous infusion. To determine whether rapid bolus administration, in comparison with slow infusion, results in greater extravasation of albumin in experimental septic shock we performed a randomized controlled trial with 32 endotoxemic pigs. The animals were monitored and ventilated with standard intensive care equipment and given 10 mL × kg 5% albumin labeled with Technetium-99m, either as a rapid 15-min bolus (Bolus group, n = 16) or as a 2-h infusion (Infusion group, n = 16). Radioactivity was monitored in plasma, extracellular microdialysate, and urine for 6 h. Physiological parameters were monitored hourly. Radioactivity in the liver, spleen, kidney, and lung was analyzed post mortem.The plasma area under the curve activity0-6 h was 4.4 ± 0.9 × 10 in the Bolus group and 4.4 ± 1.1 × 10 counts × min × mL × h in the Infusion group. Blood hemoglobin levels increased in both groups, suggesting severe capillary leakage. Yet, there were no group differences in albumin radioactivity in plasma, muscle tissue, urine, or in the post-mortem analysis of the organs. Following albumin administration, circulatory and respiratory parameters were similar in the two groups.In conclusion, the present results suggest that albumin might be given as a bolus without leading to increased extravasation of albumin, in contrast to previous animal experiments in rodents.

Normal mediastinal and hilar lymph nodes evaluated by 5 mm slice bolus injection CT scan

International Nuclear Information System (INIS)

Yamamoto, Takako; Tsukada, Hiroshi; Koizumi, Naoya; Akita, Shinichi; Oda, Junichi; Sakai, Kunio

1995-01-01

We evaluated the number and size of normal mediastinal and hilar lymph nodes by 5 mm slice bolus injection CT (12 patients), compared with 10 mm slice CT (12 patients). More lymph nodes were clearly demonstrated by 5 mm slice CT than by 10 mm slice CT. Especially left-sided tracheobronchial (no.4), subaortic (no.5), subcarinal (no.7) and hilar lymph nodes were clearly visible. We concluded 5 mm slice bolus injection CT was useful to evaluate mediastinal and hilar lymph nodes. (author)

Should colloid boluses be prioritized over crystalloid boluses for the management of dengue shock syndrome in the presence of ascites and pleural effusions?

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Weerasinghe Mindu

2011-02-01

Full Text Available Abstract Background Although the WHO guideline for the management of dengue fever considers the presence of ascites or pleural effusions in the diagnosis of DSS, it does not emphasize the importance of their presence when selecting fluids for resuscitation. Case presentation We highlight three patients with DSS who received boluses of crystalloids on priority basis as recommended by WHO guidelines during resuscitation. All three patients had varying degrees of third space fluid loss (ascites and pleural effusions at the time of development of DSS. Ascites and pleural effusions were detected in all 3 patients at the time of shock irrespective of whether iv fluids were given or not. All three patients had documented liver involvement at the time of shock evidenced by elevation of AST (4800 iu/L, 5000 iu/L and 1960 iu/L. One patient who had profound shock died 6 hours after admission with evidence of acute pulmonary oedema in the convalescence phase. All of them needed CPAP ventilator support and potent diuretics. Conclusions We therefore feel that resuscitation of patients with DSS who already have third space fluid accumulation with crystalloid boluses on priority basis may contribute to recovery phase pulmonary oedema.

21 CFR 520.1720a - Phenylbutazone tablets and boluses.

Science.gov (United States)

2010-04-01

... Section 520.1720a Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES...-mg or 1-g tablets, or 2- or 4-g boluses, in dogs and horses. (2) Nos. 000010 and 059130 for use of 100- or 200-mg or 1-g tablets in dogs and horses. (3) Nos. 000856 and 061623 for use of 100-mg or 1-g...

Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial

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Rao Kadam V

2017-07-01

Full Text Available Vasanth Rao Kadam,1 Roelof M Van Wijk,1 John L Moran,2 Shantan Ganesh,3 A Kumar,1 Rajesh Sethi,1 Patricia Williams2,4 1Department of Anaesthesia, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 2Intensive Care Unit, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 3Department of Surgery, The Queen Elizabeth Hospital, School of Medicine, University of Adelaide, Adelaide, SA, 4Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia Background: Continuous and intermittent bolus techniques of transversus abdominis plane (TAP blocks have been used for analgesia after abdominal surgery. Although both are effective, there are no studies comparing them. The aim of this study is to compare analgesia and cost-effectiveness between these groups.Methods: After obtaining ethical approval, 20 American Society of Anesthesiologists ASA grade I to III patients undergoing elective abdominal surgery were recruited with 10 patients allocated to each arm. Bilateral ultrasound-guided TAP blocks were performed with an initial bolus of 0.5% ropivacaine 20 mL per side, followed by catheter insertion. After surgery, the continuous infusion group received 0.2% ropivacaine 8 mL/hour on each side and the intermittent bolus group received doses of 0.2% ropivacaine 20 mL per side every 8 hours for 48 hours. Both groups received intravenous fentanyl patient-controlled analgesia and regular oral paracetamol. Parameters recorded included numerical rating scores for pain and post-operative analgesic consumption at baseline (time 0 and at 1 hour, 1 day and 2 days post-operatively. The duration of catheter insertion, complications, patient satisfaction and information regarding costs were also recorded. Patient satisfaction was assessed utilizing a 4-point �

The influence of a slow-release multi-trace element ruminal bolus on trace element status, number of ovarian follicles and pregnancy outcomes in synchronized Afshari ewes

Science.gov (United States)

Abdollahi, E.; Kohram, H.; Shahir, M. H.; Nemati, M. H.

2015-01-01

Published data on the effects of ruminal bolus on the number of ovulatory follicles in ewes does not exist. The present study determined the effects of a ruminal bolus on trace element status, follicular dynamics and reproductive performance in ewes. Eighty Afshari cycling ewes were synchronized during breeding season using CIDR for 14 days and assigned to 4 groups (n=20); group 1 received a single Ferrobloc bolus four weeks prior to CIDR insertion following 400 IU eCG on CIDR removal, group 2 received two boluses four weeks prior to CIDR insertion following 400 IU eCG on CIDR removal, group 3 received only 400 IU eCG on CIDR removal and group 4 (control) received no bolus and no eCG. Transrectal ultrasonography was done to monitor the ovarian follicles on the day of CIDR removal and a day later. Results showed that boluses increased the status of copper, selenium and iodine on mating day and days 90 to 100 of gestation. Ruminal bolus did not significantly increase the number of different classes of ovarian follicles in ewes fed a diet meeting all trace mineral requirements. All ewes eventually became pregnant with 1 or 2 boluses but the multiple births rate (80%) was higher (P<0.05) after 2 boluses compared to the other groups. PMID:27175153

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

OpenAIRE

Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro

2017-01-01

Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery ...

Comparison between intravenous boluses versus infusion of tranexamic acid (TXA) to reduce bleeding in paediatric cyanotic congenital heart disease (CHD) surgeries

International Nuclear Information System (INIS)

Junejo, F.; Irfan, M.; Akhtar, M.I.; Hamid, M.; Ahmed, S.S.

2018-01-01

To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid (TXA) to reduce postoperative bleeding in cyanotic congenital heart disease surgeries. Study Design:Single-blinded randomised clinical trial. Place and Duration of Study:Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017. Methodology:Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass (CPB), were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg after induction, after going to bypass and after protamine reversal. Data was collected through predesigned proforma. There were two primary outcomes: postoperative bleeding in the first 24 hours, and chest closure time. Results:Postoperative bleeding was 13.94 (10.27-20.18) ml/kg in the first 24 hours in infusion group and 15.05 (9.04-23.50) ml/kg in the bolus group. Chest closure time was 38.5 (25-45) in infusion group and 30 (20-46.25) minutes in the bolus group. There was no statistically significant and clinical difference between both groups regarding postoperative bleeding in the first 24 hours and chest closure time. Conclusion:These infusion and bolus groups had comparable postoperative bleeding and chest closure time. (author)

Gender und Militär Gender and the Military

OpenAIRE

Jutta Kühl

2004-01-01

Dieser Band der Heinrich-Böll Stiftung enthält aktuelle internationale Forschungsergebnisse zum Verhältnis von Gender und Militär. Das Themenspektrum in den Beiträgen reicht von der Frage nach der Repräsentation von Frauen in den jeweiligen Streitkräften bis zu Untersuchungen zur gesellschaftlichen Rolle des Militärs bei der Konstruktion von Gender.This volume of the Heinrich-Böll Foundation contains results of current international research on the relationship between gender and the military...

The application of DSA bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus

International Nuclear Information System (INIS)

Ren Chongyang; Di Zhenhai; Mao Xuequn; Zou Rong; Zhang Jian; Wang Meirong; Li Quan

2010-01-01

Objective: To retrospectively evaluate the digital subtraction angiography (DSA) bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus. Methods: From January 2004 to March 2010, DSA was performed in forty-five diabetes patients with suspicious vascular diseases of lower extremities. Among them, 24 cases (31 lower limbs)were examined with DSA bolus chase technology and the remaining 21 cases (21 lower limbs)were examined with traditional segmentational technique. The contrast dosage used in angiography, the total exposure time, the examination time and the imaging value for making diagnosis were analyzed and compared between two techniques. Results: For DSA bolus chase technology group, the contrast dosage used in angiography, the total exposure time and the examination time were 25.26 ml, 13.23 s and 37.26 min, respectively,with an average exposure of 101.65 pictures. For traditional segmentational technique group, the contrast dosage used in angiography, the total exposure time and the examination time were 130.00 ml, 52.38 s and 50.48 min, respectively, with an average exposure of 118.33 pictures. The percentage of high quality images in bolus chase technology group and in traditional segmentational technique group were 90.3% and 90.5%, respectively. All the images could meet the requirements for making a reliable diagnosis. Conclusion: Digital subtraction angiography by using bolus-chase technology can well demonstrate the vascular pathology of lower extremities caused by diabetes mellitus, obtain sufficient imaging information necessary for making a reliable diagnosis. DSA bolus chase technology is superior to traditional segmentational technique in shortening procedure time, reducing contrast medium dosage and decreasing radiation dose. (authors)

Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia

NARCIS (Netherlands)

McCoy, E.P; Mirakhur, R.K; Maddineni, V.R; Wierda, J.MKH; Proost, Hans

We have studied the pharmacokinetics of a single bolus of rocuronium (Org 9426), followed by an infusion, in eight patients during anaesthesia with halothane and nitrous oxide in oxygen. Neuromuscular block was monitored using train-of-four (TOF) stimulation and recording the force of contraction of

Enteral nutrition for preterm infants: by bolus or continuous? An update

Directory of Open Access Journals (Sweden)

Valentina Bozzetti

2017-06-01

Full Text Available Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants.

MRI assessment of cerebral blood volume in patients with brain infarcts

International Nuclear Information System (INIS)

Wu, R.H.; Bruening, R.; Berchtenbreiter, C.; Weber, J.; Peller, M.; Penzkofer, H.; Reiser, M.; Steiger, H.J.

1998-01-01

MRI perfusion studies have focussed mainly on acute ischaemia and characterisation in ischaemia. Our purpose was to analyse regional brain haemodynamic information in acute, subacute, and chronic ischaemia. We performed 16 examinations of 11 patients on a 1.5 T MR images. Conventional and dynamic contrast-enhanced imaging were employed in all examinations. For the dynamic susceptibility sequences, a bolus (0.2 mmol/kg) of gadopentetate dimeglumine was injected. Reconstructed regional relative cerebral blood volume (rCBV) maps, bolus maps, and conventional images were analysed by consensus reading. In all examinations decreases in rCBV were observed in the lesions. The distribution of regional rCBV in lesions was heterogeneous. The rCBV of the periphery of the lesions was higher than that at their center. There was a correlation between the time since onset and abnormalities on the rCBV map and T2-weighted images (T2WI). In the early stage of acute stroke, the abnormalities tended to be larger on the rCBV than on T2WI. Many patterns of bolus passage were observed in ischaemic regions. rCBV maps provide additional haemodynamic information in patients with brain infarcts. (orig.)

Effects of copper oxide wire particle bolus therapy on trichostrongyle fecal egg counts in exotic artiodactylids.

Science.gov (United States)

Fontenot, Deidre K; Kinney-Moscona, Allyson; Kaplan, Ray M; Miller, James

2008-12-01

Four species of artiodactylids (scimitar-horned oryx [Oryx dama]), roan antelope [Hippotragus equinus], blackbuck [Antilope cervicapra]), and blesbok [Damaliscus pygargus phillipsi]) totaling 13 animals were treated with a one-time 12.5-g dose of copper oxide wire particles (COWPs) in a bolus form. Pretreatment, individual trichostrongyle fecal egg counts (FECs) were performed using the McMaster technique. Individual posttreatment FECs were performed every 7 days for 35 days beginning 7 days after bolus administration, and FEC reduction ratios (FECRRs) expressed as percentage reductions from pretreatment values were calculated every 7 days. Mean FECRRs for the 13 animals were 93% +/- 16%, 98% +/- 7%, 91% +/- 28%, 94% +/- 16%, and 90% +/- 13% at 7, 14, 21, 28, and 35 days posttreatment, respectively. These data demonstrate that COWPs in a bolus form were an effective method for reducing FEC in exotic artiodactylids. Based on this limited data, COWPs show promise as an anthelmintic alternative for exotic artiodactylids in zoologic collections.

The influence of carbon monoxide bolus on the measurement of total haemoglobin mass using the optimized CO-rebreathing method

International Nuclear Information System (INIS)

Turner, G; Richardson, A J; Maxwell, N S; Pringle, J S M; Ingham, S A; Fudge, B W

2014-01-01

The optimized carbon monoxide (CO) rebreathing method (oCOR-method) is routinely used to measure total haemoglobin mass (tHbmass). The tHbmass measure is subject to a test-retest typical error of ∼2%, mostly from the precision of carboxyhaemoglobin (HbCO) measurement. We hypothesized that tHbmass would be robust to differences in the bolus of CO administered during the oCOR-method. Twelve participants (ten males and two females; age 27 ± 6 yr, height 177 ± 11 cm and mass 73.9 ± 12.1 kg) completed the oCOR-method on four occasions. Different bolus of CO were administered (LOW: 0.6 ml kg −1 ; MED 1 : 1.0 ml kg −1  and HIGH: 1.4 ml kg −1 ); to determine the reliability of MED 1 , a second trial was conducted (MED 2 ). tHbmass was found to be significantly less from the HIGH CO bolus (776 ± 148 g) when compared to the LOW CO (791 ± 149 g) or MED 1  CO (788 ± 149 g) trials. MED 2  CO was 785 ± 150 g. The measurement of tHbmass is repeatable to within 0.8%, but a small and notable difference was seen when using a HIGH CO bolus (1.4 to 1.9% less), potentially due to differences in CO uptake kinetics. Previously, an improved precision of the oCOR-method was thought to require a higher bolus of CO (i.e. larger ▵%HbCO), as commercial hemoximeters only estimate %HbCO levels to a single decimal place (usually ± 0.1%). With the new hemoximeter used in this study, a bolus of 1.0 ml kg −1  allows adequate precision with acceptable safety. (note)

Glottal volume velocity waveform characteristics in subjects with and without vocal training, related to gender, sound intensity, fundamental frequency, and age

NARCIS (Netherlands)

Sulter, AM; Wit, HP

Glottal volume velocity waveform characteristics of 224 subjects, categorized in four groups according to gender and vocal training, were determined, and their relations to sound-pressure level, fundamental frequency, intra-oral pressure, and age were analyzed. Subjects phonated at three intensity

Glottal volume velocity waveform characteristics in subjects with and without vocal training, related to gender, sound intensity, fundamental frequency, and age

NARCIS (Netherlands)

Sulter, AM; Wit, HP

1996-01-01

Glottal volume velocity waveform characteristics of 224 subjects, categorized in four groups according to gender and vocal training, were determined, and their relations to sound-pressure level, fundamental frequency, intra-oral pressure, and age were analyzed. Subjects phonated at three intensity

Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus. Comparison to transesophageal echocardiography

Energy Technology Data Exchange (ETDEWEB)

Staab, W.; Zwaka, P.A.; Sohns, J.M.; Schwarz, A.; Lotz, J. [University Medical Center Goettingen Univ. (Germany). Inst. for Diagnostic and Interventional Radiology; Sohns, C.; Vollmann, D.; Zabel, M.; Hasenfuss, G. [Goettingen Univ. (Germany). Dept. of Cardiology and Pneumology; Schneider, S. [Goettingen Univ. (Germany). Dept. of Medical Statistics

2014-11-15

Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent. A total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6% male, mean age: 64.1 ± 10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30 ml and main bolus of 70 ml iodinated contrast agent separated by a short time delay. In this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE. MDCT was 100% accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.

Gender bias affects forests worldwide

Science.gov (United States)

Marlène Elias; Susan S Hummel; Bimbika S Basnett; Carol J.P. Colfer

2017-01-01

Gender biases persist in forestry research and practice. These biases result in reduced scientific rigor and inequitable, ineffective, and less efficient policies, programs, and interventions. Drawing from a two-volume collection of current and classic analyses on gender in forests, we outline five persistent and inter-related themes: gendered governance, tree tenure,...

TU-F-CAMPUS-I-01: Investigation of the Effective Dose From Bolus Tracking Acquisitions at Different Anatomical Locations in the Chest for CT

Energy Technology Data Exchange (ETDEWEB)

Nowik, P; Bujila, R; Merzan, D [Dept. of Medical Physics, Karolinska University Hospital, Stockholm (Sweden)

2015-06-15

Purpose: Stationary table acquisitions (Bolus tracking) in X-ray Computed Tomography (CT) can Result in dose length products (DLP) comparable to spiral scans. It is today unclear whether or not the effective dose (E) for Bolus Tracking can be approximated using target region specific conversion factors (E/DLP). The purpose of this study was to investigate how E depends on the anatomical location of the Bolus Tracking in relation to Chest CT scans with the same DLP. Methods: Effective doses were approximated for the ICRP 110 adult Reference Male (AM) and adult Reference Female (FM) computational voxel phantoms using software for CT dose approximations (pre-simulated MC data). The effective dose was first approximated for a Chest CT scan using spiral technique and a CTDIvol (32 cm) of 6 mGy. The effective dose from the spiral scan was then compared to E approximated for contiguous Bolus Tracking acquisitions (1 cm separation), with a total collimation of 1 cm, over different locations of the chest of the voxel phantoms. The number of rotations used for the Bolus Tracking acquisitions was adjusted to yield the same DLP (32 cm) as the spiral scan. Results: Depending on the anatomical location of the Bolus Tracking, E ranged by factors of 1.3 to 6.8 for the AM phantom and 1.4 to 3.3 for the AF phantom, compared to the effective dose of the spiral scans. The greatest E for the Bolus Tracking acquisitions was observed for anatomical locations coinciding with breast tissue. This can be expected as breast tissue has a high tissue weighting factor in the calculation of E. Conclusion: For Chest CT scans, the effective dose from Bolus Tracking is highly dependent on the anatomical location where the scan is administered and will not always accurately be represented using target region specific conversion factors.

Poster - 38: On the physical and dosimetric properties of 3D printed electron bolus fabricated using polylactic acid

Energy Technology Data Exchange (ETDEWEB)

Sasaki, David; Jensen, Martin; Rickey, Daniel W; Dubey, Arbind; Harris, Chad; McCurdy, Boyd [CancerCare Manitoba, CancerCare Manitoba, CancerCare Manitoba, CancerCare Manitoba, CancerCare Manitoba, CancerCare Manitoba (Canada)

2016-08-15

Purpose: 3D printing technology could simplify and improve electron bolus fabrication. The purpose of this study was to characterize the density, dimensional accuracy, uniformity, and attenuation of PLA boluses fabricated with a low-cost 3D printer. Methods: Several solid square slabs were printed with specific requested dimensions and 100% infill using different fill patterns. These pieces were imaged using an x-ray flat panel imager in order to check for uniformity of the prints. Percentage depth doses (PDDs) were measured downstream of the slabs in solid water using a parallel plate chamber and compared to measurements in water in order to characterize attenuation. The dimensions of the PLA slabs were measured using digital calipers. The slabs were also weighed to find their density. Results: The fill pattern used to create boluses can affect the attenuation of the bolus. Fill patterns should be chosen carefully and quality assurance should be done for each printed piece. PLA causes the electron PDD to shift towards shallower depths, compared to water, by 1.7 mm for each centimeter of PLA. Agreement with design dimensions was within 1 mm in the plane of the printer bed, and within 1/3 of a millimeter (roughly the thickness of a single layer), perpendicular to the printer bed. Average density was in the range 1.20 – 1.22. Conclusions: 3D printing shows great promise for use in fabricating electron bolus. This work indicates that printed PLA can be a suitable material provided the increased attenuation is properly accounted for.

Poster - 38: On the physical and dosimetric properties of 3D printed electron bolus fabricated using polylactic acid

International Nuclear Information System (INIS)

Sasaki, David; Jensen, Martin; Rickey, Daniel W; Dubey, Arbind; Harris, Chad; McCurdy, Boyd

2016-01-01

Purpose: 3D printing technology could simplify and improve electron bolus fabrication. The purpose of this study was to characterize the density, dimensional accuracy, uniformity, and attenuation of PLA boluses fabricated with a low-cost 3D printer. Methods: Several solid square slabs were printed with specific requested dimensions and 100% infill using different fill patterns. These pieces were imaged using an x-ray flat panel imager in order to check for uniformity of the prints. Percentage depth doses (PDDs) were measured downstream of the slabs in solid water using a parallel plate chamber and compared to measurements in water in order to characterize attenuation. The dimensions of the PLA slabs were measured using digital calipers. The slabs were also weighed to find their density. Results: The fill pattern used to create boluses can affect the attenuation of the bolus. Fill patterns should be chosen carefully and quality assurance should be done for each printed piece. PLA causes the electron PDD to shift towards shallower depths, compared to water, by 1.7 mm for each centimeter of PLA. Agreement with design dimensions was within 1 mm in the plane of the printer bed, and within 1/3 of a millimeter (roughly the thickness of a single layer), perpendicular to the printer bed. Average density was in the range 1.20 – 1.22. Conclusions: 3D printing shows great promise for use in fabricating electron bolus. This work indicates that printed PLA can be a suitable material provided the increased attenuation is properly accounted for.

Volume of hydration in terminal cancer patients.

Science.gov (United States)

Bruera, E; Belzile, M; Watanabe, S; Fainsinger, R L

1996-03-01

In this retrospective study we reviewed the volume and modality of hydration of consecutive series of terminal cancer patients in two different settings. In a palliative care unit 203/290 admitted patients received subcutaneous hydration for 12 +/- 8 days at a daily volume of 1015 +/- 135 ml/day. At the cancer center, 30 consecutive similar patients received intravenous hydration for 11.5 +/- 5 days (P > 0.2) but at a daily volume of 2080 +/- 720 ml/day (P palliative care unit patients required discontinuation of hydration because of complications. Hypodermoclysis was administered mainly as a continuous infusion, an overnight infusion, or in one to three 1-h boluses in 62 (31%), 98 (48%) and 43 (21%) patients, respectively. Our findings suggest that, in some settings, patients may be receiving excessive volumes of hydration by less comfortable routes such as the intravenous route. Increased education and research in this area are badly needed.

The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

DEFF Research Database (Denmark)

Duus, Nicolaj; Shogilev, Daniel J; Skibsted, Simon

2015-01-01

PURPOSE: We investigated the reproducibility of passive leg raise (PLR) and fluid bolus (BOLUS) using the Non-Invasive Cardiac Output Monitor (NICOM; Cheetah Medical, Tel Aviv, Israel) for assessment of fluid responsiveness (FR) in spontaneously breathing emergency department (ED) patients. METHODS...

Use of an automated bolus calculator in MDI-treated type 1 diabetes

DEFF Research Database (Denmark)

Schmidt, Signe; Meldgaard, Merete; Serifovski, Nermin

2012-01-01

To investigate the effect of flexible intensive insulin therapy (FIIT) and an automated bolus calculator (ABC) in a Danish type 1 diabetes population treated with multiple daily injections. Furthermore, to test the feasibility of teaching FIIT in a 3-h structured course....

Introduction to the special issue "The determinants of gender gaps"

OpenAIRE

Casarico, Alessandra; Profeta, Paola

2015-01-01

This volume contributes to advancing our knowledge on the determinants of gender gaps. It focuses on the role of historical factors in shaping persistent gender gaps and on how careful institutional design can allow different outcomes to reflect only differences in abilities rather than differences in gender. The contributions collected in this volume emphasize that there is no unique determinant of the gender gaps and that the gender gap itself is a multidimensional, complex indicator. They ...

Distribution and mixing of a liquid bolus in pleural space.

Science.gov (United States)

Bodega, Francesca; Tresoldi, Claudio; Porta, Cristina; Zocchi, Luciano; Agostoni, Emilio

2006-02-28

Distribution and mixing time of boluses with labeled albumin in pleural space of anesthetized, supine rabbits were determined by sampling pleural liquid at different times in various intercostal spaces (ics), and in cranial and caudal mediastinum. During sampling, lung and chest wall were kept apposed by lung inflation. This was not necessary in costo-phrenic sinus. Here, 10 min after injection, lung inflation increased concentration of labeled albumin by 50%. Lung inflation probably displaces some pleural liquid cranio-caudally, increasing labeled albumin concentration caudally to injection point (6th ics), and decreasing it cranially. Boluses of 0.1-1 ml did not preferentially reach mediastinal regions, as maintained by others. Time for an approximate mixing was approximately 1 h for 0.1 ml, and approximately 30 min for 1 ml. This relatively long mixing time does not substantially affect determination of contribution of lymphatic drainage through stomata to overall removal of labeled albumin from 0.3 ml hydrothoraces lasting 3 h [Bodega, F., Agostoni, E., 2004. Contribution of lymphatic drainage through stomata to albumin removal from pleural space. Respir. Physiol. Neurobiol. 142, 251-263].

Comparison of bolus versus fractionated oral applications of [13C]-linoleic acid in humans.

Science.gov (United States)

Demmelmair, H; Iser, B; Rauh-Pfeiffer, A; Koletzko, B

1999-07-01

The endogenous conversion of linoleic acid into long-chain polyunsaturated fatty acids is of potential importance for meeting substrate requirements, particularly in young infants. After application of [13C]-linoleic acid, we estimated its conversion to dihomo-gamma-linolenic and arachidonic acids from only two blood samples. Oral tracer doses were given to five healthy adults as a single bolus. In four subjects the tracer was given in nine equal portions over 3 days. Concentration and 13C content of fatty acids from serum phospholipids were analysed by gas chromatography combustion isotope ratio-mass spectrometry. Areas under the tracer-concentration curves were calculated, and fractional transfer and turnover rates estimated from compartmental models. The median fractional turnover of linoleic acid was 93.7% per day (interquartile range 25.3) in the bolus group and 80. 0% per day (6.3) in the fraction group (NS). Fractional conversion of linoleic to dihomo-gamma-linolenic acid was 1.5% (0.9) vs. 2.1% (0.7) (bolus vs. fraction, P /= 0.94, P < 0.05) with the ratio of areas under the curve. Using areas under the curve overestimates the conversion, because different residence times are not considered. Estimation of conversion intensity appears possible with only one blood sample obtained after tracer application.

Open-loop glucose control: Automatic IOB-based super-bolus feature for commercial insulin pumps.

Science.gov (United States)

Rosales, Nicolás; De Battista, Hernán; Vehí, Josep; Garelli, Fabricio

2018-06-01

Although there has been significant progress towards closed-loop type 1 diabetes mellitus (T1DM) treatments, most diabetic patients still treat this metabolic disorder in an open-loop manner, based on insulin pump therapy (basal and bolus insulin infusion). This paper presents a method for automatic insulin bolus shaping based on insulin-on-board (IOB) as an alternative to conventional bolus dosing. The methodology presented allows the pump to generate the so-called super-bolus (SB) employing a two-compartment IOB dynamic model. The extra amount of insulin to boost the bolus and the basal cutoff time are computed using the duration of insulin action (DIA). In this way, the pump automatically re-establishes basal insulin when IOB reaches its basal level. Thus, detrimental transients caused by manual or a-priori computations are avoided. The potential of this method is illustrated via in-silico trials over a 30 patients cohort in single meal and single day scenarios. In the first ones, improvements were found (standard treatment vs. automatic SB) both in percentage time in euglycemia (75g meal: 81.9 ± 15.59 vs. 89.51 ± 11.95, ρ ≃ 0; 100g meal: 75.12 ± 18.23 vs. 85.46 ± 14.96, ρ ≃ 0) and time in hypoglecymia (75g meal: 5.92 ± 14.48 vs. 0.97 ± 4.15, ρ=0.008; 100g meal: 9.5 ± 17.02 vs. 1.85 ± 7.05, ρ=0.014). In a single day scenario, considering intra-patient variability, the time in hypoglycemia was reduced (9.57 ± 14.48 vs. 4.21 ± 6.18, ρ=0.028) and improved the time in euglycemia (79.46 ± 17.46 vs. 86.29 ± 11.73, ρ=0.007). The automatic IOB-based SB has the potential of a better performance in comparison with the standard treatment, particularly for high glycemic index meals with high carbohydrate content. Both glucose excursion and time spent in hypoglycemia were reduced. Copyright © 2018 Elsevier B.V. All rights reserved.

Feasibility of test-bolus DCE-MRI using CAIPIRINHA-VIBE for the evaluation of pancreatic malignancies

Energy Technology Data Exchange (ETDEWEB)

Huh, Jimi; Seo, Nieun; Kim, Bohyun [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Choi, Yoonseok; Woo, Dong-Cheol; Lee, Chang Kyung [Asan Medical Center, Bioimaging Center, Asan Institute for Life Sciences, Seoul (Korea, Republic of); Kim, In Seong [Siemens Healthcare, Seoul (Korea, Republic of); Nickel, Dominik [Siemens Healthcare, Erlangen (Germany); Kim, Kyung Won [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Asan Medical Center, Bioimaging Center, Asan Institute for Life Sciences, Seoul (Korea, Republic of)

2016-11-15

To evaluate the feasibility of test-bolus dynamic contrast-enhanced (DCE) MRI with CAIPIRINHA-VIBE for pancreatic malignancies. Thirty-two patients underwent DCE-MRI with CAIPIRINHA-VIBE after injection of 2 mL gadolinium. From the resulting time-intensity curve (TIC), we estimated the arterial (AP) and portal venous phase (PVP) scan timing for subsequent multiphasic MRI. DCE-MRI perfusion maps were generated, and perfusion parameters were calculated. The image quality was rated on a 5-point scale (1: poor, 5: excellent). Goodness-of-fit of the TIC was evaluated by Pearson's χ{sup 2} test. Test-bolus DCE-MRIs with high temporal (3 s) and spatial resolution (1 x 1 x 4 mm{sup 3}) were acquired with good-quality perfusion maps of Ktrans and iAUC (mean score 4.313 ± 0.535 and 4.125 ± 0.554, respectively). The mean χ{sup 2} values for fitted TICs were 0.115 ± 0.082 for the pancreatic parenchyma and 0.784 ± 0.074 for pancreatic malignancies, indicating an acceptable goodness-of-fit. Test-bolus DCE-MRI was highly accurate in estimating the proper timing of AP (90.6 %) and PVP (100 %) of subsequent multiphasic MRI. Between pancreatic adenocarcinomas and neuroendocrine tumours, there were significant differences in the Ktrans (0.073 ± 0.058 vs. 0.308 ± 0.062, respectively; p = 0.007) and iAUC (1.501 ± 0.828 vs. 3.378 ± 0.378, respectively; p = 0.045). Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for incorporating perfusion analysis of pancreatic tumours into routine multiphasic MRI. (orig.)

Radiation dermatitis caused by a bolus effect from an abdominal compression device

International Nuclear Information System (INIS)

Connor, Michael; Wei, Randy L.; Yu, Suhong; Sehgal, Varun; Klempner, Samuel J.; Daroui, Parima

2016-01-01

American Association of Physicists in Medicine (AAPM) Task Group 176 evaluated the dosimetric effects caused by couch tops and immobilization devices. The report analyzed the extensive physics-based literature on couch tops, stereotactic body radiation therapy (SBRT) frames, and body immobilization bags, while noting the scarcity of clinical reports of skin toxicity because of external devices. Here, we present a clinical case report of grade 1 abdominal skin toxicity owing to an abdominal compression device. We discuss the dosimetric implications of the utilized treatment plan as well as post hoc alternative plans and quantify differences in attenuation and skin dose/build-up between the device, a lower-density alternative device, and an open field. The description of the case includes a 66-year-old male with HER2 amplified poorly differentiated distal esophageal adenocarcinoma treated with neoadjuvant chemo-radiation and the use of an abdominal compression device. Radiation was delivered using volumetric modulated arc therapy (VMAT) with 2 arcs using abdominal compression and image guidance. The total dose was 50.4 Gy delivered over 40 elapsed days. With 2 fractions remaining, the patient developed dermatitis in the area of the compression device. The original treatment plan did not include a contour of the device. Alternative post hoc treatment plans were generated, one to contour the device and a second with anterior avoidance. In conclusion, replanning with the device contoured revealed the bolus effect. The skin dose increased from 27 to 36 Gy. planned target volume (PTV) coverage at 45 Gy was reduced to 76.5% from 95.8%. The second VMAT treatment plan with an anterior avoidance sector and more oblique beam angles maintained PTV coverage and spared the anterior wall, however at the expense of substantially increased dose to lung. This case report provides an important reminder of the bolus effect from external devices such as abdominal compression. Special

Radiation dermatitis caused by a bolus effect from an abdominal compression device

Energy Technology Data Exchange (ETDEWEB)

Connor, Michael; Wei, Randy L.; Yu, Suhong; Sehgal, Varun [Department of Radiation Oncology, University of California, Irvine Medical Center, Orange, CA (United States); Klempner, Samuel J. [Department of Medicine, Division of Hematology/Oncology, University of California, Orange, CA (United States); Daroui, Parima, E-mail: pdaroui@uci.edu [Department of Radiation Oncology, University of California, Irvine Medical Center, Orange, CA (United States)

2016-10-01

American Association of Physicists in Medicine (AAPM) Task Group 176 evaluated the dosimetric effects caused by couch tops and immobilization devices. The report analyzed the extensive physics-based literature on couch tops, stereotactic body radiation therapy (SBRT) frames, and body immobilization bags, while noting the scarcity of clinical reports of skin toxicity because of external devices. Here, we present a clinical case report of grade 1 abdominal skin toxicity owing to an abdominal compression device. We discuss the dosimetric implications of the utilized treatment plan as well as post hoc alternative plans and quantify differences in attenuation and skin dose/build-up between the device, a lower-density alternative device, and an open field. The description of the case includes a 66-year-old male with HER2 amplified poorly differentiated distal esophageal adenocarcinoma treated with neoadjuvant chemo-radiation and the use of an abdominal compression device. Radiation was delivered using volumetric modulated arc therapy (VMAT) with 2 arcs using abdominal compression and image guidance. The total dose was 50.4 Gy delivered over 40 elapsed days. With 2 fractions remaining, the patient developed dermatitis in the area of the compression device. The original treatment plan did not include a contour of the device. Alternative post hoc treatment plans were generated, one to contour the device and a second with anterior avoidance. In conclusion, replanning with the device contoured revealed the bolus effect. The skin dose increased from 27 to 36 Gy. planned target volume (PTV) coverage at 45 Gy was reduced to 76.5% from 95.8%. The second VMAT treatment plan with an anterior avoidance sector and more oblique beam angles maintained PTV coverage and spared the anterior wall, however at the expense of substantially increased dose to lung. This case report provides an important reminder of the bolus effect from external devices such as abdominal compression. Special

Dextrose boluses versus burette dextrose infusions in prevention of hypoglycemia among preterms admitted at Mulago Hospital: an open label randomized clinical trial.

Science.gov (United States)

Kutamba, E; Lubega, S; Mugalu, J; Ouma, J; Mupere, E

2014-09-01

Hypoglycemia is a major cause of morbidity and mortality among preterm infants and its management remains a challenge in resource limited settings. Use of dextrose infusion by the recommended infusion pumps is not feasible in our environment due to their high costs and yet the current use of mini dextrose boluses with syringes as adapted at Mulago national referral and tertiary teaching hospital has unknown efficacy in prevention of hypoglycemia. We determined the efficacy of dextrose infusions by burettes versus two hourly dextrose boluses in prevention of hypoglycemia among preterms admitted in the first 72 hours at Special Care Unit, Mulago Hospital. One hundred and forty preterms aged 0 to 24 hours of life were randomized to receive 10% IV dextrose either as mini boluses or by infusion using burettes in an open label clinical trial. Blood glucose was measured at 0, two hourly for next 6 hours, 6 hourly for next 12 hours and thereafter 12 hourly until end of 72 hours following admission. Primary end point was incidence of hypoglycemia (random blood sugar (RBS) dextrose infusion was computed using 1-RR. From February 2012 to April 2012, 68 preterms in the bolus arm and 72 in the infusion arm were studied. Hypoglycemia was detected in 34% (48/140). The incidence of hypoglycemia in the bolus arm was 59% (40/68) compared to 11% (8/72) in the infusion arm (RR; 0.19, 95% CI; 0.09-0.37). Efficacy (1-RR) of infusion by burettes versus boluses in prevention of hypoglycemia among preterms was 0.81 (95% CI; 0.63-0.90). Continuous 10% dextrose infusion by burettes reduced the incidence of hypoglycemia by 81% in the first 72 hours of admission compared to two hourly 10% mini dextrose boluses among preterms admitted at Special Care Unit, Mulago Hospital. (ClinicalTrials.gov Identifier: NCT01688674).

Comparison of Power Versus Manual Injection in Bolus Shape and Image Quality on Contrast-Enhanced Magnetic Resonance Angiography: An Experimental Study in a Swine Model.

Science.gov (United States)

Tsuboyama, Takahiro; Jost, Gregor; Pietsch, Hubertus; Tomiyama, Noriyuki

2017-09-01

The aim of this study was to compare power versus manual injection in bolus shape and image quality on contrast-enhanced magnetic resonance angiography (CE-MRA). Three types of CE-MRA (head-neck 3-dimensional [3D] MRA with a test-bolus technique, thoracic-abdominal 3D MRA with a bolus-tracking technique, and thoracic-abdominal time-resolved 4-dimensional [4D] MRA) were performed after power and manual injection of gadobutrol (0.1 mmol/kg) at 2 mL/s in 12 pigs (6 sets of power and manual injections for each type of CE-MRA). For the quantitative analysis, the signal-to-noise ratio was measured on ascending aorta, descending aorta, brachiocephalic trunk, common carotid artery, and external carotid artery on the 6 sets of head-neck 3D MRA, and on ascending aorta, descending aorta, brachiocephalic trunk, abdominal aorta, celiac trunk, and renal artery on the 6 sets of thoracic-abdominal 3D MRA. Bolus shapes were evaluated on the 6 sets each of test-bolus scans and 4D MRA. For the qualitative analysis, arterial enhancement, superimposition of nontargeted enhancement, and overall image quality were evaluated on 3D MRA. Visibility of bolus transition was assessed on 4D MRA. Intraindividual comparison between power and manual injection was made by paired t test, Wilcoxon rank sum test, and analysis of variance by ranks. Signal-to-noise ratio on 3D MRA was statistically higher with power injection than with manual injection (P < 0.001). Bolus shapes (test-bolus, 4D MRA) were represented by a characteristic standard bolus curve (sharp first-pass peak followed by a gentle recirculation peak) in all the 12 scans with power injection, but only in 1 of the 12 scans with manual injection. Standard deviations of time-to-peak enhancement were smaller in power injection than in manual injection. Qualitatively, although both injection methods achieved diagnostic quality on 3D MRA, power injection exhibited significantly higher image quality than manual injection (P = 0.001) due to

Whole-body adipose tissue and lean muscle volumes and their distribution across gender and age: MR-derived normative values in a normal-weight Swiss population.

Science.gov (United States)

Ulbrich, Erika J; Nanz, Daniel; Leinhard, Olof Dahlqvist; Marcon, Magda; Fischer, Michael A

2018-01-01

To determine age- and gender-dependent whole-body adipose tissue and muscle volumes in healthy Swiss volunteers in Dixon MRI in comparison with anthropometric and bioelectrical impedance (BIA) measurements. Fat-water-separated whole-body 3 Tesla MRI of 80 healthy volunteers (ages 20 to 62 years) with a body mass index (BMI) of 17.5 to 26.2 kg/m 2 (10 men, 10 women per decade). Age and gender-dependent volumes of total adipose tissue (TAT), visceral adipose tissue (VAT), total abdominal subcutaneous adipose tissue (ASAT) and total abdominal adipose tissue (TAAT), and the total lean muscle tissue (TLMT) normalized for body height were determined by semi-automatic segmentation, and correlated with anthropometric and BIA measurements as well as lifestyle parameters. The TAT, ASAT, VAT, and TLMT indexes (TATi, ASATi, VATi, and TLMTi, respectively) (L/m 2  ± standard deviation) for women/men were 6.4 ± 1.8/5.3 ± 1.7, 1.6 ± 0.7/1.2 ± 0.5, 0.4 ± 0.2/0.8 ± 0.5, and 5.6 ± 0.6/7.1 ± 0.7, respectively. The TATi correlated strongly with ASATi (r > 0.93), VATi, BMI and BIA (r > 0.70), and TAATi (r > 0.96), and weak with TLMTi for both genders (r > -0.34). The VAT was the only parameter showing an age dependency (r > 0.32). The BMI and BIA showed strong correlation with all MR-derived adipose tissue volumes. The TAT mass was estimated significantly lower from BIA than from MRI (both genders P muscle volumes might serve as normative values. The estimation of adipose tissue volumes was significantly lower from anthropometric and BIA measurements than from MRI. Magn Reson Med 79:449-458, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

Bolus and continuous infusion mitoxantrone in newly diagnosed adult acute lymphoblastic leukemia: results of two consecutive phase II clinical studies.

Science.gov (United States)

Koc, Y; Akpek, G; Kansu, E; Kars, A; Tekuzman, G; Baltali, E; Güler, N; Barista, I; Güllü, I; Ozisik, Y; Firat, D

1998-01-01

Two consecutive phase II clinical studies were designed to evaluate the efficacy and safety of bolus and continuous infusion (CI) mitoxantrone (MTZ) in 39 patients with newly diagnosed acute lymphocytic leukemia (ALL). MTZ was used as part of the classical ALL induction regimen. Twenty patients were treated with bolus MTZ (10 mg/m2 for 3 days) combined with vincristine and prednisone. The same regimen was given to a second set of 19 patients, except that MTZ was administered as a 24-hr CI. Both groups received bimonthly intensifications with vincristine and prednisone for 3 years, along with oral maintenance therapy. Patients in the CI-MTZ study arm received additional MTZ on the first day of intensification cycles. Seventeen patients (85%) in the bolus arm and 15 patients (79%) in the CI arm achieved complete remission (CR). Median disease-free survivals (DFS) in the bolus and CI groups were 11 and 15 months after median follow-ups of 16 (3.5-96) and 13 (2.3-32) months, respectively. At 2.5 years, DFS rates were 29.4% and 34.4% in the bolus and CI groups (p > 0.05). There were no significant differences between two groups in rates of early death, degree of organ toxicity, or duration of neutropenia and thrombocytopenia. Significant cardiac toxicity was not observed in either group. Bolus or CI administration of MTZ was equally effective and was well tolerated. Neither the mode of administration nor increasing the dose intensity of MTZ by incorporating intensification cycles reduced relapse rates. Development of new antileukemia agents and novel treatment approaches are still needed to improve the high relapse rates in adult ALL once a complete response is achieved.

Factors Influencing ACT After Intravenous Bolus Administration of 100 IU/kg of Unfractionated Heparin During Cardiac Catheterization in Children.

Science.gov (United States)

Muster, Ileana; Haas, Thorsten; Quandt, Daniel; Kretschmar, Oliver; Knirsch, Walter

2017-10-01

Anticoagulation using intravenous bolus administration of unfractionated heparin (UFH) aims to prevent thromboembolic complications in children undergoing cardiac catheterization (CC). Optimal UFH dosage is needed to reduce bleeding complications. We analyzed the effect of bolus UFH on activated clotting time (ACT) in children undergoing CC focusing on age-dependent, anesthesia-related, or disease-related influencing factors. This retrospective single-center study of 183 pediatric patients receiving UFH during CC analyzed ACT measured at the end of CC. After bolus administration of 100 IU UFH/kg body weight, ACT values between 105 and 488 seconds were reached. Seventy-two percent were within target level of 160 to 240 seconds. Age-dependent differences were not obtained ( P = .407). The ACT values were lower due to hemodilution (total fluid and crystalloid administration during CC, both P ACT values but occurred more frequently in children between 1 month and 1 year of age (91%). In conclusion, with a bolus of 100 IU UFH/kg, an ACT target level of 160 to 240 seconds can be achieved during CC in children in 72%, which is influenced by hemodilution and anticoagulant and antiplatelet premedication but not by age.

Precision flow-controlled rubidium-82 generator for bolus and constant infusion studies

International Nuclear Information System (INIS)

Yano, Y.

1981-01-01

A unique flow rate controller and large reservoir pumping system have been developed for infusing rubidium-82 intravenously at bolus, constant, or variable infusion rates. Using rubidium-82 and the positron ring detector tomograph, extraction or flow information can be obtained in studies of the heart, head, or kidneys

Adductor Canal Block With Continuous Infusion Versus Intermittent Boluses and Morphine Consumption

DEFF Research Database (Denmark)

Jaeger, Pia; Baggesgaard, Jonas; Sørensen, Johan K

2018-01-01

a randomized, blinded, controlled study, including patients scheduled for total knee arthroplasty with spinal anesthesia. Patients received 0.2% ropivacaine via a catheter in the adductor canal administered as either repeated intermittent boluses (21 mL/3 h) or continuous infusion (7 mL/h). The primary outcome...

Use of 3D printers to create a patient‐specific 3D bolus for external beam therapy

Science.gov (United States)

Baker, Jamie; Hsia, An Ting; Xu, Zhigang

2015-01-01

The purpose of this paper is to demonstrate that an inexpensive 3D printer can be used to manufacture patient‐specific bolus for external beam therapy, and to show we can accurately model this printed bolus in our treatment planning system for accurate treatment delivery. Percent depth‐dose measurements and tissue maximum ratios were used to determine the characteristics of the printing materials, acrylonitrile butadiene styrene and polylactic acid, as bolus material with physical density of 1.04 and 1.2 g/cm3, and electron density of 3.38×1023electrons/cm3 and 3.80×1023 electrons/cm3, respectively. Dose plane comparisons using Gafchromic EBT2 film and the RANDO phantom were used to verify accurate treatment planning. We accurately modeled a printing material in Eclipse treatment planning system, assigning it a Hounsfield unit of 260. We were also able to verify accurate treatment planning using gamma analysis for dose plane comparisons. With gamma criteria of 5% dose difference and 2 mm DTA, we were able to have 86.5% points passing, and with gamma criteria of 5% dose difference and 3 mm DTA, we were able to have 95% points passing. We were able to create a patient‐specific bolus using an inexpensive 3D printer and model it in our treatment planning system for accurate treatment delivery. PACS numbers: 87.53.Jw, 87.53.Kn, 87.56.ng PMID:26103485

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

NARCIS (Netherlands)

Heetla, H. W.; Staal, M. J.; van Laar, T.

Study design: Pilot study. Objective: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, the

SU-F-T-86: Electron Dosimetric Effects of Bolus and Lens Shielding in Treating Superficial Eye Lesions

Energy Technology Data Exchange (ETDEWEB)

Young, L [University of Washington Medical Center, Seattle, WA (United States); Wootton, L [University of Washington School of Medicine, Seattle, WA (United States); Gopan, O; Liao, J [University of Washington, Seattle, WA (United States)

2016-06-15

Purpose: Electron therapy for the treatment of ocular lymphomas requires the lens to be shielded to prevent secondary cataracts. This work evaluates the dosimetry under a suspended eyeshield with and without bolus for low energy electron fields. Methods: Film (GafChromic EBT3) dosimetry and relative output factors were measured for 6, 8, and 10 MeV electron energies. A customized 5 cm diameter circle electron orbital cutout was constructed for a 6×6 cm applicator with a lens shield, 1 cm diameter Cerrobend cylinder with 2.2 cm length, suspended from an XV film covering the open field. Relative output factors were measured using a Scanditronix electron diode in a solid water phantom. Depth dose profiles were collected for bolus thicknesses of 0, 3, and 5 mm in solid water at a source to surface distance (SSD) of 100 cm. These measurements were repeated in a Rando phantom. Results: At 5 mm, the approximate distance of the lens from the surface of the cornea, the estimated dose in solid water under the suspended lens shield was reduced to 16%, 14%, and 13% of the unblocked dose at the same depth, for electron energies of 6, 8, and 10 MeV, respectively. Applying bolus increased estimated doses under the block to 22% for 3-mm and 32% for 5-mm thicknesses for a 6 MeV incident electron beam. This effect is reduced for higher energies where the corresponding values were 15.5% and 18% for 3-mm and 5-mm for an 8 MeV electron beam. Conclusion: The application of bolus to treat superficial eye lesions of the conjunctiva increases lens dose at a depth of 5-mm under the shielding block with decreasing electron energy. Careful selection of electron energy is needed to account for electron scatter under the lens shield with the application of bolus in order to prevent cataracts.

The effect of food bolus location on jaw movement smoothness and masticatory efficiency.

Science.gov (United States)

Molenaar, W N B; Gezelle Meerburg, P J; Luraschi, J; Whittle, T; Schimmel, M; Lobbezoo, F; Peck, C C; Murray, G M; Minami, I

2012-09-01

Masticatory efficiency in individuals with extensive tooth loss has been widely discussed. However, little is known about jaw movement smoothness during chewing and the effect of differences in food bolus location on movement smoothness and masticatory efficiency. The aim of this study was to determine whether experimental differences in food bolus location (anterior versus posterior) had an effect on masticatory efficiency and jaw movement smoothness. Jaw movement smoothness was evaluated by measuring jerk-cost (calculated from acceleration) with an accelerometer that was attached to the skin of the mentum of 10 asymptomatic subjects, and acceleration was recorded during chewing on two-colour chewing gum, which was used to assessed masticatory efficiency. Chewing was performed under two conditions: posterior chewing (chewing on molars and premolars only) and anterior chewing (chewing on canine and first premolar teeth only). Jerk-cost and masticatory efficiency (calculated as the ratio of unmixed azure colour to the total area of gum, the unmixed fraction) were compared between anterior and posterior chewing with the Wilcoxon signed rank test (two-tailed). Subjects chewed significantly less efficiently during anterior chewing than during posterior chewing (P = 0·0051). There was no significant difference in jerk-cost between anterior and posterior conditions in the opening phase (P = 0·25), or closing phase (P = 0·42). This is the first characterisation of the effect of food bolus location on jaw movement smoothness at the same time as recording masticatory efficiency. The data suggest that anterior chewing decreases masticatory efficiency, but does not influence jerk-cost. © 2012 Blackwell Publishing Ltd.

The effect of food bolus location on jaw movement smoothness and masticatory efficiency

NARCIS (Netherlands)

Molenaar, W.N.B.; Gezelle Meerburg, P.J.; Luraschi, J.; Whittle, T.; Schimmel, M.; Lobbezoo, F.; Peck, C.C.; Murray, G.M.; Minami, I.

2012-01-01

Masticatory efficiency in individuals with extensive tooth loss has been widely discussed. However, little is known about jaw movement smoothness during chewing and the effect of differences in food bolus location on movement smoothness and masticatory efficiency. The aim of this study was to

Gender Equality, Citizenship and Human Rights

DEFF Research Database (Denmark)

reflect upon challenges to gender equality, citizenship, and human rights in their respective societies; it combines theoretical insights with empirically grounded studies. The volume contextualises feminist political theory in China and the Nordic countries and subsequently puts it into a global......This comparative volume examines the ways in which current controversies and political, legal, and social struggles for gender equality raise conceptual questions and challenge our thinking on political theories of equality, citizenship and human rights. Bringing together scholars and activists who...

Amniotic fluid index predicts the relief of variable decelerations after amnioinfusion bolus.

Science.gov (United States)

Spong, C Y; McKindsey, F; Ross, M G

1996-10-01

Our purpose was to determine whether intrapartum amniotic fluid index before amnioinfusion can be used to predict response to therapeutic amnioinfusion. Intrapartum patients (n = 85) with repetitive variable decelerations in fetal heart rate that necessitated amnioinfusion (10 ml/min for 60 minutes) underwent determination of amniotic fluid index before and after bolus amnioinfusion. The fetal heart tracing was scored (scorer blinded to amniotic fluid index values) for number and characteristics of variable decelerations before and 1 hour after initiation of amnioinfusion. The amnioinfusion was considered successful if it resulted in a decrease of > or = 50% in total number of variable decelerations or a decrease of > or = 50% in the rate of atypical or severe variable decelerations after administration of the bolus. Spontaneous vaginal births before completion of administration of the bolus (n = 18) were excluded from analysis. The probability of success of amnioinfusion in relation to amniotic fluid index was analyzed with the chi(2) test for progressive sequence. The mean amniotic fluid index before amnioinfusion was 6.2 +/- 3.3 cm. An amniotic fluid index of amnioinfusion decreased with increasing amniotic fluid index before amnioinfusion (76% [16/21] when initial amniotic fluid index was 0 to 4 cm, 63% [17/27] when initial amniotic fluid index was 4 to 8 cm, 44% [7/16] when initial amniotic fluid index was 8 to 12 cm, and 33% [1/3] when initial amniotic fluid index was > 12 cm, p = 0.03). The incidence of nuchal cords or true umbilical cord knots increased in relation to amniotic fluid index before amnioinfusion. Amniotic fluid index before amnioinfusion can be used to predict the success of amnioinfusion for relief of variable decelerations in fetal heart rate. Failure of amnioinfusion at a high amniotic fluid index before amnioinfusion may be explained by the increased prevalence of nuchal cords or true knots in the umbilical cord.

Effect of fluid loading with normal saline and 6% hydroxyethyl starch on stroke volume variability and left ventricular volume

Directory of Open Access Journals (Sweden)

Kanda H

2015-09-01

Full Text Available Hirotsugu Kanda,1 Yuji Hirasaki,2 Takafumi Iida,1 Megumi Kanao,1 Yuki Toyama,1 Takayuki Kunisawa,1 Hiroshi Iwasaki,11Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, 2Department of Anatomy, The Jikei University Graduate School of Medicine, Tokyo, JapanPurpose: The aim of this clinical trial was to investigate changes in stroke volume variability (SVV and left ventricular end-diastolic volume (LVEDV after a fluid bolus of crystalloid or colloid using real-time three-dimensional transesophageal echocardiography (3D-TEE and the Vigileo-FloTrac™ system.Materials and methods: After obtaining Institutional Review Board approval, and informed consent from the research participants, 22 patients undergoing scheduled peripheral vascular bypass surgery were enrolled in the study. The patients were randomly assigned to receive 500 mL of hydroxyethyl starch (HES; HES group, n=11 or normal saline (Saline group, n=11 for fluid replacement therapy. SVV was measured using the Vigileo-FloTrac system. LVEDV, stroke volume, and cardiac output were measured by 3D-TEE. The measurements were performed over 30 minutes before and after the fluid bolus in both groups.Results: SVV significantly decreased after fluid bolus in both groups (HES group, 14.7%±2.6% to 6.9%±2.7%, P<0.001; Saline group, 14.3%±3.9% to 8.8%±3.1%, P<0.001. LVEDV significantly increased after fluid loading in the HES group (87.1±24.0 mL to 99.9±27.2 mL, P<0.001, whereas no significant change was detected in the Saline group (88.8±17.3 mL to 91.4±17.6 mL, P>0.05. Stroke volume significantly increased after infusion in the HES group (50.6±12.5 mL to 61.6±19.1 mL, P<0.01 but not in the Saline group (51.6±13.4 mL to 54.1±12.8 mL, P>0.05. Cardiac output measured by 3D-TEE significantly increased in the HES group (3.5±1.1 L/min to 3.9±1.3 L/min, P<0.05, whereas no significant change was seen in the Saline group (3.4±1.1 L/min to 3.3±1.0 L

Continuous versus bolus intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease.

Science.gov (United States)

Richards, Robyn; Foster, Jann P; Psaila, Kim

2014-07-17

Gastro-oesophageal reflux disease is a particularly common condition in preterm and low birth weight infants. These infants are also more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus or continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease. To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants.We intended to perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast vs bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication prescribed and given similarly to both intervention groups). We used the standard search strategy of the Cochrane Neonatal Group as described in The Cochrane Library (www.thecochranelibrary.com) to search for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to September 2013). We also searched previous reviews, including cross-references, abstracts and conference and symposia proceedings of the Perinatal Society of Australia and New Zealand and the Pediatric Academic Societies (American Pediatric Society/Society for Pediatric Research and European Society for Paediatric Research) from 1990 to 2012. Published and unpublished RCTs and quasi

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method-Automatic Repeated Bolus Versus Continuous Basal Infusion-Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers.

Science.gov (United States)

Khatibi, Bahareh; Said, Engy T; Sztain, Jacklynn F; Monahan, Amanda M; Gabriel, Rodney A; Furnish, Timothy J; Tran, Johnathan T; Donohue, Michael C; Ilfeld, Brian M

2017-04-01

administration technique (continuous basal versus hourly bolus) when using ropivacaine 0.2% and TAP catheters at 8 mL/h and 24 mL every 3 hours significantly influences the cutaneous effects after 6 hours of administration. Additional research is required to determine whether changing variables (eg, local anesthetic concentration, basal infusion rate, bolus dose volume, and/or interval) would provide different results.

The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial.

Science.gov (United States)

Saunders, Rhodri; Lian, Jean; Karolicki, Boris; Valentine, William

2014-12-01

Abstract Background and aims: Intensification of basal insulin-only therapy in type 2 diabetes is often achieved through addition of bolus insulin 3-times daily. The FullSTEP trial demonstrated that stepwise addition (SWA) of bolus insulin aspart was non-inferior to full basal-bolus (FBB) therapy and reduced the rate of hypoglycemia. Here the cost-effectiveness and budget impact of SWA is evaluated. Cost-effectiveness and budget impact models were developed to assess the cost and quality-of-life (QoL) implications of intensification using SWA compared with FBB in the US setting. At assessment, SWA patients added one bolus dose to their current regimen if the HbA1c target was not met. SWA patients reaching three bolus doses used FBB event rates. Outcomes were evaluated at trial end and projected annually up to 5 years. Models captured hypoglycemic events, the proportion meeting HbA1c target, and self-measured blood glucose. Event rates and QoL utilities were taken from trial data and published literature. Costs were evaluated from a healthcare-payer perspective, reported in 2013 USD, and discounted (like clinical outcomes) at 3.5% annually. This analysis applies to patients with HbA1c 7.0-9.0% and body mass index Budget impact analysis estimated that, by moving from FBB to SWA, a health plan with 77,000 patients with type 2 diabetes, of whom 7.8% annually intensified to basal-bolus therapy, would save USD 1304 per intensifying patient over the trial period. SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.

Optimized enhancement in helical CT: Experiences with a real-time bolus tracking system in 628 patients

International Nuclear Information System (INIS)

Kirchner, J.; Kickuth, R.; Laufer, U.; Noack, M.; Liermann, D.

2000-01-01

AIMS: Ultrafast detector technology enables bolus-triggered application of contrast media. In a prospective study we investigated the benefit of this new method with the intention of optimizing enhancement during examination of the chest and abdomen. MATERIALS AND METHODS: In total, we examined 548 patients under standardized conditions. All examinations were performed on a Somatom Plus 4 Power CT system (Siemens Corp., Forchheim, Germany) using the CARE-Bolus software. This produces repetitive low-dose test images (e.g. for the lung: 140 kV, 43 mA, TI 0.5 s) and measures the Hounsfield attenuation in a pre-selected region of interest. After exceeding a defined threshold, a diagnostic spiral CT examination was begun automatically. The data obtained from 321 abdominal CT and 179 lung CT examinations were correlated with different parameters such as age, weight and height of the patients and parameters of vascular access. In a group of 80 patients, the injection of contrast medium was stopped after reaching a pre-defined threshold of an increase of 100 HU over the baseline. Then, we assessed the maximal enhancement of liver, pulmonal artery trunk and aortic arch. RESULTS: There was no correlation between bolus geometry and age, body surface or weight. In helical CT of the abdomen the threshold was reached after a mean trigger time of 27 s (range 13-67 s) and only 65 ml (range 41-105 ml) of contrast medium were administered. In helical CT of the lung the threshold was reached after 21 s (range 12-48 s) and the mean amount of administered contrast medium was 48 ml (range 38-71 ml). CONCLUSION: Bolus triggering allows optimized enhancement of the organs and reduces the dose of contrast material required compared with standard administration. Kirchner, J. (2000). Clinical Radiology 55, 368-373

Optimized enhancement in helical CT: experiences with a real-time bolus tracking system in 628 patients.

Science.gov (United States)

Kirchner, J; Kickuth, R; Laufer, U; Noack, M; Liermann, D

2000-05-01

Ultrafast detector technology enables bolus-triggered application of contrast media. In a prospective study we investigated the benefit of this new method with the intention of optimizing enhancement during examination of the chest and abdomen. In total, we examined 548 patients under standardized conditions. All examinations were performed on a Somatom Plus 4 Power CT system (Siemens Corp., Forchheim, Germany) using the CARE-Bolus software. This produces repetitive low-dose test images (e.g. for the lung: 140 kV, 43 mA, TI 0.5 s) and measures the Hounsfield attenuation in a pre-selected region of interest. After exceeding a defined threshold, a diagnostic spiral CT examination was begun automatically. The data obtained from 321 abdominal CT and 179 lung CT examinations were correlated with different parameters such as age, weight and height of the patients and parameters of vascular access. In a group of 80 patients, the injection of contrast medium was stopped after reaching a pre-defined threshold of an increase of 100 HU over the baseline. Then, we assessed the maximal enhancement of liver, pulmonal artery trunk and aortic arch. There was no correlation between bolus geometry and age, body surface or weight. In helical CT of the abdomen the threshold was reached after a mean trigger time of 27 s (range 13-67 s) and only 65 ml (range 41-105 ml) of contrast medium were administered. In helical CT of the lung the threshold was reached after 21 s (range 12-48 s) and the mean amount of administered contrast medium was 48 ml (range 38-71 ml). Bolus triggering allows optimized enhancement of the organs and reduces the dose of contrast material required compared with standard administration. Copyright 2000 The Royal College of Radiologists.

Bolus timing in high-pitch CT angiography of the aorta

International Nuclear Information System (INIS)

Beeres, Martin; Loch, Matthias; Schulz, Boris; Kerl, Matthias; Al-Butmeh, Firas; Bodelle, Boris; Herrmann, Eva; Gruber-Rouh, Tatjana; Lee, Clara; Jacobi, Volkmar; Vogl, Thomas J.

2013-01-01

Objective: To investigate the bolus geometry in high-pitch CT angiography (CTA) of the aorta without ECG synchronisation in comparison to single-source CT. Methods: Overall 160 consecutive patients underwent CTA either in conventional single-source mode with a pitch of 1.2 (group 1), or in dual-source mode with a pitch of 3.0 (groups 2, 3 and 4) using different contrast media timings with bolus triggering at 140 HU (5 s, group 1; 10 s, group 2; 12 s, group 3; 14 s, group 4). Contrast material, saline flush, flow rate and kV/mAs settings were kept equal for optimum comparability. Aortic attenuation was measured along the z-axis of the patient at different anatomic landmarks and subjective image quality was compared. Results: The most homogeneous enhancement of the aorta was reached with a delay of 10 s after reaching the trigger threshold. The imaging length was not significantly different, but the examination time was significantly (p < 0.001) shorter in the high-pitch group (7.7 s vs. 1.7 s for group 1 vs. 2, 3 and 4). Conclusion: In high-pitch CT angiography using a start delay of 10 s after a trigger threshold of 140 HU in the descending aorta is reached, a homogenous contrast along the z-axis is accomplished

Bolus electron conformal therapy for the treatment of recurrent inflammatory breast cancer: a case report

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Kim, Michelle M., E-mail: mmkim@mdanderson.org [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Kudchadker, Rajat J.; Kanke, James E.; Zhang, Sean; Perkins, George H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2012-07-01

The treatment of locoregionally recurrent breast cancer in patients who have previously undergone radiation therapy is challenging. Special techniques are often required that both eradicate the disease and minimize the risks of retreatment. We report the case of a patient with an early-stage left breast cancer who developed inflammatory-type recurrence requiring re-irradiation of the chest wall using bolus electron conformal therapy with image-guided treatment delivery. The patient was a 51-year-old woman who had undergone lumpectomy, axillary lymph node dissection, and adjuvant whole-breast radiation therapy for a stage I left breast cancer in June 1998. In March 2009, she presented at our institution with biopsy-proven recurrent inflammatory carcinoma and was aggressively treated with multi-agent chemotherapy followed by mastectomy that left a positive surgical margin. Given the patient's prior irradiation and irregular chest wall anatomy, bolus electron conformal therapy was used to treat her chest wall and draining lymphatics while sparing the underlying soft tissue. The patient still had no evidence of disease 21 months after treatment. Our results indicate that bolus electron conformal therapy is an accessible, effective radiation treatment approach for recurrent breast cancer in patients with irregular chest wall anatomy as a result of surgery. This approach may complement standard techniques used to reduce locoregional recurrence in the postmastectomy setting.

Intravenous Bolus versus Continuous Infusion of Famotidine or Ranitidine on 24 H Intragastric Acidity in Fasting Healthy Volunteers

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ABR Thomson

1995-01-01

Full Text Available Infusions of H2-receptor antagonists may be clinically indicated to maintain intragastric pH above 4 to reduce acute gastric mucosal lesions or to treat patients with bleeding peptic ulcers. Eight fasting healthy volunteers were randomly assigned to receive ranitidine infusion alone (150 mg/day, ranitidine infusion plus 50 mg bolus injection of ranitidine (total of 200 mg/day, famotidine infusion alone (40 mg/day or famotidine infusion plus 40 mg bolus injection of famotidine (total of 80 mg/day. Gastric fluid contents were aspirated for 24 h and collected as half-hourly samples in which pH measurements were made. Measures analyzed were mean and median pH, percentage pH at or below 3, 4 or 5 for the 24 h period, daytime, evening and nighttime. The data for each of the variables were analyzed as a Latin square crossover design of variance therapy; base pH before treatment administration in each crossover phase was employed as the covariant. Significant differential treatment means were tested by Newman-Keul’s multiple range test at the 5% level of significance. The mean and median evening pH were higher after famotidine than after ranitidine infusion, but all other pH readings were similar when using these doses. The addition of an initial loading bolus of 50 mg ranitidine to the ranitidine infusion did not result in any added differences in pH, whereas the addition of an initial loading bolus of 40 mg famotidine to the famotidine infusion resulted in a higher 24 h median pH, as well as a lower percentage of pH values of 4 or below, 16.6% versus 28.5%, P<0.05. However, the loading doses of ranitidine and famotidine were not equivalent in potency, and studies are needed to compare the potency of equivalent doses of ranitidine and famotidine when given by bolus plus infusion. Also the clinical relevance of these findings needs to be explored further in the type of individuals potentially requiring intravenous H2-receptor antagonists.

SU-E-T-71: A Radiochromic Film Based Quantitative Assessment of Thermoplastic Mask Bolus Effect in Head and Neck IMRT/VMAT

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Kalavagunta, C; Lin, M; Snider, J; Xu, H; Schrum, A; Vadnais, P; Marter, K; Suntharalingam, M; Prado, K [University of Maryland School of Medicine, Baltimore, MD (United States)

2015-06-15

Purpose: To quantify the factors leading to thermoplastic mask bolus-associated-increased skin dose in head and neck IMRT/VMAT using EBT2 film. Methods: EBT2 film placed beneath a dual layer 3-point ORFIT head, neck and shoulder mask was used to test the effect of mask thickness, beam modulation, air gap, and beam obliquity on bolus effect. Mask thickness was varied based on the distribution of 1.6mm Orfilight layer on top of 2 mm Efficast layer. Beam modulation was varied by irradiating the film with an open field (no beam modulation) and a step and shoot field (beam modulation). Air gap between mask and film was varied from 0 to 5mm. Beam obliquity was varied by irradiating the film at gantry angles of 0°, 35°, and 70°.Finally, film strips placed on a Rando phantom under an Orfit mask, in regions of expected high dose, were irradiated using 5 IMRT and 5 VMAT plans with various modulation levels (modulation factor 2 to 5) and the results were compared with those obtained placing OSLDs at the same locations. Results: An 18–34% increase in mask bolus effect was observed for three factors where the effect of beam obliquity ≥ beam modulation > mask thickness. No increase in mask bolus effect was observed for change in air gap. A 6–13% increase in dose due to mask bolus effect was observed on film strips. Conclusion: This work underlines the role of beam obliquity and beam modulation combined with thermoplastic mask thickness in increasing mask bolus-associated skin dose in head and neck IMRT/VMAT. One possible method of dose reduction, based on knowledge gained from this work, is inclusion of skin as an avoidance structure in treatment planning. Another approach is to design a mask with the least amount of thermoplastic material necessary for immobilization.

SU-E-T-71: A Radiochromic Film Based Quantitative Assessment of Thermoplastic Mask Bolus Effect in Head and Neck IMRT/VMAT

International Nuclear Information System (INIS)

Kalavagunta, C; Lin, M; Snider, J; Xu, H; Schrum, A; Vadnais, P; Marter, K; Suntharalingam, M; Prado, K

2015-01-01

Purpose: To quantify the factors leading to thermoplastic mask bolus-associated-increased skin dose in head and neck IMRT/VMAT using EBT2 film. Methods: EBT2 film placed beneath a dual layer 3-point ORFIT head, neck and shoulder mask was used to test the effect of mask thickness, beam modulation, air gap, and beam obliquity on bolus effect. Mask thickness was varied based on the distribution of 1.6mm Orfilight layer on top of 2 mm Efficast layer. Beam modulation was varied by irradiating the film with an open field (no beam modulation) and a step and shoot field (beam modulation). Air gap between mask and film was varied from 0 to 5mm. Beam obliquity was varied by irradiating the film at gantry angles of 0°, 35°, and 70°.Finally, film strips placed on a Rando phantom under an Orfit mask, in regions of expected high dose, were irradiated using 5 IMRT and 5 VMAT plans with various modulation levels (modulation factor 2 to 5) and the results were compared with those obtained placing OSLDs at the same locations. Results: An 18–34% increase in mask bolus effect was observed for three factors where the effect of beam obliquity ≥ beam modulation > mask thickness. No increase in mask bolus effect was observed for change in air gap. A 6–13% increase in dose due to mask bolus effect was observed on film strips. Conclusion: This work underlines the role of beam obliquity and beam modulation combined with thermoplastic mask thickness in increasing mask bolus-associated skin dose in head and neck IMRT/VMAT. One possible method of dose reduction, based on knowledge gained from this work, is inclusion of skin as an avoidance structure in treatment planning. Another approach is to design a mask with the least amount of thermoplastic material necessary for immobilization

Ultrasound and Histologic Examination after Subcutaneous Injection of Two Volumizing Hyaluronic Acid Fillers: A Preliminary Study

Science.gov (United States)

Besse, Stéphanie; Sarazin, Didier; Quinodoz, Pierre; Elias, Badwi; Safa, Marva; Vandeputte, Joan

2017-01-01

Background: This study examined the influence of hyaluronic acid (HA) crosslinking technology on the ultrasound and histologic behavior of HA fillers designed for subcutaneous injection. Methods: One subject received subcutaneous injections of 0.25 ml Cohesive Polydensified Matrix (CPM) and Vycross volumizing HA in tissue scheduled for abdominoplasty by bolus and retrograde fanning techniques. Ultrasound analyses were performed on days 0 and 8 and histologic analyses on days 0 and 21 after injection. A series of simple rheologic tests was also performed. Results: Day 0 ultrasound images after bolus injection showed CPM and Vycross as hypoechogenic papules in the hypodermis. CPM appeared little changed after gentle massage, whereas Vycross appeared more hyperechogenic and diminished in size. Ultrasound images at day 8 were similar. On day 0, both gels appeared less hypoechogenic after retrograde fanning than after bolus injection. Vycross was interspersed with hyperechogenic areas (fibrous septa from the fat network structure) and unlike CPM became almost completely invisible after gentle massage. On day 8, CPM appeared as a hypoechogenic pool and Vycross as a long, thin rod. Day 0 histologic findings confirmed ultrasound results. Day 21 CPM histologic findings showed a discrete inflammatory reaction along the injection row after retrograde fanning. Vycross had a more pronounced inflammatory reaction, particularly after retrograde fanning, with macrophages and giant cells surrounding the implant. Rheologic tests showed CPM to have greater cohesivity and resistance to traction forces than Vycross. Conclusions: CPM HA volumizer appears to maintain greater tissue integrity than Vycross after subcutaneous injection with less inflammatory activity. PMID:28280664

Optimization of initial propofol bolus dose for EEG Narcotrend Index-guided transition from sevoflurane induction to intravenous anesthesia in children.

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Dennhardt, Nils; Boethig, Dietmar; Beck, Christiane; Heiderich, Sebastian; Boehne, Martin; Leffler, Andreas; Schultz, Barbara; Sümpelmann, Robert

2017-04-01

Sevoflurane induction followed by intravenous anesthesia is a widely used technique to combine the benefits of an easier and less traumatic venipuncture after sevoflurane inhalation with a recovery with less agitation, nausea, and vomiting after total intravenous anesthesia (TIVA). Combination of two different anesthetics may lead to unwanted burst suppression in the electroencephalogram (EEG) during the transition phase. The objective of this prospective clinical observational study was to identify the optimal initial propofol bolus dose for a smooth transition from sevoflurane induction to TIVA using the EEG Narcotrend Index (NI). Fifty children aged 1-8 years scheduled for elective pediatric surgery were studied. After sevoflurane induction and establishing of an intravenous access, a propofol bolus dose range 0-5 mg·kg -1 was administered at the attending anesthetist's discretion to maintain a NI between 20 and 64, and sevoflurane was stopped. Anesthesia was continued as TIVA with a propofol infusion dose of 15 mg·kg -1 ·h -1 for the first 15 min, followed by stepwise reduction according to McFarlan's pediatric infusion regime, and remifentanil 0.25 μg·kg -1 ·min -1 . Endtidal concentration of sevoflurane, NI, and hemodynamic data were recorded during the whole study period using a standardized case report form. Propofol plasma concentrations were calculated using the paedfusor dataset and a TIVA simulation program. Median endtidal concentration of sevoflurane at the time of administration of the propofol bolus was 5.1 [IQR 4.7-5.9] Vol%. The median propofol bolus dose was 1.2 [IQR 0.9-2.5] mg·kg -1 and median NI thereafter was 33 [IQR 23-40]. Nine children presented with a NI 13-20 and three children with burst suppression in the EEG (NI 0-12); all of them received an initial propofol bolus dose >2 mg·kg -1 . Regression equation demonstrated that NI 20-64 was achieved with a 95% probability when using a propofol bolus dose of 1 mg·kg -1 after

Enhancing automatic closed-loop glucose control in type 1 diabetes with an adaptive meal bolus calculator - in silico evaluation under intra-day variability.

Science.gov (United States)

Herrero, Pau; Bondia, Jorge; Adewuyi, Oloruntoba; Pesl, Peter; El-Sharkawy, Mohamed; Reddy, Monika; Toumazou, Chris; Oliver, Nick; Georgiou, Pantelis

2017-07-01

Current prototypes of closed-loop systems for glucose control in type 1 diabetes mellitus, also referred to as artificial pancreas systems, require a pre-meal insulin bolus to compensate for delays in subcutaneous insulin absorption in order to avoid initial post-prandial hyperglycemia. Computing such a meal bolus is a challenging task due to the high intra-subject variability of insulin requirements. Most closed-loop systems compute this pre-meal insulin dose by a standard bolus calculation, as is commonly found in insulin pumps. However, the performance of these calculators is limited due to a lack of adaptiveness in front of dynamic changes in insulin requirements. Despite some initial attempts to include adaptation within these calculators, challenges remain. In this paper we present a new technique to automatically adapt the meal-priming bolus within an artificial pancreas. The technique consists of using a novel adaptive bolus calculator based on Case-Based Reasoning and Run-To-Run control, within a closed-loop controller. Coordination between the adaptive bolus calculator and the controller was required to achieve the desired performance. For testing purposes, the clinically validated Imperial College Artificial Pancreas controller was employed. The proposed system was evaluated against itself but without bolus adaptation. The UVa-Padova T1DM v3.2 system was used to carry out a three-month in silico study on 11 adult and 11 adolescent virtual subjects taking into account inter-and intra-subject variability of insulin requirements and uncertainty on carbohydrate intake. Overall, the closed-loop controller enhanced by an adaptive bolus calculator improves glycemic control when compared to its non-adaptive counterpart. In particular, the following statistically significant improvements were found (non-adaptive vs. adaptive). Adults: mean glucose 142.2 ± 9.4vs. 131.8 ± 4.2mg/dl; percentage time in target [70, 180]mg/dl, 82.0 ± 7.0vs. 89.5 ± 4

Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis

NARCIS (Netherlands)

Beenen, Ludo F. M.; Sierink, Joanne C.; Kolkman, Saskia; Nio, C. Yung; Saltzherr, Teun Peter; Dijkgraaf, Marcel G. W.; Goslings, J. Carel

2015-01-01

For the evaluation of severely injured trauma patients a variety of total body computed tomography (CT) scanning protocols exist. Frequently multiple pass protocols are used. A split bolus contrast protocol can reduce the number of passes through the body, and thereby radiation exposure, in this

Standortdebatte: (Gender Mainstreaming und Herrschaftskritik A Debate of Placement: (Gender Mainstreaming and Criticism of Power

Directory of Open Access Journals (Sweden)

Eva Sänger

2004-07-01

Full Text Available Die Autorinnen des Bandes Feminismus, Gender, Geschlecht der schweizerischen Zeitschrift Widerspruch diskutieren die Chancen und Risiken von Gender-Mainstreaming-Strategien im Horizont des neoliberalen Gesellschaftsumbaus und fragen im Diskussionsteil nach den Erkenntnispotenzialen und herrschaftskritischen Perspektiven der feministischen Theorie bzw. poststrukturalistischer und konstruktivistischer Ansätze.The authors of the volume Feminismus, Gender, Geschlecht of the Swiss journal Widerspruch discuss the prospects and risks of gender-mainstreaming strategies in the context of neoliberal social restructuring. In the discussion section, they consider the potential and critical perspectives of feminist theory, i.e. poststructuralist and constructivist methods.

Study of the usefulness on liver CT using intermittent bolus injection method

International Nuclear Information System (INIS)

Hayashi, Hideo

1990-01-01

Usefulness on the liver CT using intermittent bolus injection method of contrast media (IM-CE) was studied in 108 hepatic space occupying lesions, particularly to analyze hepatocellular carcinoma (HCC). Scans were obtained before, 20∼30 (arterial phase) and 60 seconds (parenchymal phase) after intravenous bolus injection of 65%-diatrizoate (angiografin) or 300 mg I-iopamidol (iopamiron 300), and in case of necessity, added 3∼15 minutes (late phase) after all injections of contrast media. These scans imaging the features of hepatic mass provided us much useful information. Early enhancement of the arterial phase, and early wash out of the parenchymal phase and delayed ring enhancement of the capsule improved the rates of detection to 96%, 60%, and 49% respectively in case of HCC. Especially. at the small HCC (less than 2cm in diameter), these rates were 89%, 50%, and 28% respectively. Combination of these 3 findings suggested the possibility of HCC in comparison with other hepatic mass. The rate of accurate diagnosis of HCC by this IM-CE was 81%. Thus IM-CE CT provides the useful information in diagnosis of hepatic mass and should be considered as the routine examination of hepatic mass. (author)

Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus.

Science.gov (United States)

Smith, D F; Ott, D J; Gelfand, D W; Chen, M Y

1998-11-01

The purpose of this investigation was to determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus. Our prospective study included 130 patients who underwent barium examination of the esophagus. All patients completed a questionnaire regarding the anatomic location of their symptoms of dysphagia. In addition to a multiphasic examination of the esophagus, all patients also underwent fluoroscopic observation and videotaping while swallowing a marshmallow bolus; any symptoms that were provoked were recorded. Lower esophageal mucosal rings were shown in 26 (20%) of the 130 patients. The diameter of the rings was 9-12 mm in six patients, 13-20 mm in 18 patients, and larger than 20 mm in two patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring; the impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to the neck in seven, the sternal angle in two, the mid chest in two, and the lower chest in one patient. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms. Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints.

Multidetector computed tomography with triple-bolus contrast medium administration protocol for preoperative anatomical and functional assessment of potential living renal donors

International Nuclear Information System (INIS)

Knox, Matthew K.; Rivers-Bowerman, Michael D.; Bardgett, Harry P.; Cowan, Nigel C.

2010-01-01

To evaluate multidetector computed tomography (MDCT) with a triple-bolus contrast administration protocol for preoperative anatomical and functional assessment of living renal donors. Fifty-five potential living renal donors underwent MDCT of which 27 proceeded to donor nephrectomy. A triple-bolus contrast administration protocol was used for simultaneous acquisition of arterial, nephrographic, and excretory phases. MDCT images were independently reviewed in random order by two radiologists blinded to surgical anatomy findings. Diagnostic accuracy for anatomical variants was quantified by sensitivity and specificity. Differential renal function (DRF) was derived from MDCT for 54 patients and compared with technetium-99 m dimercaptosuccinic acid renography (Tc-99 m DMSA). All triple-bolus MDCT examinations were technically adequate. Accessory renal arteries and veins were identified at surgery in 33% (n = 9/27) and 22% (n = 6/27) of donor kidneys. The mean difference between MDCT-derived DRF and DMSA was 0.8% (95% CI 0.1-1.6) with 95% limits of agreement of -4.6% (95% CI -3.3 to -5.9) to 6.3% (95% CI 5.0-7.6). MDCT delivered a mean (SD, range) radiation dose of 9.5 (3.6, 3.6-17.3) mSv. MDCT with a triple-bolus contrast administration provides accurate anatomical and functional evaluation of living renal donors. (orig.)

Multidetector computed tomography with triple-bolus contrast medium administration protocol for preoperative anatomical and functional assessment of potential living renal donors

Energy Technology Data Exchange (ETDEWEB)

Knox, Matthew K. [University of Calgary, Faculty of Medicine, UME Office, Health Sciences Centre, Calgary, Alberta (Canada); Rivers-Bowerman, Michael D. [University of British Columbia, Faculty of Medicine, MD Undergraduate Program, Diamond Health Care Centre, Vancouver, British Columbia (Canada); Bardgett, Harry P. [Bradford Teaching Hospitals, Department of Radiology, Bradford (United Kingdom); Cowan, Nigel C. [The Churchill Hospital, Department of Radiology, Oxford (United Kingdom)

2010-11-15

To evaluate multidetector computed tomography (MDCT) with a triple-bolus contrast administration protocol for preoperative anatomical and functional assessment of living renal donors. Fifty-five potential living renal donors underwent MDCT of which 27 proceeded to donor nephrectomy. A triple-bolus contrast administration protocol was used for simultaneous acquisition of arterial, nephrographic, and excretory phases. MDCT images were independently reviewed in random order by two radiologists blinded to surgical anatomy findings. Diagnostic accuracy for anatomical variants was quantified by sensitivity and specificity. Differential renal function (DRF) was derived from MDCT for 54 patients and compared with technetium-99 m dimercaptosuccinic acid renography (Tc-99 m DMSA). All triple-bolus MDCT examinations were technically adequate. Accessory renal arteries and veins were identified at surgery in 33% (n = 9/27) and 22% (n = 6/27) of donor kidneys. The mean difference between MDCT-derived DRF and DMSA was 0.8% (95% CI 0.1-1.6) with 95% limits of agreement of -4.6% (95% CI -3.3 to -5.9) to 6.3% (95% CI 5.0-7.6). MDCT delivered a mean (SD, range) radiation dose of 9.5 (3.6, 3.6-17.3) mSv. MDCT with a triple-bolus contrast administration provides accurate anatomical and functional evaluation of living renal donors. (orig.)

Evaluation of regional cerebral blood flow and volume of rapidly exchangeable water in man by positron emission tomography

International Nuclear Information System (INIS)

Depresseux, J.C.; Cheslet, J.P.; Hodiaumont, J.

1982-01-01

The present investigation uses bolus inhalation of C 15 O 2 and sequential positron emission tomography of the brain in view to simultaneously evaluate regional cerebral blood flow and regional cerebral volume of rapidly exchangeable water in normal human subjects. Arguments allow to infer that the cerebral distribution volume of radiowater does vary with time during the initial period of invasion of tissue by the indicator. Implications of this variation on the validity of classical data procedures is discussed and an alternative original method is proposed [fr

An additional bolus of rapid-acting insulin to normalise postprandial cardiovascular risk factors following a high-carbohydrate high-fat meal in patients with type 1 diabetes: A randomised controlled trial.

Science.gov (United States)

Campbell, Matthew D; Walker, Mark; Ajjan, Ramzi A; Birch, Karen M; Gonzalez, Javier T; West, Daniel J

2017-07-01

To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes. A total of 10 males with type 1 diabetes [HbA 1c 52.5 ± 5.9 mmol/mol (7.0% ± 0.5%)] underwent three conditions: (1) a low-fat (LF) meal with normal bolus insulin, (2), a high-fat (HF) meal with normal bolus insulin and (3) a high-fat meal with normal bolus insulin with an additional 30% insulin bolus administered 3-h post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-h post-meal and analysed for triglyceride, non-esterified-fatty acids, apolipoprotein B48, glucagon, tumour necrosis factor alpha, fibrinogen, human tissue factor activity and plasminogen activator inhibitor-1. Continuous glucose monitoring captured interstitial glucose responses. Triglyceride concentrations following LF remained similar to baseline, whereas triglyceride levels following HF were significantly greater throughout the 6-h observation period. The additional insulin bolus (HFA) normalised triglyceride similarly to low fat 3-6 h following the meal. HF was associated with late postprandial elevations in tumour necrosis factor alpha, whereas LF and HFA was not. Fibrinogen, plasminogen activator inhibitor-1 and tissue factor pathway levels were similar between conditions. Additional bolus insulin 3 h following a high-carbohydrate high-fat meal prevents late rises in postprandial triglycerides and tumour necrosis factor alpha, thus improving cardiovascular risk profile.

Radiation dosimetry for bolus administration of oxygen-15-water

International Nuclear Information System (INIS)

Brihaye, C.; Depresseux, J.C.; Comar, D.

1995-01-01

The authors describe the development of a biokinetic model which permits an estimation of organ activities and the dosimetry of a bolus of 15 O-water. The aim of this study was to estimate time-activity functions and deduce the cumulated activities in different organs so that the radiation absorbed dose values can be estimated. The model used includes the right heart chambers, lungs, left heart chambers, brain, liver, kidneys, muscles, gasrointestinal tract and the remainder of the body. Activity in an organ will decay by physical decay with the decay constant, γ, and can diffuse in the organ. An exception is the heart, where blood is ejected from the heart chambers. Depending on the location of the organ in relation to the blood sampling point, organ activities can be calculated by convolution or deconvolution. The radiation absorbed dose values were estimated and an effective dose equivalent H E of 1.16 μSv/MBq (4.32 mrem/mCi) as well as an effective dose E of 1.15 μSv/MBq (4.25 mrem/mCi) were calculated. The cumulated activities in select organs measured by PET gave good agreement with the values calculated by this model. The values of effective dose equivalent and effective dose for bolus administration of 15 O-water calculated from the absorbed doses estimated by the proposed kinetic model are almost three times higher than those previously published. A total of 8700 MBq (235 mCi) of 15 O-water can be administered if an effective dose of 10 mSv (1 rem) is accepted. 32 refs., 5 figs., 2 tabs

Pathological bolus exposure may define gastro-esophageal reflux better than pathological acid exposure in patients with globus.

Science.gov (United States)

Sinn, Dong Hyun; Kim, Beom Jin; Son, Hee Jung; Kim, Jae J; Rhee, Jong Chul; Rhee, Poong-Lyul

2012-01-01

Conventionally, pathological acid exposure (PAE), defined by acid reflux only, is used to identify gastro-esophageal reflux disease (GERD). However, weak acid reflux or non-acid reflux also induces reflux symptoms. Defining abnormal reflux based on all reflux episodes may better identify GERD and would be more useful among patients with atypical GERD symptoms, such as globus. Impedance-pHmetry results of 31 globus patients, off acid suppressants, were analysed. A median of 24 episodes of reflux were observed. Of the reflux episodes, 54% were non-acid reflux and 50% reached the proximal extent. PAE was observed in 6 patients (19%). For 5 patients (16%) without PAE, there was evidence of increased bolus exposure compared to normal controls (an intraesophageal bolus exposure for more than 1.4% of the recording time, defined as pathological bolus exposure, PBE). When GERD was defined by PAE or esophagitis, the prevalence of GERD was 29%. When GERD was defined by PBE, PAE or esophagitis, the prevalence was 42%. PBE identified 13% of the patients who otherwise would have been missed. A significant proportion of patients without PAE had evidence of PBE. PBE may be a more useful definition for identifying patients with abnormal increase in reflux in patients with globus. Further studies are warranted.

Comparison of first pass bolus AIFs extracted from sequential 18F-FDG PET and DSC-MRI of mice

International Nuclear Information System (INIS)

Evans, Eleanor; Sawiak, Stephen J.; Ward, Alexander O.; Buonincontri, Guido; Hawkes, Robert C.; Adrian Carpenter, T.

2014-01-01

Accurate kinetic modelling of in vivo physiological function using positron emission tomography (PET) requires determination of the tracer time–activity curve in plasma, known as the arterial input function (AIF). The AIF is usually determined by invasive blood sampling methods, which are prohibitive in murine studies due to low total blood volumes. Extracting AIFs from PET images is also challenging due to large partial volume effects (PVE). We hypothesise that in combined PET with magnetic resonance imaging (PET/MR), a co-injected bolus of MR contrast agent and PET ligand can be tracked using fast MR acquisitions. This protocol would allow extraction of a MR AIF from MR contrast agent concentration–time curves, at higher spatial and temporal resolution than an image-derived PET AIF. A conversion factor could then be applied to the MR AIF for use in PET kinetic analysis. This work has compared AIFs obtained from sequential DSC-MRI and PET with separate injections of gadolinium contrast agent and 18 F-FDG respectively to ascertain the technique′s validity. An automated voxel selection algorithm was employed to improve MR AIF reproducibility. We found that MR and PET AIFs displayed similar character in the first pass, confirmed by gamma variate fits (p<0.02). MR AIFs displayed reduced PVE compared to PET AIFs, indicating their potential use in PET/MR studies

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

Science.gov (United States)

Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro; Sata, Masataka

2017-01-01

Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p EATV Index (Corrected R2 = 0.266, p = 0.005). Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

Effect of contrast media iodine concentration on bolus tracking

International Nuclear Information System (INIS)

Ishihara, Toshihiro; Hayashi, Takayuki; Nakaya, Yoshihiro; Naoi, Kuniji; Ikeno, Naoya; Kobayashi, Tatsushi; Satake, Mitsuo

2006-01-01

Computer-assisted bolus tracking has been confirmed to be a useful technique in computed tomography (CT) imaging and allows images to be captured with automated timing. The inflow of the contrast medium is monitored, and when the contrast medium reaches a predetermined level, CT image capture starts automatically. However, it has been shown that the preset threshold value of contrast medium is affected by its iodine concentration, which causes variations in image capture times. Greater speed in current multislice CT imaging requires that medical technicians pay more attention to setting the timing of image capture during venous examinations by taking into account the iodine concentration in contrast media. (author)

Direct bolus imaging of cervical blood vessels by means of MRI

International Nuclear Information System (INIS)

Satoh, Toshihiko; Fujioka, Mutsuhisa; Watari, Tsutomu; Nishimura, Gen; Matsumoto, Toshihiko; Washiya, Sumio; Inoue, Kiyoshi; Horita, Masatoshi; Shimizu, Kohji.

1991-01-01

Direct bolus imaging (DBI) is one of the non-invasive method for flow measurements which is based on the bolus tracking technique. DBI permits the direct visualization of flow velocity profiles and vessel band width. We performed screening for cervical vessel disease in patients with vertigo by means of DBI. MR system used here was 0.5 T superconducting imager-SMT-50A (Shimazu Co. Ltd). Pulse sequence parameters were TR= 60 ms, TE= 50 ms, NEX= 1, acquisition matrix; 128 x 256, slice thickness= 5 mm, with cardiac gating. Pulse sequence employed a slice selective RF pulse at the level of C5 vertebral body to tag a disk of fluid perpendicular to the direction of flow, followed by a gradient reforcussed echo. We evaluated each peak high and band width of the common-carotid arteries and the vertebral arteries. Seventy nine of 83 cases had optimal examinations. Abnormal findings of DBI were seen in 15 of 79 cases, (including 2 of subclavian steal syndrome, 1 of carotid obstruction, 5 of vertebral obstruction, 1 of basilar artery obstruction, and 6 of hypoplasia of vertebral artery). The abnormal findings of DBI were well correlated with those of angiographic examinations. We concluded that DBI was suitable to the screening for cervical vessel diseases in patients with vertigo, and should be added to the routine MR studies. (author)

A Factor Increasing Venous Contamination on Bolus Chase Three-dimensional Magnetic Resonance Imaging: Charcot Neuroarthropathy.

Science.gov (United States)

Çildağ, Mehmet B; Ertuğrul, Mustafa B; Köseoğlu, Ömer Fk; Armstrong, David G

2018-01-01

The study aimed to evaluate the ratio of venous contamination in diabetic cases without foot lesion, with foot lesion and with Charcot neuroarthropathy (CN). Bolus-chase three-dimensional magnetic resonance (MR) of 396 extremities of patients with diabetes mellitus was analyzed, retrospectively. Extremities were divided into three groups as follows: diabetic patients without foot ulcer or Charcot arthropathy (Group A), patients with diabetic foot ulcers (Group B) and patients with CN accompanying diabetic foot ulcers (Group C). Furthermore, amount of venous contamination classified as no venous contamination, mild venous contamination, and severe venous contamination. The relationship between venous contamination and extremity groups was investigated. Severe venous contamination was seen in Group A, Group B, and Group C, 5.6%, 15.2%, and 34.1%, respectively. Statistically significant difference was seen between groups with regard to venous contamination. Venous contamination following bolus chase MR was higher in patients with CN.

Quantifying normal ankle joint volume: An anatomic study

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Draeger Reid

2009-01-01

Full Text Available Background: Many therapeutic and diagnostic modalities such as intraarticular injections, arthrography and ankle arthroscopy require introduction of fluid into the ankle joint. Little data are currently available in the literature regarding the maximal volume of normal, nonpathologic, human ankle joints. The purpose of this study was to measure the volume of normal human ankle joints. Materials and Methods: A fluoroscopic guided needle was passed into nine cadaveric adult ankle joints. The needle was connected to an intracompartmental pressure measurement device. A radiopaque dye was introduced into the joint in 2 mL boluses, while pressure measurements were recorded. Fluid was injected into the joint until three consecutive pressure measurements were similar, signifying a maximal joint volume. Results: The mean maximum ankle joint volume was 20.9 ± 4.9 mL (range, 16-30 mL. The mean ankle joint pressure at maximum volume was 142.2 ± 13.8 mm Hg (range, 122-166 mm Hg. Two of the nine samples showed evidence of fluid tracking into the synovial sheath of the flexor hallucis longus tendon. Conclusion: Maximal normal ankle joint volume was found to vary between 16-30 mL. This study ascertains the communication between the ankle joint and the flexor hallucis longus tendon sheath. Exceeding maximal ankle joint volume suggested by this study during therapeutic injections, arthrography, or arthroscopy could potentially damage the joint.

Impaired bolus clearance in combined high-resolution esophageal manometry and impedance measurement helps to differentiate between esophagogastric junction outflow obstruction and achalasia.

Science.gov (United States)

Zizer, Eugen; Seufferlein, Thomas; Hänle, Mark Martin

2017-02-01

Introduction and aims  High-resolution esophageal manometry (HRM) has improved the diagnostic work-up of esophageal motility disorders. Simultaneous evaluation of bolus clearance delivers useful information about the function of tubular esophagus. We assessed bolus clearance in a combined HRM-impedance examination for esophagogastric junction outflow obstruction (EGJOO) in comparison to achalasia patients. The collected data were assessed in a retrospective analysis. Patients and methods  After gastroscopy excluded a mechanical esophageal or gastric obstruction, 142 consecutive patients underwent combined HRM-impedance examination. The assessment and interpretation of the manometry results were done according to the Chicago Classification of esophageal motility disorders v3.0. After classifying the motility disorder, the evaluation of bolus clearance was done according to published studies. Results  All patients with achalasia (n = 24) showed a significantly impaired bolus clearance (achalasia cases. This might be helpful as an additional tool to differentiate between achalasia and EGJOO patients. Furthermore, the role of the combined impedance-HRM investigation for early diagnosis of achalasia in "pre-achalasia" condition or in evaluation of potential progress of EGJOO to achalasia should be evaluated in a prospective study. © Georg Thieme Verlag KG Stuttgart · New York.

In Silico Assessment of Literature Insulin Bolus Calculation Methods Accounting for Glucose Rate of Change.

Science.gov (United States)

Cappon, Giacomo; Marturano, Francesca; Vettoretti, Martina; Facchinetti, Andrea; Sparacino, Giovanni

2018-05-01

The standard formula (SF) used in bolus calculators (BCs) determines meal insulin bolus using "static" measurement of blood glucose concentration (BG) obtained by self-monitoring of blood glucose (SMBG) fingerprick device. Some methods have been proposed to improve efficacy of SF using "dynamic" information provided by continuous glucose monitoring (CGM), and, in particular, glucose rate of change (ROC). This article compares, in silico and in an ideal framework limiting the exposition to possibly confounding factors (such as CGM noise), the performance of three popular techniques devised for such a scope, that is, the methods of Buckingham et al (BU), Scheiner (SC), and Pettus and Edelman (PE). Using the UVa/Padova Type 1 diabetes simulator we generated data of 100 virtual subjects in noise-free, single-meal scenarios having different preprandial BG and ROC values. Meal insulin bolus was computed using SF, BU, SC, and PE. Performance was assessed with the blood glucose risk index (BGRI) on the 9 hours after meal. On average, BU, SC, and PE improve BGRI compared to SF. When BG is rapidly decreasing, PE obtains the best performance. In the other ROC scenarios, none of the considered methods prevails in all the preprandial BG conditions tested. Our study showed that, at least in the considered ideal framework, none of the methods to correct SF according to ROC is globally better than the others. Critical analysis of the results also suggests that further investigations are needed to develop more effective formulas to account for ROC information in BCs.

SU-E-T-356: Accuracy of Eclipse Electron Macro Monte Carlo Dose Algorithm for Use in Bolus Electron Conformal Therapy

International Nuclear Information System (INIS)

Carver, R; Popple, R; Benhabib, S; Antolak, J; Sprunger, C; Hogstrom, K

2014-01-01

Purpose: To evaluate the accuracy of electron dose distribution calculated by the Varian Eclipse electron Monte Carlo (eMC) algorithm for use with recent commercially available bolus electron conformal therapy (ECT). Methods: eMC-calculated electron dose distributions for bolus ECT have been compared to those previously measured for cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid-PTV CT anatomy for each site. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The bolus ECT treatment plans were imported into the Eclipse treatment planning system and calculated using the maximum allowable histories (2×10 9 ), resulting in a statistical error of <0.2%. Smoothing was not used for these calculations. Differences between eMC-calculated and measured dose distributions were evaluated in terms of absolute dose difference as well as distance to agreement (DTA). Results: Results from the eMC for the retromolar trigone phantom showed 89% (41/46) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of −0.12% with a standard deviation of 2.56%. Results for the nose phantom showed 95% (54/57) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of 1.12% with a standard deviation of 3.03%. Dose calculation times for the retromolar trigone and nose treatment plans were 15 min and 22 min, respectively, using 16 processors (Intel Xeon E5-2690, 2.9 GHz) on a Varian Eclipse framework agent server (FAS). Results of this study were consistent with those previously reported for accuracy of the eMC electron dose algorithm and for the .decimal, Inc. pencil beam redefinition algorithm used to plan the bolus. Conclusion: These results show that the accuracy of the Eclipse eMC algorithm is suitable for clinical implementation of bolus ECT

SU-E-T-356: Accuracy of Eclipse Electron Macro Monte Carlo Dose Algorithm for Use in Bolus Electron Conformal Therapy

Energy Technology Data Exchange (ETDEWEB)

Carver, R [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Popple, R; Benhabib, S [UniversityAlabama Birmingham, Birmingham, AL (United Kingdom); Antolak, J [Mayo Clinic, Rochester, MN (United States); Sprunger, C [Louisiana State University, Baton Rouge, LA (United States); Hogstrom, K [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Louisiana State University, Baton Rouge, LA (United States)

2014-06-01

Purpose: To evaluate the accuracy of electron dose distribution calculated by the Varian Eclipse electron Monte Carlo (eMC) algorithm for use with recent commercially available bolus electron conformal therapy (ECT). Methods: eMC-calculated electron dose distributions for bolus ECT have been compared to those previously measured for cylindrical phantoms (retromolar trigone and nose), whose axial cross sections were based on the mid-PTV CT anatomy for each site. The phantoms consisted of SR4 muscle substitute, SR4 bone substitute, and air. The bolus ECT treatment plans were imported into the Eclipse treatment planning system and calculated using the maximum allowable histories (2×10{sup 9}), resulting in a statistical error of <0.2%. Smoothing was not used for these calculations. Differences between eMC-calculated and measured dose distributions were evaluated in terms of absolute dose difference as well as distance to agreement (DTA). Results: Results from the eMC for the retromolar trigone phantom showed 89% (41/46) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of −0.12% with a standard deviation of 2.56%. Results for the nose phantom showed 95% (54/57) of dose points within 3% dose difference or 3 mm DTA. There was an average dose difference of 1.12% with a standard deviation of 3.03%. Dose calculation times for the retromolar trigone and nose treatment plans were 15 min and 22 min, respectively, using 16 processors (Intel Xeon E5-2690, 2.9 GHz) on a Varian Eclipse framework agent server (FAS). Results of this study were consistent with those previously reported for accuracy of the eMC electron dose algorithm and for the .decimal, Inc. pencil beam redefinition algorithm used to plan the bolus. Conclusion: These results show that the accuracy of the Eclipse eMC algorithm is suitable for clinical implementation of bolus ECT.

Plasma Volume Expansion Resulting from Intravenous Glucose Tolerance Test

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Robert G. Hahn

2011-01-01

Full Text Available Objective. To quantify the degree of plasma volume expansion that occurs during an intravenous glucose tolerance test (IVGTT. Methods. Twenty healthy volunteers (mean age, 28 years underwent IVGTTs in which 0.3 g/kg of glucose 30% was injected as a bolus over 1 min. Twelve blood samples were collected over 75 min. The plasma glucose and blood hemoglobin concentrations were used to calculate the volume distribution (Vd and the clearance (CL of both the exogenous glucose and the injected fluid volume. Results. The IVGTT caused a virtually instant plasma volume expansion of 10%. The half-life of the glucose averaged 15 min and the plasma volume expansion 16 min. Correction of the fluid kinetic model for osmotic effects after injection reduced CL for the infused volume by 85%, which illustrates the strength of osmosis in allocating fluid back to the intracellular fluid space. Simulations indicated that plasma volume expansion can be reduced to 60% by increasing the injection time from 1 to 5 min and reducing the glucose load from 0.3 to 0.2 g/kg. Conclusion. A regular IVGTT induced an acute plasma volume expansion that peaked at 10% despite the fact that only 50–80 mL of fluid were administered.

Influence of vascular enhancement, age and gender on pulmonary perfused blood volume quantified by dual-energy-CTPA

International Nuclear Information System (INIS)

Meinel, Felix G.; Graef, Anita; Sommer, Wieland H.; Thierfelder, Kolja M.; Reiser, Maximilian F.; Johnson, Thorsten R.C.

2013-01-01

Objectives: To determine the influence of technical and demographic parameters on quantification of pulmonary perfused blood volume (PBV) in dual energy computed tomography pulmonary angiography (DE-CTPA). Materials and methods: Pulmonary PBV was quantified in 142 patients who underwent DE-CTPA for suspected pulmonary embolism but in whom no thoracic pathologies were detected. Multivariate linear regression analysis was performed to calculate the influence of age, gender, enhancement of pulmonary trunk and enhancement difference between pulmonary trunk and left atrium (as a measure of timing) on PBV values. The resulting regression coefficients were used to calculate age-specific ranges of normal for PBV values adjusted for vascular enhancement and timing. Results: Enhancement of the pulmonary trunk (β = −0.29, p = 0.001) and enhancement difference between pulmonary trunk and left atrium (β = −0.24, p = 0.003) were found to significantly influence PBV values. Age (β = −0.33, p < 0.001) but not gender (β = 0.14, p = 0.05) had a significant negative influence on pulmonary PBV values. There was a 20% relative decrease of pulmonary PBV from patients aged <30 to patients over 80 years of age. Conclusions: DE-CTPA derived PBV values need to be corrected for age, vascular enhancement and timing but not for gender. The age-specific ranges of normal derived from this study can be used as a reference in future studies of PBV in pulmonary pathologies

Effect of Volume of Fluid Resuscitation on Metabolic Normalization in Children Presenting in Diabetic Ketoacidosis: A Randomized Controlled Trial.

Science.gov (United States)

Bakes, Katherine; Haukoos, Jason S; Deakyne, Sara J; Hopkins, Emily; Easter, Josh; McFann, Kim; Brent, Alison; Rewers, Arleta

2016-04-01

The optimal rate of fluid administration in pediatric diabetic ketoacidosis (DKA) is unknown. Our aim was to determine whether the volume of fluid administration in children with DKA influences the rate of metabolic normalization. We performed a randomized controlled trial conducted in a tertiary pediatric emergency department from December 2007 until June 2010. The primary outcome was time to metabolic normalization; secondary outcomes were time to bicarbonate normalization, pH normalization, overall length of hospital treatment, and adverse outcomes. Children between 0 and 18 years of age were eligible if they had type 1 diabetes mellitus and DKA. Patients were randomized to receive intravenous (IV) fluid at low volume (10 mL/kg bolus + 1.25 × maintenance rate) or high volume (20 mL/kg bolus + 1.5 × maintenance rate) (n = 25 in each). After adjusting for initial differences in bicarbonate levels, time to metabolic normalization was significantly faster in the higher-volume infusion group compared to the low-volume infusion group (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.0-3.9; p = 0.04). Higher-volume IV fluid infusion appeared to hasten, to a greater extent, normalization of pH (HR = 2.5; 95% CI 1.2-5.0; p = 0.01) than normalization of serum bicarbonate (HR = 1.2; 95% CI 0.6-2.3; p = 0.6). The length of hospital treatment HR (0.8; 95% CI 0.4-1.5; p = 0.5) and time to discharge HR (0.8; 95% CI 0.4-1.5; p = 0.5) did not differ between treatment groups. Higher-volume fluid infusion in the treatment of pediatric DKA patients significantly shortened metabolic normalization time, but did not change overall length of hospital treatment. ClinicalTrials.gov ID NCT01701557. Copyright © 2016 Elsevier Inc. All rights reserved.

Doxorubicin: Comparison between 3-h continuous and bolus intravenous administration paradigms on cardio-renal axis, mitochondrial sphingolipids and pathology

International Nuclear Information System (INIS)

Kamendi, Harriet; Zhou, Ying; Crosby, Meredith; Keirstead, Natalie; Snow, Debra; Bentley, Patricia; Patel, Nilaben; Barthlow, Herbert; Luo, Wenli; Dragan, Yvonne; Bialecki, Russell

2015-01-01

Doxorubicin (DOX) is a potent and effective broad-spectrum anthracycline antitumor agent, but its clinical usefulness is restricted by cardiotoxicity. This study compared pharmacokinetic, functional, structural and biochemical effects of single dose DOX bolus or 3-h continuous iv infusion (3-h iv) in the Han–Wistar rat to characterize possible treatment-related differences in drug safety over a 72 h observation period. Both DOX dosing paradigms significantly altered blood pressure, core body temperature and QA interval (indirect measure of cardiac contractility); however, there was no recovery observed in the bolus iv treatment group. Following the 3-h iv treatment, blood pressures and QA interval normalized by 36 h then rose above baseline levels over 72 h. Both treatments induced biphasic changes in heart rate with initial increases followed by sustained decreases. Cardiac injury biomarkers in plasma were elevated only in the bolus iv treatment group. Tissue cardiac injury biomarkers, cardiac mitochondrial complexes I, III and V and cardiac mitochondrial sphingolipids were decreased only in the bolus iv treatment group. Results indicate that each DOX dosing paradigm deregulates sinus rhythm. However, slowing the rate of infusion allows for functional compensation of blood pressure and may decrease the likelihood of cardiac myocyte necrosis via a mechanism associated with reduced mitochondrial damage. - Highlights: • Despite damaging cardiomyocytes, continuous iv doxorubicin improves cardiovascular outcomes. • This study supports administration of doxorubicin via slow continuous iv infusion limits acute cardio-toxicity. • This study supports use of metabolomic-derived lipid biomarkers for improved quantification of cardiovascular risk. • This study supports systems-based physiological approach to generate a data that can greatly inform risk assessments.

Doxorubicin: Comparison between 3-h continuous and bolus intravenous administration paradigms on cardio-renal axis, mitochondrial sphingolipids and pathology

Energy Technology Data Exchange (ETDEWEB)

Kamendi, Harriet, E-mail: harriet_kamendi@kandih.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Zhou, Ying, E-mail: yingzhou526@gmail.com [Oncology Innovative Medicines and Early Development, AstraZeneca, Waltham, MA 02451 (United States); Crosby, Meredith, E-mail: Meredith.crosby@astrazeneca.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Keirstead, Natalie, E-mail: Nkeirstead@alnylam.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Snow, Debra, E-mail: Debra.snow@astrazeneca.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Bentley, Patricia, E-mail: patricia.bentley@abbvie.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Patel, Nilaben, E-mail: patelnilaben@yahoo.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Barthlow, Herbert, E-mail: Herbert.barthlow@astrazeneca.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Luo, Wenli, E-mail: Wenli.luo@astrazeneca.com [Discovery Sciences, Innovative Medicines, AstraZeneca, Waltham, MA 02451 (United States); Dragan, Yvonne, E-mail: Yvonne.P.Dragan@takeda.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States); Bialecki, Russell, E-mail: russell.bialecki@astrazeneca.com [Drug Safety and Metabolism, AstraZeneca, Waltham, MA 02451 (United States)

2015-12-15

Doxorubicin (DOX) is a potent and effective broad-spectrum anthracycline antitumor agent, but its clinical usefulness is restricted by cardiotoxicity. This study compared pharmacokinetic, functional, structural and biochemical effects of single dose DOX bolus or 3-h continuous iv infusion (3-h iv) in the Han–Wistar rat to characterize possible treatment-related differences in drug safety over a 72 h observation period. Both DOX dosing paradigms significantly altered blood pressure, core body temperature and QA interval (indirect measure of cardiac contractility); however, there was no recovery observed in the bolus iv treatment group. Following the 3-h iv treatment, blood pressures and QA interval normalized by 36 h then rose above baseline levels over 72 h. Both treatments induced biphasic changes in heart rate with initial increases followed by sustained decreases. Cardiac injury biomarkers in plasma were elevated only in the bolus iv treatment group. Tissue cardiac injury biomarkers, cardiac mitochondrial complexes I, III and V and cardiac mitochondrial sphingolipids were decreased only in the bolus iv treatment group. Results indicate that each DOX dosing paradigm deregulates sinus rhythm. However, slowing the rate of infusion allows for functional compensation of blood pressure and may decrease the likelihood of cardiac myocyte necrosis via a mechanism associated with reduced mitochondrial damage. - Highlights: • Despite damaging cardiomyocytes, continuous iv doxorubicin improves cardiovascular outcomes. • This study supports administration of doxorubicin via slow continuous iv infusion limits acute cardio-toxicity. • This study supports use of metabolomic-derived lipid biomarkers for improved quantification of cardiovascular risk. • This study supports systems-based physiological approach to generate a data that can greatly inform risk assessments.

A factor increasing venous contamination on bolus chase three-dimensional magnetic resonance imaging: Charcot neuroarthropathy

Directory of Open Access Journals (Sweden)

Mehmet B Cildag

2018-01-01

Full Text Available Background: The study aimed to evaluate the ratio of venous contamination in diabetic cases without foot lesion, with foot lesion and with Charcot neuroarthropathy (CN. Materials and Methods: Bolus-chase three-dimensional magnetic resonance (MR of 396 extremities of patients with diabetes mellitus was analyzed, retrospectively. Extremities were divided into three groups as follows: diabetic patients without foot ulcer or Charcot arthropathy (Group A, patients with diabetic foot ulcers (Group B and patients with CN accompanying diabetic foot ulcers (Group C. Furthermore, amount of venous contamination classified as no venous contamination, mild venous contamination, and severe venous contamination. The relationship between venous contamination and extremity groups was investigated. Results: Severe venous contamination was seen in Group A, Group B, and Group C, 5.6%, 15.2%, and 34.1%, respectively. Statistically significant difference was seen between groups with regard to venous contamination. Conclusion: Venous contamination following bolus chase MR was higher in patients with CN.

Evaluation of reconstruction parameters of electrical impedance tomography on aorta detection during saline bolus injection

Directory of Open Access Journals (Sweden)

Thürk Florian

2016-09-01

Full Text Available An accurate detection of anatomical structures in electrical impedance tomography (EIT is still at an early stage. Aorta detection in EIT is of special interest, since it would favor non-invasive assessment of hemodynamic processes in the body. Here, diverse EIT reconstruction parameters of the GREIT algorithm were systematically evaluated to detect the aorta after saline bolus injection in apnea. True aorta position and size were taken from computed tomography (CT. A comparison with CT showed that the smallest error for aorta displacement was attained for noise figure nf = 0.7, weighting radius rw = 0.15, and target size ts = 0.01. The spatial extension of the aorta was most precise for nf = 0.7, rw = 0.25, and ts = 0.07. Detection accuracy (F1-score was highest with nf = 0.6, rw = 0.15, and ts = 0.04. This work provides algorithm-related evidence for potentially accurate aorta detection in EIT after injection of a saline bolus.

Comparison of first pass bolus AIFs extracted from sequential {sup 18}F-FDG PET and DSC-MRI of mice

Energy Technology Data Exchange (ETDEWEB)

Evans, Eleanor, E-mail: ee244@cam.ac.uk [Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ (United Kingdom); Sawiak, Stephen J. [Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ (United Kingdom); Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, Cambridge, CB2 3EB (United Kingdom); Ward, Alexander O.; Buonincontri, Guido; Hawkes, Robert C.; Adrian Carpenter, T. [Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ (United Kingdom)

2014-01-11

Accurate kinetic modelling of in vivo physiological function using positron emission tomography (PET) requires determination of the tracer time–activity curve in plasma, known as the arterial input function (AIF). The AIF is usually determined by invasive blood sampling methods, which are prohibitive in murine studies due to low total blood volumes. Extracting AIFs from PET images is also challenging due to large partial volume effects (PVE). We hypothesise that in combined PET with magnetic resonance imaging (PET/MR), a co-injected bolus of MR contrast agent and PET ligand can be tracked using fast MR acquisitions. This protocol would allow extraction of a MR AIF from MR contrast agent concentration–time curves, at higher spatial and temporal resolution than an image-derived PET AIF. A conversion factor could then be applied to the MR AIF for use in PET kinetic analysis. This work has compared AIFs obtained from sequential DSC-MRI and PET with separate injections of gadolinium contrast agent and {sup 18}F-FDG respectively to ascertain the technique′s validity. An automated voxel selection algorithm was employed to improve MR AIF reproducibility. We found that MR and PET AIFs displayed similar character in the first pass, confirmed by gamma variate fits (p<0.02). MR AIFs displayed reduced PVE compared to PET AIFs, indicating their potential use in PET/MR studies.

EVALUATING GENDER-BIAS IN THE IRANIAN PRE-UNIVERSITY ENGLISH TEXTBOOKS

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Ali Roohani

2013-07-01

Full Text Available Abstract: Textbooks can affect learners’ attitudes, viewpoints, and their choice of language in second/foreign language (L2 communication. The various ways in which the people are displayed in communication may affect students’ viewpoints. This study was an attempt to examine several potential areas of gender-bias in the representation of women and men in the pre-university English textbook, an English language teaching (ELT textbook with two volumes taught in the high schools of Iran. To evaluate this textbook, content analysis was done in terms of gender-bias, gender-neutral, male-generics, and the firstness in the reading texts, instructions, exercises and illustrations. The frequency and percentages of names, nouns, pronouns and pictures attributed to each gender (i.e., males and females were obtained and chi-square tests were carried out. In general, names, nouns and pictures pertinent to males outnumbered those attributed to females. Besides, there was a statistically significant difference between males and females in the two volumes of the pre-university textbook in terms of the above features. Also, male-oriented terms came first more frequently. However, there was not a statistically significant difference between male and female pronouns between the two volumes, though the percentage of male pronouns was higher. Moreover, the textbook included many gender-neutral nouns and pronouns not having any gender orientations. Findings indicated that the Iranian pre-university English textbook was somehow male-oriented and gender-biased as regards names, nouns, firstness and pictures associated with them though great efforts were made to avoid specific gender orientations.

One year results of preoperative single bolus ATG-Fresenius induction therapy in sensitized renal transplant recipients.

Science.gov (United States)

Wang, D; Chen, J H; Wu, W Z; Yang, S L; Wu, G J; Wang, H; Tan, J M

2007-01-01

Sensitization in kidney transplantation is associated with more acute rejections, inferior graft survival, and an increase in delayed graft function. This study was designed to evaluate the efficacy and safety of preoperative single bolus antithymocyte globulin (ATG) induction therapy in sensitized renal transplant recipients. Fifty-six cadaveric donor kidney transplant recipients were divided into two groups: Group I (nonsensitized group, n = 30) and group II (sensitized group, PRA>10%, n = 26). ATG was given as a single preoperative bolus induction therapy to group II (ATG IV; 9 mg/kg). The group I patients were treated with mycophenolate mofetil preoperatively as induction therapy. The basic immunosuppressive regimen included tacrolimus (FK-506) or cyclosporine, mycophenolate mofetil, and prednisolone. After hospital discharge, patients were followed on a routine outpatient basis for 12 months. Acute rejection episodes (ARE) occurred in 20% (6/30) of group I and 15.38% (4/26) of group II patients (P = NS). Infections occurred in eight patients (26.7%) as 11 episodes (36.7%), averaging 1.4 episodes per infected patient in group 1, and 6 patients (23.1%) for a total of 10 episodes (38.5%), averaging 1.7 episodes per infected patient, in group II (P = NS). Occurrence of side effects and hospital stay were almost comparable in the two groups. No delayed graft function was observed in either group. The 12-month actuarial patient and graft survival were 100% in Group I and II. A preoperative single bolus ATG induction therapy was an effective and safe therapeutic measure, yielding an acceptable acute rejection rate in presensitized renal transplant recipients.

Frontal and temporal volumes in Childhood Absence Epilepsy.

Science.gov (United States)

Caplan, Rochelle; Levitt, Jennifer; Siddarth, Prabha; Wu, Keng Nei; Gurbani, Suresh; Sankar, Raman; Shields, W Donald

2009-11-01

This study compared frontotemporal brain volumes in children with childhood absence epilepsy (CAE) to age- and gender-matched children without epilepsy. It also examined the association of these volumes with seizure, demographic, perinatal, intelligence quotient (IQ), and psychopathology variables. Twenty-six children with CAE, aged 7.5-11.8 years, and 37 children without epilepsy underwent brain magnetic resonance imaging (MRI) scans at 1.5 Tesla. Tissue was segmented, and total brain, frontal lobe, frontal parcellations, and temporal lobe volumes were computed. All children had IQ testing and structured psychiatric interviews. Parents provided seizure, perinatal, and behavioral information on each child. The CAE group had significantly smaller gray matter volumes of the left orbital frontal gyrus as well as both left and right temporal lobes compared to the age- and gender-matched children without epilepsy. In the CAE group these volumes were related to age, gender, ethnicity, and pregnancy complications but not to seizure, IQ, and psychopathology variables. In the group of children without epilepsy, however, the volumes were related to IQ. These findings suggest that CAE impacts brain development in regions implicated in behavior, cognition, and language. In addition to supporting the cortical focus theory of CAE, these findings also imply that CAE is not a benign disorder.

Ocular dynamics of Garcinia cola (Heckel on healthy volunteers following bolus ingestion

Directory of Open Access Journals (Sweden)

S. A. Igwe

2007-12-01

Full Text Available Garcinia cola Heckel, an angiospermae belonging to the  family Guttiferae, is known in commerce as bitter cola. It is a plant found in the West African subregion, mostly in moist conditions, and often in association with Cola acuminata. The seeds are highly valued ingredients in African ethonomedicine. The seeds have several social uses and applications in folk medicine. These seeds are ordinarily chewed by the local people without prescription or restriction. In an in vivo case control study, the effects of Garcinia cola on some visual functions: pupil diameter, near point of convergence (NPC, amplitude of accommodation (AA, intraocular pressure (IOP, visual acuity (VA and habitual phoria; following bolus ingestion of 20 g was undertaken using healthy visually active volunteers. Results showed that bolus ingestion of Garcinia cola constricted the pupil by 68%, reduced the NPC by 28%, increased the AA by 17.8% at peak effect and decreased the intraocular pressure by 31% without affecting the distance and near VA. The lateral phoria at far and near tended towards esophoria. Possibly the miotic effect and reduction in IOP could be of benefit to patients with raised IOP where conventional drugs may not be effective. Also it is possible that the effects on phoria could be exploited in oculomotor function in combination with visual training.

Reproducibility of 5-HT2A receptor measurements and sample size estimations with [18F]altanserin PET using a bolus/infusion approach

DEFF Research Database (Denmark)

Haugbøl, Steven; Pinborg, Lars H; Arfan, Haroon M

2006-01-01

PURPOSE: To determine the reproducibility of measurements of brain 5-HT2A receptors with an [18F]altanserin PET bolus/infusion approach. Further, to estimate the sample size needed to detect regional differences between two groups and, finally, to evaluate how partial volume correction affects...... reproducibility and the required sample size. METHODS: For assessment of the variability, six subjects were investigated with [18F]altanserin PET twice, at an interval of less than 2 weeks. The sample size required to detect a 20% difference was estimated from [18F]altanserin PET studies in 84 healthy subjects....... Regions of interest were automatically delineated on co-registered MR and PET images. RESULTS: In cortical brain regions with a high density of 5-HT2A receptors, the outcome parameter (binding potential, BP1) showed high reproducibility, with a median difference between the two group measurements of 6...

Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

Directory of Open Access Journals (Sweden)

Gulinu Maimaituxun

Full Text Available Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV in patients undergoing coronary artery bypass grafting (CABG remains unknown.Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57 who underwent CABG or non-coronary valvular surgery (non-CABG.In men, EATV, EATV index (EATV/body surface area and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001, while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005.Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

Myocardial oxygen extraction fraction measured using bolus inhalation of 15O-oxygen gas and dynamic PET

NARCIS (Netherlands)

Lubberink, Mark; Wong, YY; Raijmakers, P. G.; Huisman, Marc C.; Schuit, Robert C.; Luurtsema, Geert; Boellaard, Ronald; Knaapen, P; Vonk-Noordegraaf, Anton; Lammertsma, Adriaan A.

Abstract The aim of this study was to determine the accuracy of oxygen extraction fraction (OEF) measurements using a dynamic scan protocol after bolus inhalation of 15O2. The method of analysis was optimized by investigating potential reuse of myocardial blood flow (MBF), perfusable tissue

Fractional filling with the microdepot technique as an alternative to bolus hyaluronic acid injections in facial volume restoration.

Science.gov (United States)

Lim, Adrian C; Lowe, Patricia M

2011-05-01

For volume restoration of the face, hyaluronic acid is conventionally injected through long, large-bore, 18-gauge needles because of the higher viscosity subtypes required. These hyaluronic acids are either more highly cross-linked or larger in particle size than the less-viscous subtypes. The microdepot injection technique involves using the 31-gauge BD insulin syringe (Becton-Dickinson, North Ryde, NSW Australia) to deposit small amounts of filler (0.05-0.1 mL) throughout the area of volume loss. The procedure is extremely well tolerated, requiring only topical and ice anaesthesia. Using this method, volume restoration can be achieved naturally and progressively over a period of time. Fractional filling every 3-4 months is continued until the desired level of volume correction is attained. Patients undergoing fractional filling followed over a 12-month period did not indicate any observable compromise in filler longevity, even when highly viscous hyaluronic acid fillers were injected through small-bore, 31-gauge insulin syringes. © 2011 The Authors. Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists.

Age- and gender-specific differences in left ventricular cardiac function and volumes determined by gated SPET

International Nuclear Information System (INIS)

Bondt, P. de; Wiele, C. van de; Winter, F. de; Dierckx, R.A.; Sutter, J. de; Backer, G. de

2001-01-01

The aim of this study was to determine normative volumetric data and ejection fraction values derived from gated myocardial single-photon emission tomography (SPET) using the commercially available software algorithm QGS (quantitative gated SPET). From a prospective database of 876 consecutive patients who were referred for a 2-day stress-rest technetium-99m tetrofosmin (925 MBq) gated SPET study, 102 patients (43 men, 59 women) with a low (<10%) pre-test likelihood of coronary disease were included (mean age 57.6 years). For stress imaging, a bicycle protocol was used in 79 of the patients and a dipyridamole protocol in 23. Left ventricular ejection fraction (LVEF) and end-diastolic and -systolic volumes (EDV and ESV) were calculated by QGS. EDV and ESV were corrected for body surface area, indicated by EDVi and ESVi. To allow comparison with previous reports using other imaging modalities, men and women were divided into three age groups (<45 years, ≥45 years but <65 years and ≥65 years). Men showed significantly higher EDVi and ESVi values throughout and lower LVEF values when compared with women in the subgroup ≥65 years (P<0.05, ANOVA). Significant negative and positive correlations were found between age and EDVi and ESVi values for both women and men and between LVEF and age in women (Pearson P≤0.01). LVEF values at bicycle stress were significantly higher than at rest (P=0.000, paired t test), which was the result of a significant decrease in ESV (P=0.003), a phenomenon which did not occur following dipyridamole stress (P=0.409). The data presented suggest that LVEF and EDVi and ESVi as assessed by QGS are strongly gender-specific. Although the physiological significance of these results is uncertain and needs further study, these findings demonstrate that the evaluation of cardiac function and volumes of patients by means of QGS should consider age- and gender-matched normative values. (orig.)

Measurement of right ventricular volumes using 131I-MAA

International Nuclear Information System (INIS)

Sekimoto, T.; Grover, R.F.

1975-01-01

A method is presented for determining the right ventricular residual ratio, that is, the ratio of the end-systolic volume to the end-diastolic volume during each cardiac cycle. 131 I-MAA was injected as a bolus into the right ventricle, and the ratio of isotope remaining in the chamber during the succeeding cardiac cycles was determined with a collimated scintillation counter placed over the right ventricle. Since the counter detected the radioactivity from the entire right ventricular cavity, potential errors from incomplete mixing were minimized. The washout curve from the ventricle was distorted somewhat by the accumulation of isotope in intervening lung tissue. This distortion was eliminated by subtracting the build-up curve of radioactivity in the lung recorded simultaneously with a second scintillation counter positioned over the lateral chest wall. In 14 dogs anesthetized with chloralose, the right ventricular residual ratio was relatively constant at 40.4 +- 3.1 per cent. Duplicate measurements differed by less than 3 percent indicating the good reproducibility of the method. Right ventricular stroke volume was determined from cardiac output (dye dilution) and heart rate. With this and the simultaneously determined residual ratio ( 131 I-MAA), end-diastolic volume could be calculated. Stroke volume and stroke work were highly correlated with end-diastolic volume, in keeping with the Frank-Starling mechanism. (U.S.)

The measurement of fringing fields in a radio-frequency hyperthermia array with emphasis on bolus size

NARCIS (Netherlands)

Wiersma, J.; van Dijk, J. D.; Sijbrands, J.; Schneider, C. J.

1998-01-01

The limited aperture size through which the em-field of the applicator is emanated and the constraining of this em-field near the bolus' edge is related to the appearance of superficial 'hot spot' phenomena in radiative hyperthermia. Regarding systems based on the concept of the annular phased array

Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively.

Science.gov (United States)

Lahner, D; Kabon, B; Marschalek, C; Chiari, A; Pestel, G; Kaider, A; Fleischmann, E; Hetz, H

2009-09-01

Fluid management guided by oesophageal Doppler monitor has been reported to improve perioperative outcome. Stroke volume variation (SVV) is considered a reliable clinical predictor of fluid responsiveness. Consequently, the aim of the present trial was to evaluate the accuracy of SVV determined by arterial pulse contour (APCO) analysis, using the FloTrac/Vigileo system, to predict fluid responsiveness as measured by the oesophageal Doppler. Patients undergoing major abdominal surgery received intraoperative fluid management guided by oesophageal Doppler monitoring. Fluid boluses of 250 ml each were administered in case of a decrease in corrected flow time (FTc) to 10%. The ability of SVV to predict fluid responsiveness was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. Twenty patients received 67 fluid boluses. Fifty-two of the 67 fluid boluses administered resulted in fluid responsiveness. SVV achieved an area under the ROC curve of 0.512 [confidence interval (CI) 0.32-0.70]. A cut-off point for fluid responsiveness was found for SVV > or =8.5% (sensitivity: 77%; specificity: 43%; positive predictive value: 84%; and negative predictive value: 33%). This prospective, interventional observer-blinded study demonstrates that SVV obtained by APCO, using the FloTrac/Vigileo system, is not a reliable predictor of fluid responsiveness in the setting of major abdominal surgery.

Dosimetry characterization and clinical application of Exa skin: Bolus of high of high density for use with photons; Caracterizacion dosimetrica y aplicacion clinica de Exaskin: bolus de alta densidad para uso con fotones

Energy Technology Data Exchange (ETDEWEB)

Ortiz Seidel, M.; Velazquez Miranda, S.

2013-07-01

Bolus of high density eXaSkin of density 1.6 g/cm{sub 3} is calculated correctly in the planning systems, is easy to use and generates optimum coupling with the radiation area, at the same time which is easily reproducible in their placement, avoiding the use of electron beams. On the other hand its behavior varies very slightly with the presence of air gaps. (Author)

Therapeutic efficacy and toxicity of bolus application of chemotherapy protocol in the treatment of metastatic colorectal cancer.

Science.gov (United States)

Šišić, Ibrahim; Pojskić, Belma; Mekić Abazović, Alma; Kovčin, Vladimir

2015-08-01

To compare efficacy and toxicity of bolus application of chemotherapy protocol, oxaliplatin, fluorouracil (bolus), leucovorin (folfox) between two groups of patients in the therapy of metastatic colorectal carcinoma (mCRC). A total of 63 patients were treated for mCRC in the period January 2009 - January 2010 at the Department of Oncology of the Cantonal Hospital Zenica, Bosnia and Herzegovina (first group, 30 patients) and at the Department of Oncology of the Clinical Hospital Centre Bežanijska kosa in Belgrade, Serbia, in the period January 2005 - January 2006 (second group, 33 patients). The patients were treated according the same protocol, i.v. bolus infusion, but in different day intervals (D), 1, 8, 15/28 days or D1-D5/28 days, respectively. In all patients the following factors were analyzed: tumor response, overall survival (OS), progression free survival, hematological and non-hematological toxicity . Colon was the primary localization in almost two thirds of patients. There was no statistically significant difference between the groups according to the age, hematological and non-hematological toxicity, as well as in achieved OS. Progression free survival expressed in months was in average 5 months though with a large range between minimal and maximal survival time. Both groups have shown equivalent efficacy to applied chemotherapy protocols. Overall survival in the two groups matched data from the literature. Further research should confirm success of the combination of chemotherapy protocols and their combination with the biological therapy. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

Therapeutic efficacy and toxicity of bolus application of chemotherapy protocol in the treatment of metastatic colorectal cancer

Directory of Open Access Journals (Sweden)

Ibrahim Šišić

2015-08-01

Full Text Available Aim To compare efficacy and toxicity of bolus application of chemotherapy protocol, oxaliplatin, fluorouracil (bolus, leucovorin (folfox between two groups of patients in the therapy of metastatic colorectal carcinoma (mCRC. Methods A total of 63 patients were treated for mCRC in the period January 2009 – January 2010 at the Department of Oncology of the Cantonal Hospital Zenica, Bosnia and Herzegovina (first group, 30 patients and at the Department of Oncology of the Clinical Hospital Centre Bežanijska kosa in Belgrade, Serbia, in the period January 2005 – January 2006 (second group, 33 patients. The patients were treated according the same protocol, i.v. bolus infusion, but in different day intervals (D, 1, 8, 15/28 days or D1-D5/28 days, respectively. In all patients the following factors were analyzed: tumor response, overall survival (OS, progression free survival, hematological and non-hematological toxicity. Results Colon was the primary localization in almost two thirds of patients. There was no statistically significant difference between the groups according to the age, hematological and non-hematological toxicity, as well as in achieved OS. Progression free survival expressed in months was in average 5 months though with a large range between minimal and maximal survival time. Conclusion Both groups have shown equivalent efficacy to applied chemotherapy protocols. Overall survival in the two groups matched data from the literature. Further research should confirm success of the combination of chemotherapy protocols and their combination with the biological therapy.

Talking Gender and Sexuality

DEFF Research Database (Denmark)

This edited volume brings together scholars from psychology, linguistics, sociology and communication science to investigate how performative notions of gender and sexuality can be fruitfully explored with the rich set of tools that have been developed by conversation analysis and discursive...... psychology for analysing everyday practical language use, agency and identity in talk. Contributors re-examine the foundations of earlier research on gender in spoken interaction, critically appraise this research to see if and how it 'translates' successfully into the study of sexuality in talk, and promote...... innovative alternatives that integrate the insights of recent feminist and queer theory with qualitative studies of talk and conversation. Detailed empirical analyses of naturally occurring talk are used to uncover how gender and sexual identities, agencies and desires are contingently accomplished...

Taste enhancement in food gels: Effect of fracture properties on oral breakdown, bolus formation and sweetness intensity

NARCIS (Netherlands)

Mosca, A.C.; Velde, van de F.; Bult, J.H.F.; Boekel, van M.A.J.S.; Stieger, M.A.

2015-01-01

This study investigates the effects of fracture strain and fracture stress on oral breakdown, bolus formation and sweetness intensity of semi-solid food gels containing sucrose heterogeneously distributed in layers. The sweetness intensity of gels was mainly affected by the total surface area of gel

Effect of Admission Oral Diuretic Dose on Response to Continuous versus Bolus Intravenous Diuretics in Acute Heart Failure: An Analysis from DOSE-AHF

Science.gov (United States)

Shah, Ravi V.; McNulty, Steven; O'Connor, Christopher M.; Felker, G. Michael; Braunwald, Eugene; Givertz, Michael M.

2014-01-01

Background Results from the Diuretic Optimization Strategies in Acute Heart Failure (DOSE-AHF) study suggest that an initial continuous infusion of loop diuretics is not superior to bolus dosing with regard to clinical endpoints in AHF. We hypothesized that outpatient furosemide dose was associated with congestion and poorer renal function, and explored the hypothesis that a continuous infusion may be more effective in patients on higher outpatient diuretic doses. Methods DOSE-AHF randomized 308 patients within 24 hours of admission to high vs. low initial intravenous diuretic dose given as either a continuous infusion or bolus. We compared baseline characteristics and assessed associations between mode of administration (bolus vs. continuous) and outcomes in patients receiving high-dose (≥120 mg furosemide equivalent, n=177) versus low-dose (diuretics. Results Patients on higher doses of furosemide were less frequently on renin-angiotensin system inhibitors (P=.01), and had worse renal function and more advanced symptoms. There was a significant interaction between outpatient dose and mode of therapy (P=0.01) with respect to net fluid loss at 72 hours after adjusting for creatinine and intensification strategy. Admission diuretic dose was associated with an increased risk of death or rehospitalization at 60 days (adjusted HR=1.08 per 20-mg increment in dose, 95% CI 1.01–1.16, P=.03). Conclusions In acute HF, patients on higher diuretic doses have greater disease severity, and may benefit from an initial bolus strategy. PMID:23194486

institutionalising gender and women's studies at the university of ...

African Journals Online (AJOL)

USER

Rwandan Journal of Education - Volume 2 - Issue 1. 4 ... gaps in existing gender equity initiatives in the university, challenges associated with operationalising existing .... 1 See for example Britwum (2002) on the gender profile of UCC as well as Prah (2002) ..... sensitisation and not to mounting and teaching courses.

Effects of advanced carbohydrate counting guided by an automated bolus calculator in Type 1 diabetes mellitus (StenoABC)

DEFF Research Database (Denmark)

Hommel, E; Schmidt, S; Vistisen, D

2017-01-01

-centre, investigator-initiated clinical study. We enrolled advanced carbohydrate counting-naïve adults with Type 1 diabetes and HbA1c levels 64-100 mmol/mol (8.0-11.3%), who were receiving multiple daily insulin injection therapy. In a 1:1-ratio, participants were randomized to receive training in either advanced......AIMS: To test whether concomitant use of an automated bolus calculator for people with Type 1 diabetes carrying out advanced carbohydrate counting would induce further improvements in metabolic control. METHODS: We conducted a 12-month, randomized, parallel-group, open-label, single...... carbohydrate counting using mental calculations (MC group) or advanced carbohydrate counting using an automated bolus calculator (ABC group) during a 3.5-h group training course. For 12 months after training, participants attended a specialized diabetes centre quarterly. The primary outcome was change in HbA1c...

Dynamic computed tomography after bolus injection and infusion of perfluorooctylbromide (PFOB). Computertomographische Untersuchungen zur Dichtekinetik nach Bolusinjektion und Infusion von Perfluorooctylbromid (PFOB). Tierexperimentelle Untersuchungen

Energy Technology Data Exchange (ETDEWEB)

Adam, G.; Guenther, R.W.; Goertz, H.; Schiffer, C. (Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik); Prescher, A. (Technische Hochschule Aachen (Germany). Inst. fuer Anatomie); Bruchmueller, K. (Technische Hochschule Aachen (Germany). Inst. fuer Versuchstierkunde); Limmer, J. (Boehringer Ingelheim GmbH (Germany))

1992-05-01

We investigated the enhancement of the liver, the spleen, and of induced abscesses and the abdominal vessels after administration of 3 g/kg bodyweight Perfluoroocytlbromide (PFOB) on an animal model. Twenty-one rabbits each received the contrast medium as bolus injection and as slow infusion over half an hour. CT was performed between 2 and 48 hours after contrast medium application. Peak enhancement of the liver, the spleen and the liver abscess membrane was found between 24 and 48 hours after PFOB administration, independently of the application mode. Peak enhancement of the abdominal aorta and the IVC was observed within two hours after bolus injection. In this rabbit model PFOB permits best delineation of the vessels after bolus injection within the first two hours, while CT imaging of the liver, the spleen and the liver abscess membrane is best between 24 and 48 hours after contrast medium application, independent of the injection velocity. (orig.).

COMPARISON OF THORACIC ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF INDUCED SMALL VOLUME PNEUMOTHORAX IN THE HORSE.

Science.gov (United States)

Partlow, Jessica; David, Florent; Hunt, Luanne Michelle; Relave, Fabien; Blond, Laurent; Pinilla, Manuel; Lavoie, Jean-Pierre

2017-05-01

Small volume pneumothorax can be challenging to diagnose in horses. The current standard method for diagnosis is standing thoracic radiography. We hypothesized that thoracic ultrasonography would be more sensitive. Objectives of this prospective, experimental study were to describe a thoracic ultrasound method for detection of small volume pneumothorax in horses and to compare results of radiography and ultrasound in a sample of horses with induced small volume pneumothorax. Six mature healthy horses were recruited for this study. For each horse, five 50 ml air boluses were sequentially introduced via a teat cannula into the pleural space. Lateral thoracic radiographs and standardized ultrasound (2D and M-mode) examinations of both hemithoraces were performed following administration of each 50 ml air bolus. Radiographs and ultrasound images/videos were analyzed for detection of pneumothorax by four independent investigators who were unaware of treatment status. Sensitivity, specificity, positive predictive values, negative predictive values, and agreement among investigators (Kappa test, κ) were calculated for radiography, 2D and M-mode ultrasound. Comparisons were made using a chi-squared exact test with significance set at P pneumothorax detection (P = 0.02 and P = 0.04, respectively). Specificity and positive predictive values were similar for all three imaging modalities (P = 1). Agreement between investigators for pneumothorax detection was excellent for 2D ultrasound (κ = 1), very good for M-mode ultrasound (κ = 0.87), and good for radiography (κ = 0.79). Findings from this experimental study supported the use of thoracic ultrasonography as a diagnostic method for detecting pneumothorax in horses. © 2017 American College of Veterinary Radiology.

Development of a bolus injection system for regional deposition studies of nanoparticles in the human respiratory system

International Nuclear Information System (INIS)

Koujalagi, V; Semple, S; Ayres, J G; Ramesh, S L; Gunarathne, G P P

2009-01-01

This study presents the work carried out in developing a precision bolus injection system in order to understand the regional deposition of nanoparticles (NP) in human lung. A real-time control system has been developed that is capable of storing graphite NP, assessing human breathing pattern and delivering a bolus of the stored NP at a pre-determined instance of the inhalation phase of breathing. This will form the basis for further development of a system to deliver radioactive nanoparticles to enable 3-dimensional lung imaging using techniques such as positron emission tomography (PET). The system may then be used to better understand the actual regional deposition in human lung, which could validate or challenge the current computational lung models such as that published by the International Commission for Radiation Protection (ICRP-1994). A dose related response to inhaled PM can possibly be shown, which can be used to review the current workplace exposure limits (WELs).

Development of a bolus injection system for regional deposition studies of nanoparticles in the human respiratory system

Science.gov (United States)

Koujalagi, V.; Ramesh, S. L.; Gunarathne, G. P. P.; Semple, S.; Ayres, J. G.

2009-02-01

This study presents the work carried out in developing a precision bolus injection system in order to understand the regional deposition of nanoparticles (NP) in human lung. A real-time control system has been developed that is capable of storing graphite NP, assessing human breathing pattern and delivering a bolus of the stored NP at a pre-determined instance of the inhalation phase of breathing. This will form the basis for further development of a system to deliver radioactive nanoparticles to enable 3-dimensional lung imaging using techniques such as positron emission tomography (PET). The system may then be used to better understand the actual regional deposition in human lung, which could validate or challenge the current computational lung models such as that published by the International Commission for Radiation Protection (ICRP-1994). A dose related response to inhaled PM can possibly be shown, which can be used to review the current workplace exposure limits (WELs).

Contrast timing in computed tomography: Effect of different contrast media concentrations on bolus geometry

International Nuclear Information System (INIS)

Mahnken, Andreas H.; Jost, Gregor; Seidensticker, Peter; Kuhl, Christiane; Pietsch, Hubertus

2012-01-01

Objective: To assess the effect of low-osmolar, monomeric contrast media with different iodine concentrations on bolus shape in aortic CT angiography. Materials and methods: Repeated sequential computed tomography scanning of the descending aorta of eight beagle dogs (5 male, 12.7 ± 3.1 kg) was performed without table movement with a standardized CT scan protocol. Iopromide 300 (300 mg I/mL), iopromide 370 (370 mg I/mL) and iomeprol 400 (400 mg I/mL) were administered via a foreleg vein with an identical iodine delivery rate of 1.2 g I/s and a total iodine dose of 300 mg I/kg body weight. Time-enhancement curves were computed and analyzed. Results: Iopromide 300 showed the highest peak enhancement (445.2 ± 89.1 HU), steepest up-slope (104.2 ± 17.5 HU/s) and smallest full width at half maximum (FWHM; 5.8 ± 1.0 s). Peak enhancement, duration of FWHM, enhancement at FWHM and up-slope differed significantly between iopromide 300 and iomeprol 400 (p 0.05). Conclusions: Low viscous iopromide 300 results in a better defined bolus with a significantly higher peak enhancement, steeper up-slope and smaller FWHM when compared to iomeprol 400. These characteristics potentially affect contrast timing.

Gender Bias Affects Forests Worldwide

Directory of Open Access Journals (Sweden)

Marlène Elias

2017-04-01

Full Text Available Gender biases persist in forestry research and practice. These biases result in reduced scientific rigor and inequitable, ineffective, and less efficient policies, programs, and interventions. Drawing from a two-volume collection of current and classic analyses on gender in forests, we outline five persistent and inter-related themes: gendered governance, tree tenure, forest spaces, division of labor, and ecological knowledge. Each emerges across geographic regions in the northern and southern hemisphere and reflects inequities in women’s and men’s ability to make decisions about and benefit from trees, forests, and their products. Women’s ability to participate in community-based forest governance is typically less than men’s, causing concern for social equity and forest stewardship. Women’s access to trees and their products is commonly more limited than men’s, and mediated by their relationship with their male counterparts. Spatial patterns of forest use reflect gender norms and taboos, and men’s greater access to transportation. The division of labor results in gender specialization in the collection of forest products, with variations in gender roles across regions. All these gender differences result in ecological knowledge that is distinct but also complementary and shifting across the genders. The ways gender plays out in relation to each theme may vary across cultures and contexts, but the influence of gender, which intersects with other factors of social differentiation in shaping forest landscapes, is global.

Preschool externalizing behavior predicts gender-specific variation in adolescent neural structure.

Directory of Open Access Journals (Sweden)

Jessica Z K Caldwell

Full Text Available Dysfunction in the prefrontal cortex, amygdala, and hippocampus is believed to underlie the development of much psychopathology. However, to date only limited longitudinal data relate early behavior with neural structure later in life. Our objective was to examine the relationship of early life externalizing behavior with adolescent brain structure. We report here the first longitudinal study linking externalizing behavior during preschool to brain structure during adolescence. We examined the relationship of preschool externalizing behavior with amygdala, hippocampus, and prefrontal cortex volumes at age 15 years in a community sample of 76 adolescents followed longitudinally since their mothers' pregnancy. A significant gender by externalizing behavior interaction revealed that males-but not females-with greater early childhood externalizing behavior had smaller amygdala volumes at adolescence (t = 2.33, p = .023. No significant results were found for the hippocampus or the prefrontal cortex. Greater early externalizing behavior also related to smaller volume of a cluster including the angular gyrus and tempoparietal junction across genders. Results were not attributable to the impact of preschool anxiety, preschool maternal stress, school-age internalizing or externalizing behaviors, or adolescent substance use. These findings demonstrate a novel, gender-specific relationship between early-childhood externalizing behavior and adolescent amygdala volume, as well as a cross-gender result for the angular gyrus and tempoparietal junction.

Tabulations of Responses from the 2002 Status of the Armed Forces Survey- Workplace and Gender Relations: Volume 2, Gender Related Experiences in the Military and Gender Relations

National Research Council Canada - National Science Library

Greenlees, James

2003-01-01

The 2002 Status of the Armed Forces Survey - Workplace and Gender Relations gathered information on demographics, workplace information, mentoring, readiness, and health and well-being, gender related...

Discounting the duration of bolus exposure in impedance testing underestimates acid reflux.

Science.gov (United States)

Vikneswaran, Namasivayam; Murray, Joseph A

2016-06-08

Combined impedance-pH testing (MII) allows for detection of reflux episodes regardless of pH. However impedance-based diagnosis of reflux may not routinely account for duration of the reflux episode. We hypothesize that impedance testing may be less sensitive than pH-testing in detecting acid reflux off therapy as a result of discounting duration of exposure. Baseline characteristics and reflux parameters of MII studies performed off-anti-secretory medications were analyzed. Studies on acid suppressive medication and those with recording times less than 20 h or low baseline impedance were excluded. A total of 73 consecutive MII studies were analyzed of which 31 MII studies had elevated acid exposure while 16 were abnormal by impedance criteria. MII testing off-therapy was more likely to be abnormal by pH criteria (percent time pH reflux):[42 vs 22 % (p =0.02)]. Acid exposure (percent time pH acid reflux episodes [42 vs 34 % (p acid clearance time (pH-detected) was significantly longer than median bolus clearance time (impedance-detected) in the total [98.7 s vs 12.6 s (p acid clearance time (pH-detected) and the median bolus clearance time (impedance-detected) was significantly higher in the recumbent position compared to the upright position [11. vs 5.3 (p = 0.01)]. Ambulatory impedance testing underestimates acid reflux compared to esophageal acid exposure by discounting the prolonged period of mucosal contact with each acid reflux episode, particularly in the recumbent position.

Optimum bolus wizard settings in insulin pumps in children with Type 1 diabetes

DEFF Research Database (Denmark)

Andersen, A J B; Ostenfeld, A; Pipper, C B

2016-01-01

: Optimum insulin pump settings at pump initiation depend on both insulin requirements and use of the pump. Settings need to be individualized because the standardized calculation factors are not constant for children. There is a need to develop specific age- and insulin dose-dependent calculation factors.......AIM: To evaluate current insulin pump settings in an optimally regulated paediatric population using bolus wizard. METHODS: We used a retrospective study design to analyse data from 124 children on insulin pump therapy who had optimum HbA1c levels [

Effect of gender on pain perception and analgesic consumption in laparoscopic cholecystectomy: An observational study

Directory of Open Access Journals (Sweden)

Aziza M Hussain

2013-01-01

Full Text Available Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002, but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.

Gender disparities in the association between epicardial adipose tissue volume and coronary atherosclerosis: A 3-dimensional cardiac computed tomography imaging study in Japanese subjects

OpenAIRE

Dagvasumberel Munkhbaatar; Shimabukuro Michio; Nishiuchi Takeshi; Ueno Junji; Takao Shoichiro; Fukuda Daiju; Hirata Yoichiro; Kurobe Hirotsugu; Soeki Takeshi; Iwase Takashi; Kusunose Kenya; Niki Toshiyuki; Yamaguchi Koji; Taketani Yoshio; Yagi Shusuke

2012-01-01

Abstract Background Growing evidence suggests that epicardial adipose tissue (EAT) may contribute to the development of coronary artery disease (CAD). In this study, we explored gender disparities in EAT volume (EATV) and its impact on coronary atherosclerosis. Methods The study population consisted of 90 consecutive subjects (age: 63 ± 12 years; men: 47, women: 43) who underwent 256-slice multi-detector computed tomography (MDCT) coronary angiography. EATV was measured as the sum of cross-se...

Pituitary gland shrinkage in bipolar disorder: The role of gender.

Science.gov (United States)

Delvecchio, Giuseppe; Mandolini, Gian Mario; Perlini, Cinzia; Barillari, Marco; Marinelli, Veronica; Ruggeri, Mirella; Altamura, A Carlo; Bellani, Marcella; Brambilla, Paolo

2018-04-01

Hyperactivity of the Hypothalamic-Pituitary-Adrenal Axis (HPAA) has been consistently reported in mood disorders. However, only few studies investigated the Pituitary gland (PG) in Bipolar Disorder (BD) and the results are so far contrasting. Therefore, the aim of this study is to explore the integrity of the PG as well as the role of gender and the impact of clinical measurements on this structure in a sample of BD patients compared to healthy controls (HC). 34 BD patients and 41 HC underwent a 1.5 T MRI scan. PG volumes were manually traced for all subjects. Psychiatric symptoms were assessed by means of the Brief Psychiatry Rating Scale, the Hamilton Depression Rating Scale and the Bech Rafaelsen Mania Rating Scale. We found decreased PG volumes in BD patients compared to HC (F = 24.9, p < 0.001). Interestingly, after dividing the sample by gender, a significant PG volume decrease was detected only in female BD patients compared to female HC (F = 9.1, p < 0.001), but not in male BD compared to male HC (F = -0.12, p = 0.074). No significant correlations were observed between PG volumes and clinical variables. Our findings suggest that BD patients have decreased PG volumes, probably due to the long-term hyperactivity of the HPAA and to the consequent strengthening of the negative feedback control towards the PG volume itself. This alteration was particularly evident in females, suggesting a role of gender in affecting PG volumes in BD. Finally, the absence of significant correlations between PG volumes and clinical variables further supports that PG disruption is a trait feature of BD, being independent of symptoms severity and duration of treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Very preterm adolescents show gender-dependent alteration of the structural brain correlates of spelling abilities.

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Scott, Fiona E; Mechelli, Andrea; Allin, Matthew P; Walshe, Muriel; Rifkin, Larry; Murray, Robin M; Nosarti, Chiara

2011-07-01

Individuals born very preterm (VPT) are at risk of neurodevelopmental damage and of adverse educational outcomes in childhood and adolescence. The present study used voxel-based morphometry to investigate the association between grey matter and white matter volume and measures of language and executive functioning in VPT born adolescents and term-born controls by gender. VPT individuals (N=218) and controls (N=127) underwent neuropsychological assessment and MRI at age 14-15 as part of a longitudinal study. Differential associations were found between spelling scores and frontal regional grey matter volume when group (VPT and control) and gender (males and females) were investigated. A main effect of group demonstrated a weaker association in VPT adolescents relative to controls between grey matter volume in the left medial and right superior frontal gyri and spelling scores. A main effect of gender revealed spelling scores to be correlated with grey matter volume in the right superior frontal gyrus in females to a greater extent than in males. Furthermore, a significant interaction between group and gender was detected in two regions. Spelling scores showed a stronger association with grey matter volume in a cluster with local maxima in the left medial frontal cortex extending to the caudate nucleus in VPT females than in control females and a weaker association in VPT males compared to control males. In addition, spelling scores showed a stronger association with grey matter volume in left middle frontal gyrus in VPT males compared to control males and a weaker association in VPT females than in control females. When group and gender were investigated, there were no statistically different correlations between structural brain volumes and performance on reading and executive function tests. These data demonstrate that the typical structure-function relationship in respect to spelling abilities appears to be altered in individuals born preterm and the processes

Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

International Nuclear Information System (INIS)

Rong Yi; Yadav, Poonam; Welsh, James S.; Fahner, Tasha; Paliwal, Bhudatt

2012-01-01

The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3–50.4 Gy with daily fraction size of 1.7–2.0 Gy. Total dose to the scar PTV was prescribed to 58.0–60.2 Gy at 2.0–2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7–1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.

Age group classification and gender detection based on forced expiratory spirometry.

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Cosgun, Sema; Ozbek, I Yucel

2015-08-01

This paper investigates the utility of forced expiratory spirometry (FES) test with efficient machine learning algorithms for the purpose of gender detection and age group classification. The proposed method has three main stages: feature extraction, training of the models and detection. In the first stage, some features are extracted from volume-time curve and expiratory flow-volume loop obtained from FES test. In the second stage, the probabilistic models for each gender and age group are constructed by training Gaussian mixture models (GMMs) and Support vector machine (SVM) algorithm. In the final stage, the gender (or age group) of test subject is estimated by using the trained GMM (or SVM) model. Experiments have been evaluated on a large database from 4571 subjects. The experimental results show that average correct classification rate performance of both GMM and SVM methods based on the FES test is more than 99.3 % and 96.8 % for gender and age group classification, respectively.

Contrast bolus technique with rapid CT scanning

International Nuclear Information System (INIS)

Arnold, H.; Kuehne, D.; Rohr, W.; Heller, M.

1981-01-01

Twenty-three patients complying with the clinical criteria for brain death were studied by contrast-enhanced CT. In all but one, the great intracranial vessels escaped visualization; accordingly, angiography demonstrated cerebral circulatory arrest. In the remaining case, faint enhancement of the circle of Willis corresponded to angiographic demonstration of the proximal segments of cerebral arteris. Neither in normal brain nor in dead brain did slow CT scanning disclose any postcontrast increase in parenchymal attenuation. An improved technique is proposed to demonstrate the transit of the contrast bolus by rapid CT with image splitting. If cerebral blood flow is preserved, the grey and white matter will enhance significantly following administration of contrast medium. Vice versa, the absence of enhancement confirms brain death, even in instances in which the great cerebral vessels are obscured by hemorrhage or other extensive lesions. Two additional cases of brain death were evaluated by rapid CT scanning. As to brain death, the technique obviates the need for angiography or radionuclide angiography, usually applied in prospective organ donors, because its informative content is superior to that of either method. The CT technique described affords a reliable and safe diagnosis of brain death, and can be interpreted easily. (orig.)

Bolus dose response characteristics of single chain urokinase plasminogen activator and tissue plasminogen activator in a dog model of arterial thrombosis.

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Badylak, S F; Voytik, S; Klabunde, R E; Henkin, J; Leski, M

1988-11-15

Tissue plasminogen activator (t-PA) and single chain urokinase-plasminogen activator (scu-PA) are relatively "fibrin-specific" thrombolytic drugs with short plasma half lives of 6-8 minutes. Most treatment regimens with these agents utilize a bolus injection followed by continuous drug infusion, usually combined with anticoagulant therapy. The purpose of this study was to establish the dose-response characteristics for scu-PA and t-PA, when given as a single intravenous bolus injection, in a dog model of arterial thrombosis. Eight groups of 6 dogs each were given one of the following doses of scu-PA (mg/kg): 0.20, 0.50, 1.00, 2.00; or t-PA: 0.05, 0.10, 0.20; or an equivalent amount of saline (control group). All doses were given as a single bolus injection 60 minutes after formation of a totally occlusive femoral artery thrombus. Thrombolysis was measured by monitoring the continuous decrement of 125I activity from a radiolabelled thrombus. Ninety minutes after drug injection, all scu-PA treated dogs showed greater thrombolysis (30%, 45%, 56%, and 67%, respectively) than the control group (15%, p less than 0.01). The 0.10 and 0.20 mg/kg t-PA treated dogs showed greater thrombolysis (35% and 49%, respectively) than the control group (15%, p less than 0.01). Both scu-PA and t-PA caused a partial and dose-dependent decrease in alpha 2-antiplasmin activity but scu-PA caused a greater depletion (72% vs. 18%, respectively, p less than 0.05) at 60 minutes after the highest dose of drug administration. Both drugs showed a longer than expected thrombolytic effect based upon the known half lives. Neither drug caused significant changes in the prothrombin time, activated partial thromboplastin time, thrombin time, hematocrit, platelet count, or fibrin degradation product concentration. Single bolus injections of scu-PA and t-PA produce safe and effective thrombolysis in this dog model of arterial thrombosis.

Dual-energy CT iodine maps as an alternative quantitative imaging biomarker to abdominal CT perfusion: determination of appropriate trigger delays for acquisition using bolus tracking.

Science.gov (United States)

Skornitzke, Stephan; Fritz, Franziska; Mayer, Philipp; Koell, Marco; Hansen, Jens; Pahn, Gregor; Hackert, Thilo; Kauczor, Hans-Ulrich; Stiller, Wolfram

2018-05-01

Quantitative evaluation of different bolus tracking trigger delays for acquisition of dual energy (DE) CT iodine maps as an alternative to CT perfusion. Prior to this retrospective analysis of prospectively acquired data, DECT perfusion sequences were dynamically acquired in 22 patients with pancreatic carcinoma using dual source CT at 80/140 kV p with tin filtration. After deformable motion-correction, perfusion maps of blood flow (BF) were calculated from 80 kV p image series of DECT, and iodine maps were calculated for each of the 34 DECT acquisitions per patient. BF and iodine concentrations were measured in healthy pancreatic tissue and carcinoma. To evaluate potential DECT acquisition triggered by bolus tracking, measured iodine concentrations from the 34 DECT acquisitions per patient corresponding to different trigger delays were assessed for correlation to BF and intergroup differences between tissue types depending on acquisition time. Average BF measured in healthy pancreatic tissue and carcinoma was 87.6 ± 28.4 and 38.6 ± 22.2 ml/100 ml min -1 , respectively. Correlation between iodine concentrations and BF was statistically significant for bolus tracking with trigger delay greater than 0 s (r max = 0.89; p alternative to CT perfusion measurements of BF. Advances in knowledge: After clinical validation, DECT iodine maps of pancreas acquired using bolus tracking with appropriate trigger delay as determined in this study could offer an alternative quantitative imaging biomarker providing functional information for tumor assessment at reduced patient radiation exposure compared to CT perfusion measurements of BF.

ANALGESIC EFFECT OF INTRATHECAL BACLOFEN BOLUS ON NEUROPATHIC PAIN IN SPINAL CORD INJURY PATIENTS.

Science.gov (United States)

Kumru, Hatice; Benito-Penalva, Jesus; Kofler, Markus; Vidal, Joan

2018-05-18

GABA-ergic neurons are widely distributed throughout the central nervous system, including the spinal cord which is important for the transmission of pain impulses to the brain. Here we hypothesized that intrathecal baclofen (ITB) which is a GABA analogue might exert analgesic effects on neuropathic pain, which could be related to subtypes of pain in spinal cord injury (SCI). SCI patients with a cervical or thoracic lesion and neuropathic pain were randomized to receive either a single ITB bolus or placebo. Numerical Rating Scale (NRS), Neuropathic Pain Symptom Inventory (NPSI), and Brief Pain Inventory (BPI) were obtained for assessment of neuropathic pain. Spasticity was assessed using Modified Ashworth Scale and visual analogue scale. Evaluations were performed at baseline, and 4, 8, and 24 hours after application of ITB or placebo. Eight patients received ITB, 5 placebo. Neuropathic pain improved significantly in the ITB group based on NRS, BPI, and NPSI, which revealed an effect on all subtypes of pain. Spasticity declined significantly. In the placebo group, there was neither significant change in pain nor in spasticity. An ITB bolus exerted a significant analgesic effect on all subtypes of neuropathic pain in SCI patients. ITB has analgesic effects on all subtypes of neuropathic pain and can improve interference of neuropathic pain with activities of daily living. ITB might be a promising analgesic treatment to control neuropathic pain. Copyright © 2018. Published by Elsevier Inc.

Bolus effect to reduce skin dose of the caontralateral breast during breast cancer radiation therapy

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Won, Young Jin [Dept. of Radiation Oncology, InJe University Ilsan Paik Hospital, Goyang (Korea, Republic of); Kim, Jong Won; Kim, Jung Hoon [Dept. of Radiology, Radiation Oncology, KonYang University Hospital, Daejeon (Korea, Republic of)

2017-06-15

The aim of this study was to evaluate the dose comparison using Radon phantom with 5 mm and 10 mm tissue equivalent materials, FIF, Wedge(15, 30 angle) and IMRT, to reduce the skin dose of the contralateral breast during breast cancer radiation therapy(Total dose: 50.4Gy). The dose was measured for each treatment plan by attaching to the 8 point of the contralateral breast of the treated region using a optical-stimulated luminance dosimeter(OSLD) as a comparative dose evaluation method. Of the OSLD used in the study, 10 were used with reproducibility within 3%. As a result, the average reduction rates of 5 mm and 10 mm in the FIF treatment plan were 37.23 cGy and 41.77 cGy, respectively, and the average reduction rates in the treatment plan using Wedge 15 degrees were 70.69 cGy and 87.57 cGy, respectively. The IMRT showed a reduction of 67.37 cGy and 83.17 cGy, respectively. The results of using bolus showed that as the thickness of the bolus increased in all treatments, the dose reduction increased. We concluded that mastectomy as well as general radiotherapy for breast cancer would be very effective for patients who are more likely to be exposed to scattered radiation due to a more demanding or complex treatment plan.

Nonlinear pharmacokinetics of visnagin in rats after intravenous bolus administration.

Science.gov (United States)

Haug, Karin G; Weber, Benjamin; Hochhaus, Guenther; Butterweck, Veronika

2012-01-23

Ammi visnaga L. (syn. Khella, Apiaceae) preparations have traditionally been used in the Middle East for the treatment of kidney stone disease. Visnagin, a furanocoumarin derivative, is one of the main compounds of Ammi visnaga with potential effects on kidney stone prevention. To date, no information is available about the pharmacokinetic (PK) properties of visnagin. It was the aim of the study to characterize the PK properties of visnagin after intravenous (i.v.) bolus administration in rats and to develop an adequate model for the description of the observed data, including model parameter estimates. Therefore, three doses of visnagin (1.25, 2.5, and 5mg/kg) solubilized in 25% Captisol® were administered by i.v. bolus injection to male Sprague-Dawley rats. Plasma samples were extracted and subsequently analyzed using a validated LC-MS/MS method. Both non-compartmental and compartmental PK analyses were performed. A stepwise model building approach was applied including nonlinear mixed effect modeling for final model selection and to obtain final model estimates in NONMEM VI. The average areas under the curve (AUC(0-last)) after doses of 1.25, 2.5, and 5mg/kg were 1.03, 3.61, and 12.6 mg *h/l, respectively. The shape of the plasma concentration-time profiles and the observed disproportionate increase in AUC(0-last) with increasing dose suggested nonlinearity in the elimination of visnagin. A two-compartment Michaelis-Menten model provided the best fit with following typical values of the parameter estimates: 2.09 mg/(l*h) (V(max)), 0.08 mg/l (K(M)), 0.175 l (V(C)), 1.0 h⁻¹ (k₁₂), and 1.22 h⁻¹ (k₂₁). Associated inter-subject variability estimates (% CV) for V(max), K(M) and V(C) were 21.8, 70.9, and 9.2, respectively. Intra-subject variability (constant CV error model) was estimated to be 7.0%. The results suggest the involvement of a saturable process in the elimination of visnagin, possibly an enzyme or transporter system. Copyright © 2011

Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia

NARCIS (Netherlands)

Bogte, A.; Bredenoord, A. J.; Oors, J.; Siersema, P. D.; Smout, A. J. P. M.

2012-01-01

Background Non-obstructive dysphagia patients prove to be a difficult category for clinical management. Esophageal high-resolution manometry (HRM) is a novel method, used to analyze dysphagia. However, it is not yet clear how findings on HRM relate to bolus transport through the esophagus. Methods

Reference absolute and indexed values for left and right ventricular volume, function and mass from cardiac computed tomography

International Nuclear Information System (INIS)

Stojanovska, Jadranka; Prasitdumrong, Hutsaya; Patel, Smita; Sundaram, Baskaran; Gross, Barry H.; Yilmaz, Zeynep N.; Kazerooni, Ella A.

2014-01-01

Left ventricular (LV) and right ventricular (RV) volumetric and functional parameters are important biomarkers for morbidity and mortality in patients with heart failure. To retrospectively determine reference mean values of LV and RV volume, function and mass normalised by age, gender and body surface area (BSA) from retrospectively electrocardiographically gated 64-slice cardiac computed tomography (CCT) by using automated analysis software in healthy adults. The study was approved by the institutional review board with a waiver of informed consent. Seventy-four healthy subjects (49% female, mean age 49.6±11) free of hypertension and hypercholesterolaemia with a normal CCT formed the study population. Analyses of LV and RV volume (end-diastolic, end-systolic and stroke volumes), function (ejection fraction), LV mass and inter-rater reproducibility were performed with commercially available analysis software capable of automated contour detection. General linear model analysis was performed to assess statistical significance by age group after adjustment for gender and BSA. Bland–Altman analysis assessed the inter-rater agreement. The reference range for LV and RV volume, function, and LV mass was normalised to age, gender and BSA. Statistically significant differences were noted between genders in both LV mass and RV volume (P-value<0.0001). Age, in concert with gender, was associated with significant differences in RV end-diastolic volume and LV ejection fraction (P-values 0.027 and 0.03). Bland–Altman analysis showed acceptable limits of agreement (±1.5% for ejection fraction) without systematic error. LV and RV volume, function and mass normalised to age, gender and BSA can be reported from CCT datasets, providing additional information important for patient management.

Effects of marijuana use on prefrontal and parietal volumes and cognition in emerging adults.

Science.gov (United States)

Price, Jenessa S; McQueeny, Tim; Shollenbarger, Skyler; Browning, Erin L; Wieser, Jon; Lisdahl, Krista M

2015-08-01

Chronic marijuana (MJ) use among adolescents has been associated with structural and functional abnormalities, particularly in developing regions responsible for higher order cognition. This study investigated prefrontal (PFC) and parietal volumes and executive function in emerging adult MJ users and explored potential gender differences. Participants (ages 18-25) were 27 MJ users and 32 controls without neurologic or psychiatric disorders or heavy other drug use. A series of multiple regressions examined whether group status, past year MJ use, and their interactions with gender predicted ROI volumes. Post hoc analyses consisted of brain-behavior correlations between volumes and cognitive variables and Fisher's z tests to assess group differences. MJ users demonstrated significantly smaller medial orbitofrontal (mOFC; p = 0.004, FDR p = 0.024) and inferior parietal volumes (p = 0.04, FDR p = 0.12); follow-up regressions found that increased past year MJ use did not significantly dose-dependently predict smaller mOFC volume in a sub-sample of individuals with at least one past year MJ use. There were no significant gender interactions. There was a significant brain-behavior difference by group, such that smaller mOFC volumes were associated with poorer complex attention for MJ users (p < 0.05). Smaller mOFC volumes among MJ users suggest disruption of typical neurodevelopmental processes associated with regular MJ use for both genders. These results highlight the need for longitudinal, multi-modal imaging studies providing clearer information on timing of neurodevelopmental processes and neurocognitive impacts of youth MJ initiation.

Analysis of influence factors on the volume of pelvic bowel irradiated for rectal cancer

International Nuclear Information System (INIS)

He Yuxiang; Cai Yong; Zhu Xianggao; Han Shukui; Xu Bo

2007-01-01

Objective: To evaluate influence of prone/ supine position, gender, operation, bladder distension on bowel irradiated for patients with rectal cancer during pelvic radiotherapy. Methods: 36 patients with rectal cancer were investigated. Treatment plans were created with three dimensional treatment planning system. The dose and volume of bowel irradiated were analyzed according to dose-volume histograms (DVH) for every patient. The prescribed dose was 50 Gy. Results: The extent of bladder distension significantly influenced the mean doses and the V 45 high dose volumes of bowel irradiated. The treatment position and gender significantly influenced the V 15 low dose volume of bowel irradiated, the operation significantly influenced the mean doses of bowel. Either prone and supine position, or preoperative and postoperative, the doses of bowel irradiated for good bladder distension were lower and the volumes were smaller than that for bad bladder distension. The V 45 high dose volume of bowel irradiated for bad and good bladder distension at prone position were 15.3% and 7.4% (P=0.023), respectively, and at postoperative 14.1% and 7.2% (P=0.014), respectively. Conclusions: The doses and volumes of pelvic bowel irradiated were significantly influenced by the extent of bladder distension, and partly influenced by the prone/supine position, gender and operation. (authors)

Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically Ill patients under moderate glycemic control

NARCIS (Netherlands)

van Hooijdonk, Roosmarijn T. M.; Binnekade, Jan M.; Bos, Lieuwe D. J.; Horn, Janneke; Juffermans, Nicole P.; Abu-Hanna, Ameen; Schultz, Marcus J.

2015-01-01

We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients. 'Glycemic variability' and 'insulin infusion rate variability' were calculated from and expressed as the

Changes in basal rates and bolus calculator settings in insulin pumps during pregnancy in women with type 1 diabetes

DEFF Research Database (Denmark)

Mathiesen, Jonathan M; Secher, Anna L; Ringholm, Lene

2014-01-01

OBJECTIVE: To explore insulin pump settings in a cohort of pregnant women with type 1 diabetes on insulin pump therapy with a bolus calculator. METHODS: Twenty-seven women with type 1 diabetes on insulin pump therapy were included in this study. At 8, 12, 21, 27 and 33 weeks, insulin pump setting...

Contrast-enhanced magnetic resonance angiography: first-pass arterial enhancement as a function of gadolinium-chelate concentration, and the saline chaser volume and injection rate.

Science.gov (United States)

Husarik, Daniela B; Bashir, Mustafa R; Weber, Paul W; Nichols, Eli B; Howle, Laurens E; Merkle, Elmar M; Nelson, Rendon C

2012-02-01

To evaluate the effect of the contrast medium (CM) concentration and the saline chaser volume and injection rate on first-pass aortic enhancement characteristics in contrast-enhanced magnetic resonance angiography using a physiologic flow phantom. Imaging was performed on a 3.0-T magnetic resonance system (MAGNETOM Trio, Siemens Healthcare Solutions, Inc, Erlangen, Germany) using a 2-dimensional fast low angle shot T1-weighted sequence (repetition time, 500 milliseconds; echo time, 1.23 milliseconds; flip angle, 8 degrees; 1 frame/s × 60 seconds). The following CM concentrations injected at 2 mL/s were used with 3 different contrast agents (gadolinium [Gd]-BOPTA, Gd-HP-DO3A, Gd-DTPA): 20 mL of undiluted CM (100%) and 80%, 40%, 20%, 10%, 5%, and 2.5% of the full amount, all diluted in saline to a volume of 20 mL to ensure equal bolus volume. The CM was followed by saline chasers of 20 to 60 mL injected at 2 mL/s and 6 mL/s. Aortic signal intensity (SI) was measured, and normalized SI versus time (SI/Tn) curves were generated. The maximal SI (SI(max)), bolus length, and areas under the SI/Tn curve were calculated. Decreasing the CM concentration from 100% to 40% resulted in a decrease of SI(max) to 86.1% (mean). Further decreasing the CM concentration to 2.5% decreased SI(max) to 5.1% (mean). Altering the saline chaser volume had no significant effect on SI(max). Increasing the saline chaser injection rate had little effect (mean increase, 2.2%) on SI(max) when using ≥40% of CM. There was a larger effect (mean increase, 19.6%) when ≤20% of CM were used. Bolus time length was significantly shorter (P < 0.001), and area under the SI/T(n) curve was significantly smaller (P < 0.01) for the CM protocols followed by a saline chaser injected at 6 mL/s compared with a saline chaser injected at 2 mL/s. With 40% of CM and a fast saline chaser, SImax close to that with undiluted CM can be achieved. An increased saline chaser injection rate has a more pronounced effect on

Computer simulations suggest that acute correction of hyperglycaemia with an insulin bolus protocol might be useful in brain FDG PET

Energy Technology Data Exchange (ETDEWEB)

Buchert, R.; Brenner, W.; Apostolova, I.; Mester, J.; Clausen, M. [University Medical Center Hamburg-Eppendorf (Germany). Dept. of Nuclear Medicine; Santer, R. [University Medical Center Hamburg-Eppendorf (Germany). Center for Gynaecology, Obstetrics and Paediatrics; Silverman, D.H.S. [David Geffen School of Medicine at UCLA, Los Angeles, CA (United States). Dept. of Molecular and Medical Pharmacology

2009-07-01

FDG PET in hyperglycaemic subjects often suffers from limited statistical image quality, which may hamper visual and quantitative evaluation. In our study the following insulin bolus protocol is proposed for acute correction of hyperglycaemia (> 7.0 mmol/l) in brain FDG PET. (i) Intravenous bolus injection of short-acting insulin, one I.E. for each 0.6 mmol/l blood glucose above 7.0. (ii) If 20 min after insulin administration plasma glucose is {<=} 7.0 mmol/l, proceed to (iii). If insulin has not taken sufficient effect step back to (i). Compute insulin dose with the updated blood glucose level. (iii) Wait further 20 min before injection of FDG. (iv) Continuous supervision of the patient during the whole scanning procedure. The potential of this protocol for improvement of image quality in brain FDG PET in hyperglycaemic subjects was evaluated by computer simulations within the Sokoloff model. A plausibility check of the prediction of the computer simulations on the magnitude of the effect that might be achieved by correction of hyperglycaemia was performed by retrospective evaluation of the relation between blood glucose level and brain FDG uptake in 89 subjects in whom FDG PET had been performed for diagnosis of Alzheimer's disease. The computer simulations suggested that acute correction of hyperglycaemia according to the proposed bolus insulin protocol might increase the FDG uptake of the brain by up to 80%. The magnitude of this effect was confirmed by the patient data. The proposed management protocol for acute correction of hyperglycaemia with insulin has the potential to significantly improve the statistical quality of brain FDG PET images. This should be confirmed in a prospective study in patients. (orig.)

Computer simulations suggest that acute correction of hyperglycaemia with an insulin bolus protocol might be useful in brain FDG PET

International Nuclear Information System (INIS)

Buchert, R.; Brenner, W.; Apostolova, I.; Mester, J.; Clausen, M.; Santer, R.; Silverman, D.H.S.

2009-01-01

FDG PET in hyperglycaemic subjects often suffers from limited statistical image quality, which may hamper visual and quantitative evaluation. In our study the following insulin bolus protocol is proposed for acute correction of hyperglycaemia (> 7.0 mmol/l) in brain FDG PET. (i) Intravenous bolus injection of short-acting insulin, one I.E. for each 0.6 mmol/l blood glucose above 7.0. (ii) If 20 min after insulin administration plasma glucose is ≤ 7.0 mmol/l, proceed to (iii). If insulin has not taken sufficient effect step back to (i). Compute insulin dose with the updated blood glucose level. (iii) Wait further 20 min before injection of FDG. (iv) Continuous supervision of the patient during the whole scanning procedure. The potential of this protocol for improvement of image quality in brain FDG PET in hyperglycaemic subjects was evaluated by computer simulations within the Sokoloff model. A plausibility check of the prediction of the computer simulations on the magnitude of the effect that might be achieved by correction of hyperglycaemia was performed by retrospective evaluation of the relation between blood glucose level and brain FDG uptake in 89 subjects in whom FDG PET had been performed for diagnosis of Alzheimer's disease. The computer simulations suggested that acute correction of hyperglycaemia according to the proposed bolus insulin protocol might increase the FDG uptake of the brain by up to 80%. The magnitude of this effect was confirmed by the patient data. The proposed management protocol for acute correction of hyperglycaemia with insulin has the potential to significantly improve the statistical quality of brain FDG PET images. This should be confirmed in a prospective study in patients. (orig.)

Evaluation of a commercially available molybdate formulation and zinc oxide boluses in preventing hepatic copper accumulation and thus enzootic icterus in sheep

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C.J. Botha

2001-07-01

Full Text Available The efficacy of a molybdate formulation and a zinc oxide bolus as prophylactic agents for enzootic icterus was evaluated in sheep. Before copper loading, liver biopsies were performed on 12 male, 6-month-old, Mutton Merino sheep to determine hepatic copper (Cu and zinc (Zn concentrations. The animals were restrictively randomised according to liver copper concentrations to 3 treatment groups (n = 4 to achieve similar mean liver copper concentrations per group. All sheep received 4 m /kg of a 0.5 %aqueous solution of CuSO4·5H2O intraruminally 7 days per week for 10 weeks. On Day 0 the sheep in the Mo-group were injected subcutaneously with 42 mg molybdenum (Mo contained in a commercial molybdate formulation. The animals in the Zn-group each received a zinc oxide bolus, containing 43 g zinc oxide, via a rumen cannula. Treatment was repeated on Day 42. Four animals served as untreated controls. Urinary copper excretion, plasma copper concentration, haematocrit and glutamate dehydrogenase (GLDH activity were determined throughout the trial. The animals were sacrificed after 10 weeks and liver samples were submitted for histopathological examination. Liver and kidney copper and zinc concentrations were determined. Neither the molybdate treatment nor the zinc oxide boluses prevented hepatic copper accumulation. The urinary copper excretion, plasma copper concentration, haematocrit and GLDH activity were not significantly different (P > 0.05 from the controls.

ACIDIC AND NEUTRAL LIQUID INGESTION IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

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Dafne Calsoni GOMES

2014-09-01

Full Text Available Context Sour acidic liquid has a slower distal esophageal transit than a neutral liquid. Our hypothesis was that an acidic sour bolus has a different ingestion dynamic than a neutral bolus. Method In 50 healthy volunteers and 29 patients with gastroesophageal reflux disease (GERD, we evaluated the ingestion dynamics of 100 mL of acidic sour liquid (concentrated lemon juice, pH: 3.0 and 100 mL of water (pH: 6.8. The time to ingest the total volume, the number of swallows to ingest the volume, the interval between swallows, the flux of ingestion and the volume ingested in each swallow was measured. Results In both groups, healthy volunteers and patients in treatment for GERD, the acidic liquid took longer to be ingested, a higher number of swallows, a slower flux of ingestion and a smaller volume in each swallow than the neutral bolus. There was no difference between healthy volunteers and patients with GERD. The ingestion in women was longer than in men for acidic and neutral liquids. Conclusion Acidic liquid has a different dynamic of ingestion than the neutral liquid, which may be consequence of the slower transit through the distal esophageal body or an anticipation to drink a sour bolus. Patients with GERD have the same prolonged ingestion of the acidic liquid bolus as seen in healthy volunteers.

Acidic and neutral liquid ingestion in patients with gastroesophageal reflux disease.

Science.gov (United States)

Gomes, Dafne Calsoni; Dantas, Roberto Oliveira

2014-01-01

Sour acidic liquid has a slower distal esophageal transit than a neutral liquid. Our hypothesis was that an acidic sour bolus has a different ingestion dynamic than a neutral bolus. In 50 healthy volunteers and 29 patients with gastroesophageal reflux disease (GERD), we evaluated the ingestion dynamics of 100 mL of acidic sour liquid (concentrated lemon juice, pH: 3.0) and 100 mL of water (pH: 6.8). The time to ingest the total volume, the number of swallows to ingest the volume, the interval between swallows, the flux of ingestion and the volume ingested in each swallow was measured. In both groups, healthy volunteers and patients in treatment for GERD, the acidic liquid took longer to be ingested, a higher number of swallows, a slower flux of ingestion and a smaller volume in each swallow than the neutral bolus. There was no difference between healthy volunteers and patients with GERD. The ingestion in women was longer than in men for acidic and neutral liquids. Acidic liquid has a different dynamic of ingestion than the neutral liquid, which may be consequence of the slower transit through the distal esophageal body or an anticipation to drink a sour bolus. Patients with GERD have the same prolonged ingestion of the acidic liquid bolus as seen in healthy volunteers.

Lung disease severity in idiopathic pulmonary fibrosis is more strongly associated with impedance measures of bolus reflux than pH parameters of acid reflux alone.

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Gavini, S; Borges, L F; Finn, R T; Lo, W-K; Goldberg, H J; Burakoff, R; Feldman, N; Chan, W W

2017-05-01

Gastroesophageal reflux (GER) has been associated with idiopathic pulmonary fibrosis (IPF). Pathogenesis may be related to chronic micro-aspiration. We aimed to assess objective measures of GER on multichannel intraluminal impedance and pH study (MII-pH) and their relationship with pulmonary function testing (PFT) results, and to compare the performance of pH/acid reflux parameters vs corresponding MII/bolus parameters in predicting pulmonary dysfunction in IPF. This was a retrospective cohort study of IPF patients undergoing prelung transplant evaluation with MII-pH off acid suppression, and having received PFT within 3 months. Patients with prior fundoplication were excluded. Severe pulmonary dysfunction was defined using diffusion capacity of the lung for carbon monoxide (DLCO) ≤40%. Six pH/acid reflux parameters with corresponding MII/bolus reflux measures were specified a priori. Multivariate analyses were applied using forward stepwise logistic regression. Predictive value of each parameter for severe pulmonary dysfunction was calculated by area-under-the-receiver-operating-characteristic-curve or c-statistic. Forty-five subjects (67% M, age 59, 15 mild-moderate vs 30 severe) met criteria for inclusion. Patient demographics and clinical characteristics were similar between pulmonary dysfunction groups. Abnormal total reflux episodes and prolonged bolus clearance time were significantly associated with pulmonary dysfunction severity on univariate and multivariate analyses. No pH parameters were significant. The c-statistic of each pH parameter was lower than its MII counterpart in predicting pulmonary dysfunction. MII/bolus reflux, but not pH/acid reflux, was associated with pulmonary dysfunction in prelung transplant patients with IPF. MII-pH may be more valuable than pH testing alone in characterizing GER in IPF. © 2016 John Wiley & Sons Ltd.

Effects of Anti-VEGF on Predicted Antibody Biodistribution: Roles of Vascular Volume, Interstitial Volume, and Blood Flow

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Boswell, C. Andrew; Ferl, Gregory Z.; Mundo, Eduardo E.; Bumbaca, Daniela; Schweiger, Michelle G.; Theil, Frank-Peter; Fielder, Paul J.; Khawli, Leslie A.

2011-01-01

Background The identification of clinically meaningful and predictive models of disposition kinetics for cancer therapeutics is an ongoing pursuit in drug development. In particular, the growing interest in preclinical evaluation of anti-angiogenic agents alone or in combination with other drugs requires a complete understanding of the associated physiological consequences. Methodology/Principal Findings Technescan™ PYP™, a clinically utilized radiopharmaceutical, was used to measure tissue vascular volumes in beige nude mice that were naïve or administered a single intravenous bolus dose of a murine anti-vascular endothelial growth factor (anti-VEGF) antibody (10 mg/kg) 24 h prior to assay. Anti-VEGF had no significant effect (p>0.05) on the fractional vascular volumes of any tissues studied; these findings were further supported by single photon emission computed tomographic imaging. In addition, apart from a borderline significant increase (p = 0.048) in mean hepatic blood flow, no significant anti-VEGF-induced differences were observed (p>0.05) in two additional physiological parameters, interstitial fluid volume and the organ blood flow rate, measured using indium-111-pentetate and rubidium-86 chloride, respectively. Areas under the concentration-time curves generated by a physiologically-based pharmacokinetic model changed substantially (>25%) in several tissues when model parameters describing compartmental volumes and blood flow rates were switched from literature to our experimentally derived values. However, negligible changes in predicted tissue exposure were observed when comparing simulations based on parameters measured in naïve versus anti-VEGF-administered mice. Conclusions/Significance These observations may foster an enhanced understanding of anti-VEGF effects in murine tissues and, in particular, may be useful in modeling antibody uptake alone or in combination with anti-VEGF. PMID:21436893

Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department.

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Miller, Joseph B; Arter, Andrew; Wilson, Suprat S; Janke, Alexander T; Brody, Aaron; Reed, Brian P; Levy, Phillip D

2017-08-01

While moderate to severely elevated blood pressure (BP) is present in nearly half of all emergency department (ED) patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency. We performed a retrospective cohort study from a single, urban, teaching hospital. Using pharmacy records, we identified patients age 18-89 who received IV antihypertensive treatment in the ED. We defined treatment as inappropriate if documented suspicion for an indicated cardiovascular condition or acute end-organ injury was lacking. Data abstraction included adverse events and 30-day readmission rates, and analysis was primarily descriptive. We included a total of 357 patients over an 18-month period. The mean age was 55; 51% were male and 93% black, and 127 (36.4%) were considered inappropriately treated. Overall, labetalol (61%) was the most commonly used medication, followed by enalaprilat (18%), hydralazine (18%), and metoprolol (3%). There were no significant differences between appropriate and inappropriate BP treatment groups in terms of clinical characteristics or adverse events. Hypotension or bradycardia occurred in three (2%) patients in the inappropriate treatment cohort and in two (1%) patients in the appropriately treated cohort. Survival to discharge and 30-day ED revisit rates were equivalent. More than one in three patients who were given IV bolus antihypertensive treatment in the ED received such therapy inappropriately by our definition, suggesting that significant resources could perhaps be saved through education of

Appropriateness of Bolus Antihypertensive Therapy for Elevated Blood Pressure in the Emergency Department

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Joseph B. Miller

2017-07-01

Full Text Available Introduction: While moderate to severely elevated blood pressure (BP is present in nearly half of all emergency department (ED patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency. Methods: We performed a retrospective cohort study from a single, urban, teaching hospital. Using pharmacy records, we identified patients age 18–89 who received IV antihypertensive treatment in the ED. We defined treatment as inappropriate if documented suspicion for an indicated cardiovascular condition or acute end-organ injury was lacking. Data abstraction included adverse events and 30-day readmission rates, and analysis was primarily descriptive. Results: We included a total of 357 patients over an 18-month period. The mean age was 55; 51% were male and 93% black, and 127 (36.4% were considered inappropriately treated. Overall, labetalol (61% was the most commonly used medication, followed by enalaprilat (18%, hydralazine (18%, and metoprolol (3%. There were no significant differences between appropriate and inappropriate BP treatment groups in terms of clinical characteristics or adverse events. Hypotension or bradycardia occurred in three (2% patients in the inappropriate treatment cohort and in two (1% patients in the appropriately treated cohort. Survival to discharge and 30-day ED revisit rates were equivalent. Conclusion: More than one in three patients who were given IV bolus antihypertensive treatment in the ED received such therapy inappropriately by our definition, suggesting that significant

Blood flow and blood volume in the femoral heads of healthy adults according to age. Measurement with positron emission tomography (PET)

International Nuclear Information System (INIS)

Kubo, Toshikazu; Kimori, Kokuto; Nakamura, Fuminori; Inoue, Shigehiro; Fujioka, Mikihiro; Ueshima, Keiichiro; Hirasawa, Yasusuke; Ushijima, Yo; Nishimura, Tsunehiko

2001-01-01

To deepen understanding of hemodynamics in the femoral head, i.e., the essential factor in clarifying pathogenesis of hip disorders, this study examined blood flow and blood volume in the femoral heads of healthy adults, and their changes with age, by using positron emission tomography (PET). In 16 healthy adult males (age: 20-78 years old, mean age: 42 years), blood flow was measured by means of the H 2 15 O dynamic study method, and blood volume was measured by means of the 15 O-labeled carbon monoxide bolus inhalation method. Blood flow was 1.68-6.47 ml/min/100 g (mean ±SD: 3.52±1.2), and blood volume was 1.67-6.03 ml/100 g (mean ±SD: 3.00±1.27). Blood flow significantly decreased (p<0.01) with age, and blood volume significantly increased (P<0.05). PET was useful in the measurement of blood flow and blood volume in the femoral heads. With age, physiological hemodynamic changes also increased in femoral heads. (author)

Measuring of the cerebellar volume of normal Koreans in their 20s and 40s using magnetic resonance imaging

International Nuclear Information System (INIS)

Chung, Soon Cheol; Choi, Do Young; Lee, Beob Yi; Lee, Bong Soo; Eom, Jin Sup; Sohn, Jin Hun

2004-01-01

This study purposed to measure the standard volume of the cerebellum of normal Koreans who were in their 20s and 40s, and we also wished to find out the difference in the volume of the cerebellum according to gender and age. This study collected MR brain images from 118 people in their 20s (males: 58, females: 60) and 100 people in their 40s (males: 41, females: 59), for a total of 218 people. For each of sagittal, coronal and axial sections, the cerebellar part of the images was segmented using automatic and manual methods, and the volume was then measured. In order to observe differences according to gender and age and also to observe the interactive effect between gender and age, a two-way ANOVA test was performed using gender (2 levels) and age (2 levels) as independent variables. The average volume of the cerebellum of Koreans in their 20s was 133.74 (cm 3 ) and that of Koreans in their 40s was 121.83 (cm 3 ). The average volume of the cerebellum of male Koreans in their 20s and 40s was 134.55 (cm 3 ) and that of female Koreans was 123.06 (cm 3 ). The volume of the cerebellum was significantly larger in Koreans in their 20s than those volumes of the cerebellum of Koreans in their 40s, and the cerebellum volumes in male Koreans were larger than those of the Korean females. Moreover, the reduction of the volume of the cerebellum with age was significantly larger in male Koreans than in the Korean females. According to the results of measuring the volume of the cerebellum for normal Koreans in their 20s and 40s, the volume was significantly different according to gender and age, and the reduction of the volume of the cerebellum with age was significantly larger in men than in women

Measuring of the cerebellar volume of normal Koreans in their 20s and 40s using magnetic resonance imaging

Energy Technology Data Exchange (ETDEWEB)

Chung, Soon Cheol; Choi, Do Young; Lee, Beob Yi; Lee, Bong Soo [College of Medicine, Konkuk Univ., Chungju (Korea, Republic of); Eom, Jin Sup [Chungbuk National Univ., Chungju (Korea, Republic of); Sohn, Jin Hun [Chungnam National Univ., Daejeon (Korea, Republic of)

2004-11-01

This study purposed to measure the standard volume of the cerebellum of normal Koreans who were in their 20s and 40s, and we also wished to find out the difference in the volume of the cerebellum according to gender and age. This study collected MR brain images from 118 people in their 20s (males: 58, females: 60) and 100 people in their 40s (males: 41, females: 59), for a total of 218 people. For each of sagittal, coronal and axial sections, the cerebellar part of the images was segmented using automatic and manual methods, and the volume was then measured. In order to observe differences according to gender and age and also to observe the interactive effect between gender and age, a two-way ANOVA test was performed using gender (2 levels) and age (2 levels) as independent variables. The average volume of the cerebellum of Koreans in their 20s was 133.74 (cm{sup 3}) and that of Koreans in their 40s was 121.83 (cm{sup 3}). The average volume of the cerebellum of male Koreans in their 20s and 40s was 134.55 (cm{sup 3}) and that of female Koreans was 123.06 (cm{sup 3}). The volume of the cerebellum was significantly larger in Koreans in their 20s than those volumes of the cerebellum of Koreans in their 40s, and the cerebellum volumes in male Koreans were larger than those of the Korean females. Moreover, the reduction of the volume of the cerebellum with age was significantly larger in male Koreans than in the Korean females. According to the results of measuring the volume of the cerebellum for normal Koreans in their 20s and 40s, the volume was significantly different according to gender and age, and the reduction of the volume of the cerebellum with age was significantly larger in men than in women.

Efficacy, distribution and faecal excretion of copper oxide wire particles in a novel bolus in red deer (Cervus elaphus).

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Castillo-Alcala, F; Wilson, P R; Molenaar, R; Lopez-Villalobos, N

2007-04-01

To determine the efficacy of a novel copper oxide wire particle (COWP) formulation in elevating concentrations of copper (Cu) in the liver and serum of red deer (Cervus elaphus), and to investigate the distribution of particles in the gastrointestinal tract and the rate of their excretion in faeces. Mixed-age red deer hinds were allocated to three groups (n=10 per group) on the basis of pre-treatment liver Cu concentrations. Groups 1 and 2 were treated orally with a 10-g COWP bolus on Days 0 and 30, respectively, while the remaining group served as an untreated control. Animals were slaughtered on Day 60, when blood and liver samples were collected for determination of Cu concentrations. An additional group of 18-month-old red deer hinds (n=20) were treated orally with a 10-g COWP bolus, and four were slaughtered on each of Days 1, 5, 15, 30 and 60 after treatment. The gastrointestinal tract was secured between compartments below the oesophagus and contents rinsed until sedimentation of particles was complete. The sediment was oven-dried and COWP were separated and weighed. Faeces were collected continuously from four additional animals held in metabolism cages for 4 days after treatment, sub-sampled daily, and COWP recovered. Mean liver Cu concentrations at slaughter were 80, 597 and 447 micromol/kg for controls and hinds treated 30, and 60 days previously, respectively. Corresponding mean serum Cu concentrations were 7.7, 12.9 and 11.9 micromol/L, respectively. Liver and serum Cu concentrations were higher in both treatment groups than in untreated control animals (p<0.001). COWP were found in all compartments of the gastrointestinal tract measured, for at least 15 days, and in the rumen/reticulum and abomasum for at least 60 days post-administration. The highest rate of recovery overall was from the rumen/reticulum. Mean weight of COWP recovered from faeces was 0.09 g during the first 24 h and 0.94 g over the first 4 days following administration. The COWP bolus

Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD).

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Newman, Roger; Vilardell, Natàlia; Clavé, Pere; Speyer, Renée

2016-04-01

Fluid thickening is a well-established management strategy for oropharyngeal dysphagia (OD). However, the effects of thickening agents on the physiology of impaired swallow responses are not fully understood, and there is no agreement on the degree of bolus thickening. To review the literature and to produce a white paper of the European Society for Swallowing Disorders (ESSD) describing the evidence in the literature on the effect that bolus modification has upon the physiology, efficacy and safety of swallowing in adults with OD. A systematic search was performed using the electronic Pubmed and Embase databases. Articles in English available up to July 2015 were considered. The inclusion criteria swallowing studies on adults over 18 years of age; healthy people or patients with oropharyngeal dysphagia; bolus modification; effects of bolus modification on swallow safety (penetration/aspiration) and efficacy; and/or physiology and original articles written in English. The exclusion criteria consisted of oesophageal dysphagia and conference abstracts or presentations. The quality of the selected papers and the level of research evidence were assessed by standard quality assessments. At the end of the selection process, 33 articles were considered. The quality of all included studies was assessed using systematic, reproducible, and quantitative tools (Kmet and NHMRC) concluding that all the selected articles reached a valid level of evidence. The literature search gathered data from various sources, ranging from double-blind randomised control trials to systematic reviews focused on changes occurring in swallowing physiology caused by thickened fluids. Main results suggest that increasing bolus viscosity (a) results in increased safety of swallowing, (b) also results in increased amounts of oral and/or pharyngeal residue which may result in post-swallow airway invasion, (c) impacts the physiology with increased lingual pressure patterns, no major changes in impaired

Myocardial T1 and extracellular volume fraction mapping at 3 tesla

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Lee Jason J

2011-11-01

Full Text Available Abstract Background To compare 11 heartbeat (HB and 17 HB modified lock locker inversion recovery (MOLLI pulse sequence at 3T and to establish preliminary reference values for myocardial T1 and the extracellular volume fraction (ECV. Methods Both phantoms and normal volunteers were scanned at 3T using 11 HB and 17 HB MOLLI sequence with the following parameters: spatial resolution = 1.75 × 1.75 × 10 mm on a 256 × 180 matrix, TI initial = 110 ms, TI increment = 80 ms, flip angle = 35°, TR/TE = 1.9/1.0 ms. All volunteers were administered Gadolinium-DTPA (Magnevist, 0.15 mmol/kg, and multiple post-contrast MOLLI scans were performed at the same pre-contrast position from 3.5-23.5 minutes after a bolus contrast injection. Late gadolinium enhancement (LGE images were also acquired 12-30 minutes after the gadolinium bolus. Results T1 values of 11 HB and 17 HB MOLLI displayed good agreement in both phantom and volunteers. The average pre-contrast myocardial and blood T1 was 1315 ± 39 ms and 2020 ± 129 ms, respectively. ECV was stable between 8.5 to 23.5 minutes post contrast with an average of 26.7 ± 1.0%. Conclusion The 11 HB MOLLI is a faster method for high-resolution myocardial T1 mapping at 3T. ECV fractions are stable over a wide time range after contrast administration.

Cost-effectiveness of once daily GLP-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with type 2 diabetes in Norway.

Science.gov (United States)

Huetson, Pernilla; Palmer, James L; Levorsen, Andrée; Fournier, Marie; Germe, Maeva; McLeod, Euan

2015-01-01

Lixisenatide is a potent, selective and short-acting once daily prandial glucagon-like peptide-1 receptor agonist which lowers glycohemoglobin and body weight by clinically significant amounts in patients with type 2 diabetes treated with basal insulin, with limited risk of hypoglycemia. To assess the cost-effectiveness of lixisenatide versus bolus insulin, both in combination with basal insulin, in patients with type 2 diabetes in Norway. The IMS CORE Diabetes Model, a non-product-specific and validated simulation model, was used to make clinical and cost projections. Transition probabilities, risk adjustments and the progression of complication risk factors were derived from the UK Prospective Diabetes Study, supplemented with Norwegian data. Patients were assumed to receive combination treatment with basal insulin, lixisenatide or bolus insulin therapy for 3 years, followed by intensification of a basal-bolus insulin regimen for their remaining lifetime. Simulated healthcare costs, taken from the public payer perspective, were derived from microcosting and diagnosis related groups, discounted at 4% per annum and reported in Norwegian krone (NOK). Productivity costs were also captured based on extractions from the Norwegian Labor and Welfare Administration. Health state utilities were derived from a systematic literature review. Sensitivity and scenario analyses were performed. Lixisenatide in combination with basal insulin was associated with increased quality-adjusted life years (QALYs) and reduced lifetime healthcare costs compared to bolus insulin in combination with basal insulin in patients with Type 2 diabetes, and can be considered dominant. The net monetary benefit of lixisenatide versus bolus insulin was NOK 39,369 per patient. Results were sensitive to discounting, the application of excess body weight associated disutility and uncertainty surrounding the changes in HbA1c. Lixisenatide may be considered an economically efficient therapy in combination

Cerebral vascular effects of hypovolemia and dopamine infusions

DEFF Research Database (Denmark)

Holst Hahn, Gitte; Heiring, Christian; Pryds, Ole

2012-01-01

Despite widespread use, effects of volume boluses and dopamine in hypotensive newborn infants remain controversial. We aimed to elucidate if hypovolemia alone impairs cerebral autoregulation (CA) and if dopamine affects cerebral vasculature.......Despite widespread use, effects of volume boluses and dopamine in hypotensive newborn infants remain controversial. We aimed to elucidate if hypovolemia alone impairs cerebral autoregulation (CA) and if dopamine affects cerebral vasculature....

Mapping water exchange rates in rat tumor xenografts using the late-stage uptake following bolus injections of contrast agent.

Science.gov (United States)

Bailey, Colleen; Moosvi, Firas; Stanisz, Greg J

2014-05-01

To map the intra-to-extracellular water exchange rate constant in rat xenografts using a two-compartment model of relaxation with water exchange and a range of contrast agent concentrations and compare with histology. MDA-MB-231 cells were xenografted into six nude rats. Three bolus injections of gadodiamide were administered. When uptake in the tumor demonstrated a steady-state, T1 data were acquired by spoiled gradient recalled acquisitions at four flip angles. A global fit of data to a two-compartment model incorporating exchange was performed, assuming a distribution volume of 20% of the rat. Voxels that did not reach steady-state and were excluded from parametric maps tended to be in large necrotic areas. TUNEL-negative (nonapoptotic) regions tended to have well-defined error bounds, with an average intra-to-extracellular exchange rate constant of 0.6 s(-1) . Apoptotic regions had higher exchange, but poorly determined upper bounds, with goodness of fit similar to that for a model assuming infinitely fast exchange. A lower bound of >3 s(-1) was used to establish voxels where the exchange rate constant was fast despite a large upper bound. Water exchange rates were higher in apoptotic regions, but examination of statistical errors was an important step in the mapping process. Copyright © 2013 Wiley Periodicals, Inc.

Closed-loop double-vasopressor automated system vs manual bolus vasopressor to treat hypotension during spinal anaesthesia for caesarean section: a randomised controlled trial.

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Sng, B L; Tan, H S; Sia, A T H

2014-01-01

Hypotension necessitating vasopressor administration occurs commonly during caesarean section under spinal anaesthesia. We developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive arterial pressure monitoring. A phenylephrine bolus of 50 μg was given at 30-s intervals when systolic blood pressure fell manual boluses of either phenylephrine 100 μg or ephedrine 8 mg, administered at 1-min intervals based on the same thresholds for systolic pressure and heart rate. This randomised, controlled, double-blinded trial involved 213 healthy women who underwent elective caesarean delivery under spinal anaesthesia using 11 mg hyperbaric bupivacaine with 15 μg fentanyl and 100 μg morphine. The automated vasopressor group had better systolic pressure control, with 37/106 (34.9%) having any beat-to-beat systolic pressure reading 120% of baseline, with 8/106 (7.5%) in the automated vasopressor group vs 14/107 (13.1%) in the control group, or total dose of vasopressors. The automated vasopressor group had lower median absolute performance error of 8.5% vs control of 9.8% (p = 0.013), and reduced incidence of nausea (1/106 (0.9%) vs 11/107 (10.3%), p = 0.005). Neonatal umbilical cord pH, umbilical lactate and Apgar scores were similar. Hence, our system afforded better control of maternal blood pressure and reduced nausea with no increase in reactive hypertension when compared with manual boluses. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Multi-detector row CT of the kidney: Optimizing scan delays for bolus tracking techniques of arterial, corticomedullary, and nephrographic phases

Energy Technology Data Exchange (ETDEWEB)

Goshima, Satoshi [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193 (Japan); Kanematsu, Masayuki [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193 (Japan); Department of Radiology Services, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193 (Japan); Nishibori, Hironori; Kondo, Hiroshi; Tsuge, Yusuke [Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193 (Japan); Yokoyama, Ryujiro; Miyoshi, Toshiharu [Department of Radiology Services, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193 (Japan); Onozuka, Minoru [Department of Physiology and Neuroscience, Kanagawa Dental College, Yokosuka, Kanagawa (Japan); Shiratori, Yoshimune [Department of Medical Informatics, Gifu University School of Medicine, Gifu (Japan); Moriyama, Noriyuki [Department of Diagnostic Radiology, National Cancer Center Hospital, Tsukiji, Chuo-Ku, Tokyo (Japan); Bae, Kyongtae T. [Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

2007-09-15

Purpose: To determine optimal scan delays for renal arterial-, corticomedullary-, and nephrographic-phase imaging with multi-detector row computed tomography (MDCT) of the kidney using a bolus-tracking technique. Methods and materials: One hundred and twenty-eight patients underwent three-phase CT scan of the kidney with eight-row MDCT after receiving 2 mL/kg of 300 mg I/mL contrast medium at 4 mL/s. Patients were prospectively randomized into three groups with different scan delays for the three scan phases (arterial, corticomedullary, and nephrographic) after bolus-tracking triggered at 50 HU of aortic contrast enhancement: group 1 (5, 20, 45 s); group 2 (10, 25, 50 s); and group 3 (15, 30, 55 s). Mean CT values (HU) of the abdominal aorta, renal artery, renal vein, renal cortex, and renal medulla were measured; increases in CT values pre- to post-contrast were assessed as contrast enhancement. Renal artery-to-vein and renal cortex-to-medulla contrast differences were also assessed. Qualitative analysis was also performed. Results: Mean renal artery enhancement was 240-288 HU at 5-15 s after the trigger and peaked at 10 s (P < .001). Mean renal cortical enhancement was 195-217 HU at 10-30 s and peaked at 25 s (P < .01). Contrast enhancement in the renal medulla increased gradually and reached mean 145 HU at 55 s. Cortex-to-medulla contrast difference was high (110-140 HU) at 5-30 s and decreased below 30 HU at 45 s after the trigger. Renal artery-to-vein contrast difference was high (121-125 HU) at 5-10 s. Qualitative results correlated well with quantitative results. Conclusion: For the injection protocol used in this study, optimal scan delays after the bolus-tracking trigger were 5-10 s for renal arterial, 15-25 s for corticomedullary, and 50-55 s for nephrographic phases.

Hippocampus and amygdala volumes in patients with vaginismus.

Science.gov (United States)

Atmaca, Murad; Baykara, Sema; Ozer, Omer; Korkmaz, Sevda; Akaslan, Unsal; Yildirim, Hanefi

2016-06-22

To compare hippocampus and amygdala volumes of patients with vaginismus with those of healthy control subjects. Magnetic resonance imaging was performed on ten patients with vaginismus and ten control subjects matched for age and gender. Volumes of the hippocampus and amygdala were blindly measured. We found that the mean right amygdala volume of patients with vaginismus were smaller than that of the healthy controls. With regard to hippocampus volumes, the mean left and right hippocampus volumes were smaller than those of the healthy controls. Our present findings suggest that there have been hippocampus and amygdala structural abnormalities in patients with vaginismus. These changes provide the notion that vaginismus may be a fear-related condition.

Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft

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Esra Mercanooglu Efe

2014-07-01

Full Text Available BACKGROUND AND OBJECTIVE: The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS: After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, 0.5 mg/kg/min esmolol infusion, in Bolus Group; 2 min before intubation and sternotomy 1.5 mg/kg esmolol IV bolus and in Control Group; %0.9 NaCl was administered. All demographic parameters were recorded. Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute, during endotracheal intubation, every minute for 10 minutes after endotracheal intubation and before, during and after sternotomy at first and fifth minutes. RESULTS: While area under curve (AUC (SAP × time was being found more in Group B and C than Group I, AUC (SAP × T int and T st and AUC (SAP × T2 was found more in Group B and C than Group I (p < 0.05. Moreover AUC (HR × T st was found less in Group B than Group C but no significant difference was found between Group B and Group I. CONCLUSION: This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery.

A randomized phase III multicenter trial comparing irinotecan in combination with the Nordic bolus 5-FU and folinic acid schedule or the bolus/infused de Gramont schedule (Lv5FU2) in patients with metastatic colorectal cancer

DEFF Research Database (Denmark)

Glimelius, B; Sørbye, H; Balteskard, L

2008-01-01

not differ (4% versus 6%, P = 0.3). Grade 3/4 neutropenia (11% versus 5%, P = 0.01) and grade 2 alopecia (18% versus 9%, P = 0.002) were more common in the FLIRI group. The 60-day mortality was 2.4% versus 2.1%. CONCLUSIONS: Irinotecan with the bolus Nordic schedule (FLIRI) is a convenient treatment with PFS...... and OS comparable to irinotecan with the Lv5FU2 schedule. Neutropenia and alopecia are more prevalent, but both regimens are equally well tolerated....

Methods of bolusing the tracheostomy stoma

International Nuclear Information System (INIS)

Beitler, Jonathan J.; Yaparpalvi, Ravindra; Biancia, Cesar Della; Fontenla, Doracy P.

2001-01-01

Purpose: The tracheostomy stoma is a potential site of recurrence for patients who have subglottic cancer or subglottic spread of cancer. In these patients, it is important that the anterior supraclavicular field does not underdose the posterior wall of the tracheostomy stoma when using a 6-MV anterior photon field. Conventionally, this problem is surmounted with placement of a plastic tracheostomy tube, which is uncomfortable for the patient, potentially traumatic, and can interfere with vocalization via a tracheal esophageal puncture. Our study was designed to investigate the dosimetry of this region and see if alternate methods would be effective. Methods and Materials: A phantom was constructed using a No. 6 tracheostomy tube as the model for the tracheostomy curvature and size. Using the water-equivalent phantom, film dosimetry, and films oriented parallel to the en face field, we investigated the dose at the depth of the surface of the posterior wall of the phantom's tracheostomy stoma. Dose was measured both in space and at the tissue interface by scanning points of interest both horizontally and vertically. We measured doses with a No. 6 and No. 8 plastic tracheostomy tube, either 0.5 cm and 1.0 cm of bolus (1-cm airhole) with no tracheostomy tube, as well as 0.3 cm and 0.6 cm tissue-equivalent Aquaplast (Med-Tec Co., Orange City, Iowa) over the tracheostomy. Dosimetry at the posterior interface was confirmed using thermoluminescent dosimeters. Results: Three mm and 6 mm of Aquaplast produced a posterior tracheal dose of 93% and 100%. Conclusion: There is no need for these patients to wear a temporary plastic tracheostomy tube during their external radiation therapy. Aquaplast should allow better position reproducibility, reduce trauma, not interfere with patient respiratory efforts, and be compatible with vocalization via a tracheal esophageal puncture

The relationship of age, gender, and IQ with the brainstem and thalamus in healthy children and adolescents: a magnetic resonance imaging volumetric study.

Science.gov (United States)

Xie, Yuhuan; Chen, Yian Ann; De Bellis, Michael D

2012-03-01

In healthy children, there is a paucity of information on the growth of the brainstem and thalamus measured anatomically magnetic resonance imaging. The relations of age, gender, and age by gender with brainstem and thalamus volumes were analyzed from magnetic resonance brain images of 122 healthy children and adolescents (62 males, 60 females; ages 4 to 17). Results showed that age is a significant predictor of brainstem and thalamus volumes. The volume of the brainstem increases with age, while thalamus volume declines with age. The volume of the right thalamus is significantly larger than that of the left in both genders, with greater rightward asymmetry and greater thalamus to grey matter ratio in females. Males have larger brainstems, but these differences are not significant when covarying for cerebral volume. Larger thalami were associated with higher Verbal IQ. These normative pediatric data are of value to researchers who study these regions in neurodevelopmental disorders.

Reduced striatal volumes in Parkinson’s disease: a magnetic resonance imaging study

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Pitcher Toni L

2012-08-01

Full Text Available Abstract Background The presence and extent of structural changes in the brain as a consequence of Parkinson’s disease (PD is still poorly understood. Methods High-resolution 3-tesla T1-weighted structural magnetic resonance images in sixty-five PD and 27 age-matched healthy control participants were examined. Putamen, caudate, and intracranial volumes were manually traced in the axial plane of 3D reconstructed images. Striatal nuclei volumes were normalized to intracranial volume for statistical comparison. Disease status was assessed using the Unified Parkinson’s Disease Rating Scale and Hoehn and Yahr scale. Cognitive status was assessed using global status tests and detailed neuropsychological testing. Results Both caudate and putamen volumes were smaller in PD brains compared to controls after adjusting for age and gender. Caudate volumes were reduced by 11% (p = 0.001 and putamen volumes by 8.1% (p = 0.025. PD striatal volumes were not found to be significantly correlated with cognitive or motor decline. Conclusion Small, but significant reductions in the volume of both the caudate and putamen occur in PD brains. These reductions are independent of the effects of age and gender, however the relation of these reductions to the functional loss of dopamine, which is characteristic of PD, remains unclear.

Effect of gender and lean body mass on kidney size in healthy 10-year-old children

DEFF Research Database (Denmark)

Schmidt, I. M.; Mølgaard, C.; Main, K. M.

2001-01-01

predictor of kidney volume was lean body mass, overruling height, weight, and surface area. When total kidney volume was related to lean body mass as a ratio, the gender difference in kidney size was no longer significant. A strong negative correlation was found between fat body mass and kidney volume...

The Efficacy of Programmed Intermittent Epidural Bolus for Postoperative Analgesia after Open Gynecological Surgery: A Randomized Double-Blinded Study

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Shiho Satomi

2018-01-01

Full Text Available Background. It is well known that the programmed intermittent epidural bolus (PIEB technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI in patients undergoing gynecological surgery under combined general-epidural anesthesia. Methods. Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4 mL ropivacaine 0.2% plus fentanyl 2 μg/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4 mL/h. In both groups, additional 4 mL boluses of ropivacaine 0.2% plus fentanyl 2 μg/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale 3, 24, and 48 hours after surgery. Results. In total, 57 patients were randomized (n=28 and 29 in the PIEB and CEI groups, resp.. The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation: 155.38 (4.55 versus 159.73 (7.87 mL, P=0.016. Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower–upper quartiles]: 0 [0–0.5] versus 3 [0–5.5], P=0.002, 24 hours (1 [0–2] versus 3 [1–4], P=0.003, and 48 hours (1 [0–2] versus 2 [2–3.5], P=0.002 after surgery. Conclusion. PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.

Impact of family history and depression on amygdala volume.

LENUS (Irish Health Repository)

Saleh, Karim

2012-07-30

Family history of depression significantly impacts life-long depression risk. Family history could impact the stress and emotion regulation system that involves the amygdala. This study\\'s purpose was to investigate family history\\'s effect on amygdala volumes, and differences in first degree relatives with and without major depressive disorder (MDD). Participants, aged 18-65, were healthy volunteers (N=52) with (n=26) and without (n=26) first degree family history, and patients with MDD (N=48) with (n=27) and without (n=21)first-degree family history recruited for structural magnetic resonance imaging (MRI). Participants underwent clinical assessment followed by manual amygdala tracing. Patients with MDD without family history showed significantly larger right amygdala without a family history of MDD. These effects had larger right amygdala than healthy controls without MDD family history. These effects were pronounced in females. Family history and gender impacted amygdala volumes in all participants, providing a rationale for the inconsistent results in MDD amygdala studies. Higher familial risk in depression seems to be associated with smaller amygdala volumes, whereas depression alone is associated with larger amygdala volumes. Ultimately, these findings highlight consideration of family history and gender in research and treatment strategies.

How Early Hormones Shape Gender Development

Science.gov (United States)

Berenbaum, Sheri A.; Beltz, Adriene M.

2015-01-01

Many important psychological characteristics show sex differences, and are influenced by sex hormones at different developmental periods. We focus on the role of sex hormones in early development, particularly the differential effects of prenatal androgens on aspects of gender development. Increasing evidence confirms that prenatal androgens have facilitative effects on male-typed activity interests and engagement (including child toy preferences and adult careers), and spatial abilities, but relatively minimal effects on gender identity. Recent emphasis has been directed to the psychological mechanisms underlying these effects (including sex differences in propulsive movement, and androgen effects on interest in people versus things), and neural substrates of androgen effects (including regional brain volumes, and neural responses to mental rotation, sexually arousing stimuli, emotion, and reward). Ongoing and planned work is focused on understanding the ways in which hormones act jointly with the social environment across time to produce varying trajectories of gender development, and clarifying mechanisms by which androgens affect behaviors. Such work will be facilitated by applying lessons from other species, and by expanding methodology. Understanding hormonal influences on gender development enhances knowledge of psychological development generally, and has important implications for basic and applied questions, including sex differences in psychopathology, women’s underrepresentation in science and math, and clinical care of individuals with variations in gender expression. PMID:26688827

Comparison of treatment with continuous subcutaneous insulin infusion versus multiple daily insulin injections with bolus calculator in patients with type 1 diabetes.

Science.gov (United States)

Pérez-García, L; Goñi-Iriarte, M J; García-Mouriz, M

2015-01-01

A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily inyections (MDI) with bolus calculator group. This is a retrospective cohort study with following up during the first 12 months that CSII group (n=30) begins the use of "bolus wizard" and the MDI-calculator (n=30) group begins the use of the bolus calculator (Accu-Chek(®) Aviva Expert). HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia). T Student and nonparametric tests. The average reduction in HbA1c during the study was significantly higher in CSII group (-0.56±0.84%) compared with the MDI group (0.097±0.94%), P=.028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences were found between the 2 treatment groups after analyzing the EsDQOL, FH-15 and Clarke questionnaires. In the CSII group, perceived quality of life assessed by the EsDQOL questionnaire was found to be better at the end of the study than at the beginning of using the insulin pump. The average reduction in HbA1c was significantly higher in the CSII group. In the CSII group, perceived quality of life was better at the end of the study than at the beginning. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

2015 Workplace and Gender Relations Survey of Reserve Component Members: Statistical Methodology Report

Science.gov (United States)

2016-03-17

and sexual harassment in the U.S. military: Volume 2. Estimates for Department of Defense service members from the 2014 RAND military workplace ... Sexual harassment , gender discrimination, and sexual assault. The 2014 RMWS nonresponse adjustment involved two steps, each of which produced a...were necessary. Using completed 2015 cases, six outcome variables were modeled for females: sexual harassment , gender discrimination, sexual quid

Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson's disease.

Science.gov (United States)

Rajan, Shobana; Deogaonkar, Milind; Kaw, Roop; Nada, Eman Ms; Hernandez, Adrian V; Ebrahim, Zeyd; Avitsian, Rafi

2014-10-01

Hypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use intraoperatively. Medical records of Parkinson's disease (PD) patients undergoing DBS procedure between 2008-2011 were reviewed after Institutional Review Board approval. Anesthesia medication, preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus, anxiety, motor part of the Unified Parkinson's Disease Rating Scale score and PD duration were collected. Univariate and multivariate analysis was done between each patient characteristic and the number of antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively. Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00-1.02; p=0.005), high Joint National Committee (JNC) class (p10 years (RR 1.2; 95%CI 1.1-1.3; p=0.001) were independent predictors for antihypertensive use. No difference was noted in the mean dose of levodopa (p=0.1) and levodopa equivalent dose (p=0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to propofol did not influence antihypertensive boluses required (p=0.38). Intraoperative hypertension during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher intraoperative antihypertensive medications. Copyright © 2014 Elsevier Ltd. All rights reserved.

Der Terminator und die Femme fatale. Gender im Genre-Kino The Terminator and the Femme Fatale: Gender in Genre Cinema

Directory of Open Access Journals (Sweden)

Rochus Wolff

2005-03-01

Full Text Available Mit Hollywood hybrid legen Claudia Liebrand und Ines Steiner einen äußerst lesenswerten Sammelband vor, in dem aus unterschiedlichen Blickwinkeln Hollywoodfilme der vergangenen Jahre untersucht wurden. Im Zentrum stehen dabei stets die komplexen Wechselwirkungen zwischen Genre und Gender. Von wenigen Schwächen abgesehen, gelingen den Autor/-innen dabei durchweg überzeugende Analysen.Claudia Liesbrand and Ines Steiner’s very worth reading Hollywood hybrid is a collected volume in which Hollywood films of recent years are examined from various angles. Central to the text is the continually complex interaction between genre and gender. With this, the authors enjoy, a few weaknesses aside, ongoing success.

Usefulness of the Bolus-Tracking Baseline Scan for the Diagnosis of Hepatic Steatosis in Abdominal Computed Tomography: A Feasibility Study

International Nuclear Information System (INIS)

Gossner, J.; Schäfer, S.

2013-01-01

Nonalcoholic fatty liver disease (NAFLD) is a common pathology in western societies. Unenhanced computed tomography (CT) of the liver is a valuable tool in determining the presence of steatosis hepatis, but in most departments standard CT protocols of abdomen often do not include unenhanced scans anymore. In a small series of 22 patients the liver density was measured in the acquired low-dose baseline scan for bolus tracking and was compared to the measurement in a regular unenhanced CT scan of the upper abdomen. The mean difference between the unenhanced CT scan and the low-dose baseline scan was 3.4 HU (range 0.2–8.6 HU); the difference between these two scans was 5 HU or smaller in 82% of the patients. There was a significant difference between the two used CT scanners; this has to be kept in mind before implementing this approach into daily practice. All but one patient with fatty liver disease on unenhanced CT were diagnosed using the baseline scan. The baseline scan for bolus tracking may be useful for the diagnosis or in the followup of fatty liver disease

Gender differences in left ventricular function in patients with isolated aortic stenosis.

Science.gov (United States)

Favero, Luca; Giordan, Massimo; Tarantini, Giuseppe; Ramondo, Angelo Bruno; Cardaioli, Paolo; Isabella, Giambattista; Chioin, Raffaello; Lupia, Mario; Razzolini, Renato

2003-05-01

Hypertrophic response of the left ventricle to systolic overload in aortic stenosis appears to be gender-dependent. To examine gender-related differences in left ventricular (LV) function in patients with isolated severe aortic stenosis, 145 patients (65 women, 80 men; mean age 66 +/- 8 years; range: 50 to 89 years) with aortic valve area 199 mmHg, the mass:volume ratio was increased in men compared with women; of note, the mass:volume ratio in women was not increased in this subgroup compared with the general population. LV pump function in this subgroup was normal and did not differ between men and women. Although no clear-cut difference in hemodynamic parameters was seen, there was a trend towards a less compensatory increase in LV mass in females.

Comparison of /sup 133/Xe washout curves after bolus inhalation, perfusion, and equilibration

Energy Technology Data Exchange (ETDEWEB)

Devos, P; Demedts, M; Vandecruys, A; Cosemans, J; De Roo, M

1978-01-01

In 6 healthy subjects and 13 patients with chronic obstructive lung disease, /sup 133/Xe washout curves after bolus inhalation, perfusion and equilibration were compared, using a gamma camera and computerized data handling. In healthy subjects the washout after equilibration was significantly slower than after the two other procedures. As this phenomenon occurred at the basal zones, it was attributed to the presence of airway closure in some units. In patients, the three washouts were significantly different from each other. This indicated the existence of intraregional inhomogeneity in ventilation, perfusion and ventilation-perfusion ratio. Our conclusion is that comparison of these different washout methods yields valuable information not only on absolute values of pulmonary function but also on the intraregional distribution, which cannot be obtained by other examinations.

Compensation techniques in NIRS proton beam radiotherapy

International Nuclear Information System (INIS)

Akanuma, A.; Majima, H.; Furukawa, S.

1982-01-01

Proton beam has the dose distribution advantage in radiation therapy, although it has little advantage in biological effects. One of the best advantages is its sharp fall off of dose after the peak. With proton beam, therefore, the dose can be given just to cover a target volume and potentially no dose is delivered thereafter in the beam direction. To utilize this advantage, bolus techniques in conjunction with CT scanning are employed in NIRS proton beam radiation therapy planning. A patient receives CT scanning first so that the target volume can be clearly marked and the radiation direction and fixation method can be determined. At the same time bolus dimensions are calculated. The bolus frames are made with dental paraffin sheets according to the dimensions. The paraffin frame is replaced with dental resin. Alginate (a dental impression material with favorable physical density and skin surface contact) is now employed for the bolus material. With fixation device and bolus on, which are constructed individually, the patient receives CT scanning again prior to a proton beam treatment in order to prove the devices are suitable. Alginate has to be poured into the frame right before each treatments. Further investigations are required to find better bolus materials and easier construction methods

Compensation techniques in NIRS proton beam radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Akanuma, A. (Univ. of Tokyo, Japan); Majima, H.; Furukawa, S.

1982-09-01

Proton beam has the dose distribution advantage in radiation therapy, although it has little advantage in biological effects. One of the best advantages is its sharp fall off of dose after the peak. With proton beam, therefore, the dose can be given just to cover a target volume and potentially no dose is delivered thereafter in the beam direction. To utilize this advantage, bolus techniques in conjunction with CT scanning are employed in NIRS proton beam radiation therapy planning. A patient receives CT scanning first so that the target volume can be clearly marked and the radiation direction and fixation method can be determined. At the same time bolus dimensions are calculated. The bolus frames are made with dental paraffin sheets according to the dimensions. The paraffin frame is replaced with dental resin. Alginate (a dental impression material with favorable physical density and skin surface contact) is now employed for the bolus material. With fixation device and bolus on, which are constructed individually, the patient receives CT scanning again prior to a proton beam treatment in order to prove the devices are suitable. Alginate has to be poured into the frame right before each treatments. Further investigations are required to find better bolus materials and easier construction methods.

Measurement of brain perfusion, blood volume, and blood-brain barrier permeability, using dynamic contrast-enhanced T(1)-weighted MRI at 3 tesla

DEFF Research Database (Denmark)

Larsson, Henrik B W; Courivaud, Frédéric; Rostrup, Egill

2009-01-01

Assessment of vascular properties is essential to diagnosis and follow-up and basic understanding of pathogenesis in brain tumors. In this study, a procedure is presented that allows concurrent estimation of cerebral perfusion, blood volume, and blood-brain permeability from dynamic T(1)-weighted...... on a pixel-by-pixel basis of cerebral perfusion, cerebral blood volume, and blood-brain barrier permeability.......Assessment of vascular properties is essential to diagnosis and follow-up and basic understanding of pathogenesis in brain tumors. In this study, a procedure is presented that allows concurrent estimation of cerebral perfusion, blood volume, and blood-brain permeability from dynamic T(1)-weighted...... imaging of a bolus of a paramagnetic contrast agent passing through the brain. The methods are applied in patients with brain tumors and in healthy subjects. Perfusion was estimated by model-free deconvolution using Tikhonov's method (gray matter/white matter/tumor: 72 +/- 16/30 +/- 8/56 +/- 45 mL/100 g...

Dilemmas in the Danish approach to gender equality : gender equality without gender quota

OpenAIRE

ROLANDSEN AGUSTÍN, Lise; SIIM, Birte

2015-01-01

The paper addresses the dilemmas, contradictions and paradoxes in the Danish approach to gender quotas and gender equality and discusses the intersections of citizenship, democracy and gender justice. Gender research understands gender quota as a means to achieve equal rights, gender equality and gender parity. Gender theory has conceptualized gender parity as one step towards achieving gender justice in all arenas of social, political and economic life. The Danish cases illustrate that conte...

Assessment of sphenoid sinus volume in order to determine sexual identity, using multi-slice CT images

Directory of Open Access Journals (Sweden)

Habibeh Farazdaghi

2017-02-01

Full Text Available Background and Aims: Gender determination is an important step in identification. For gender determination, anthropometric evaluation is one of the main forensic evaluations. The aim of this study was the assessment of sphenoid sinus volume in order to determine sexual identity, using multi-slice CT images. Materials and Methods: For volumetric analysis, axial paranasal sinus CT scan with 3-mm slice thickness was used. For this study, 80 images (40 women and 40 men older than 18 years were selected. For the assessment of sphenoid sinus volume, Digimizer software was used. The volume of sphenoid sinus was calculated using the following equation: v=∑ (area of each slice × thickness of each slice. Statistical analysis was performed by independent T-test. Results: The mean volume of sphenoid sinus was significantly greater in male gender (P=0.01.The assessed Cut off point was 9/35 cm3, showing that 63.4% of volume assessments greater than cut off point was supposed to be male and 64.1% of volumetry lesser than cut off point were female. Conclusion: According to the area under Roc curve (1.65%, sphenoid sinus volume is not an appropriate factor for differentiation of male and female from each other, which means the predictability of cut off point (9/35 cm3 is 65/1% close to reality.

Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

LENUS (Irish Health Repository)

Murphy, Deirdre J

2012-02-01

BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

Study protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section.

LENUS (Irish Health Repository)

Murphy, Deirdre J

2009-01-01

BACKGROUND: Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4-10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. METHODS AND DESIGN: A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. DISCUSSION: It is both important and timely that we evaluate the optimal approach to the management of the third stage at

Volitional chewing with a conscious effort alters and facilitates swallowing during feeding sequence.

Science.gov (United States)

Furuya, J; Hara, A; Nomura, T; Kondo, H

2014-03-01

The key objective of mastication is to form a food bolus suitable for smooth swallowing. However, chewing is usually performed without a conscious effort. Poor bolus formation can cause pharyngeal residue and suffocation in elderly individuals with reduced swallowing function. Therefore, chewing with a conscious effort may help the bolus to more easily pass the pharynx. This study aimed to clarify the impact of mastication with a conscious effort on the feeding sequence. Subjects included 25 dentulous volunteers who were informed and provided written consent. Lateral videofluoroscopy was performed during the feeding of solid agar jelly under two conditions: chewing naturally in their usual manner (without volition) and chewing with a conscious effort (with volition). Temporal evaluation was performed for mastication, stage II transport (STII), swallow onset and oropharyngeal transit time. Moreover, bolus volume at swallow onset and subjective evaluation of swallowing easiness were measured. Volitional chewing with a conscious effort lengthened the duration of the chewing sequence before and after STII and delayed the swallow onset despite the fact that the bolus volume in the vallecula and hypopharynx (HYP) had significantly increased. Furthermore, with volition, the bolus transit time from swallow onset in the oral cavity, upper oropharynx and HYP was reduced, and subjective evaluation of swallowing easiness demonstrated significant improvement. These results suggest that volitional chewing with a conscious effort can alter bolus transport and swallowing, resulting in easier swallowing. © 2014 John Wiley & Sons Ltd.

Morphometric and volumetric study of caudate and putamen nuclei in normal individuals by MRI: Effect of normal aging, gender and hemispheric differences

International Nuclear Information System (INIS)

Abedelahi, Ali; Hasanzadeh, Hadi; Hadizadeh, Homaioon; Joghataie, Mohammad Taghi

2013-01-01

The aim of this study was to determine age, gender, and hemispheric differences in the volume of the human neostriatum (striatum) nucleus in healthy humans. This study was performed on 120 normal human subjects (60 males, 60 females, right-handed) 15–65 years old, divided into two groups: young (<40 yrs) and old (=≥40 yrs). Sectional brain images were obtained via magnetic resonance imaging (MRI), analyzed and processed using the Image-J software, and the striatum volume was calculated using the Cavalieri’s principle, retrospectively. The analyses revealed bilateral age-related shrinkage of the putamen in both genders and the putamen and caudate nucleus were significantly smaller in older than in younger subjects (P-value <0.001). The age-related shrinkage of the caudate and putamen nucleus in men and women was about 5%, 5% and 4%, 4%, respectively, and there were statistically significant volume differences between males and females (P-value <0.05). In both genders, a significant rightward asymmetry was observed in the caudate and putamen nucleus (3.89%, 4.21% in men and 4.51%, 3.32% in women). Bilateral age-related shrinkage and rightward asymmetry of the striate nucleus was found in healthy adults and there were significant volume differences between men and women. Obtained results provide useful baseline data on age and gender-related changes of the volume of the striatum

Gender differences in brain development in Chinese children and adolescents: a structural MRI study

Science.gov (United States)

Guo, Xiaojuan; Jin, Zhen; Chen, Kewei; Peng, Danling; Yao, Li

2008-03-01

Using optimized voxel-based morphometry (VBM), this study systematically investigated gender differences in brain development through magnetic resonance imaging (MRI) data in 158 Chinese normal children and adolescents aged 7.26 to 22.80 years (mean age 15.03+/-4.70 years, 78 boys and 80 girls). Gender groups were matched for measures of age, handedness, education level. The customized brain templates, including T I-weighted image and gray matter (GM)/white matter (WM)/cerebro-spinal fluid (CSF) prior probability maps, were created from all participants. Results showed that the total intracranial volume (TIV), global absolute GM and global WM volume in girls were significantly smaller than those in boys. The hippocampus grew faster in girls than that in boys, but the amygdala grew faster in boys than that in girls. The rate of regional GM decreases with age was steeper in the left superior parietal lobule, bilateral inferior parietal lobule, left precuneus, and bilateral supramarginal gyrus in boys compared to girls, which was possibly related to better spatial processing ability in boys. Regional GM volumes were greater in bilateral superior temporal gyrus, bilateral inferior frontal gyrus and bilateral middle frontal gyrus in girls. Regional WM volumes were greater in the left temporal lobe, right inferior parietal and bilateral middle frontal gyrus in girls. The gender differences in the temporal and frontal lobe maybe be related to better language ability in girls. These findings may aid in understanding the differences in cognitive function between boys and girls.

Intratracheal Milrinone Bolus Administration During Acute Right Ventricular Dysfunction After Cardiopulmonary Bypass.

Science.gov (United States)

Gebhard, Caroline Eva; Desjardins, Georges; Gebhard, Cathérine; Gavra, Paul; Denault, André Y

2017-04-01

To evaluate intratracheal milrinone (tMil) administration for rapid treatment of right ventricular (RV) dysfunction as a novel route after cardiopulmonary bypass. Retrospective analysis. Single-center study. The study comprised 7 patients undergoing cardiac surgery who exhibited acute RV dysfunction after cardiopulmonary bypass. After difficult weaning caused by cardiopulmonary bypass-induced acute RV dysfunction, milrinone was administered as a 5-mg bolus inside the endotracheal tube. RV function improvement, as indicated by decreasing pulmonary artery pressure and changes of RV waveforms, was observed in all 7 patients. Adverse effects of tMil included dynamic RV outflow tract obstruction (2 patients) and a decrease in systemic mean arterial pressure (1 patient). tMil may be an effective, rapid, and easily applicable therapeutic alternative to inhaled milrinone for the treatment of acute RV failure during cardiac surgery. However, sufficiently powered clinical trials are needed to confirm these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of Rheological Properties of Foods on Bolus Characteristics After Mastication

Science.gov (United States)

Hwang, Junah; Bae, Jung Hyun; Kang, Si Hyun; Seo, Kyung Mook; Kim, Byong Ki; Lee, Sook Young

2012-01-01

Objective To evaluate the effects of physical properties of foods on the changes of viscosity and mass as well as the particle size distribution after mastication. Method Twenty subjects with no masticatory disorders were recruited. Six grams of four solid foods of different textures (banana, tofu, cooked-rice, cookie) were provided, and the viscosity and mass after 10, 20, and 30 cycles of mastication and just before swallowing were measured. The physical properties of foods, such as hardness, cohesiveness, and adhesiveness, were measured with a texture analyzer. Wet sieving and laser diffraction were used to determine the distribution of food particle size. Results When we measured the physical characteristics of foods, the cookie was the hardest food, and the banana exhibited marked adhesiveness. Tofu and cooked-rice exhibited a highly cohesive nature. As the number of mastication cycles increased, the masses of all foods were significantly increased (pmastication (pmastication process and food bolus formation were affected by the physical properties of the food. PMID:23342309

Grammatical Gender Trouble and Hungarian Gender[lessness]. Part I: Comparative Linguistic Gender

Directory of Open Access Journals (Sweden)

Louise O. Vasvári

2011-01-01

Full Text Available The aim of this study is to define linguistic gender[lessness], with particular reference in the latter part of the article to Hungarian, and to show why it is a feminist issue. I will discuss the [socio]linguistics of linguistic gender in three types of languages, those, like German and the Romance languages, among others, which possess grammatical gender, languages such as English, with only pronominal gender (sometimes misnamed ‘natural gender’, and languages such as Hungarian and other Finno-Ugric languages, as well as many other languages in the world, such as Turkish and Chinese, which have no linguistic or pronomial gender, but, like all languages, can make lexical gender distinctions. While in a narrow linguistic sense linguistic gender can be said to be afunctional, this does not take into account the ideological ramifications in gendered languages of the “leakage” between gender and sex[ism], while at the same time so-called genderless languages can express societal sexist assumptions linguistically through, for example, lexical gender, semantic derogation of women, and naming conventions. Thus, both languages with overt grammatical gender and those with gender-related asymmetries of a more covert nature show language to represent traditional cultural expectations, illustrating that linguistic gender is a feminist issue.

Gender effects on age-related changes in brain structure.

Science.gov (United States)

Xu, J; Kobayashi, S; Yamaguchi, S; Iijima, K; Okada, K; Yamashita, K

2000-01-01

Previous reports have suggested that brain atrophy is associated with aging and that there are gender differences in brain atrophy with aging. These reports, however, neither exclude silent brain lesions in "healthy subjects" nor divide the brain into subregions. The aim of this study is to clarify the effect of gender on age-related changes in brain subregions by MR imaging. A computer-assisted system was used to calculate the brain matter area index (BMAI) of various regions of the brain from MR imaging of 331 subjects without brain lesions. There was significantly more brain atrophy with aging in the posterior parts of the right frontal lobe in male subjects than there was in female subjects. Age-related atrophy in the middle part of the right temporal lobe, the left basal ganglia, the parietal lobe, and the cerebellum also was found in male subjects, but not in female subjects. In the temporal lobe, thalamus, parieto-occipital lobe, and cerebellum, brain volume in the left hemisphere is significantly smaller than in the right hemisphere; sex and age did not affect the hemisphere differences of brain volume in these regions. The effect of gender on brain atrophy with aging varied in different subregions of the brain. There was more brain atrophy with aging in male subjects than in female subjects.

Ultrasound-mediated gene delivery of naked plasmid DNA in skeletal muscles: a case for bolus injections.

Science.gov (United States)

Sanches, Pedro Gomes; Mühlmeister, Mareike; Seip, Ralf; Kaijzel, Eric; Löwik, Clemens; Böhmer, Marcel; Tiemann, Klaus; Grüll, Holger

2014-12-10

Localized gene delivery has many potential clinical applications. However, the nucleic acids (e.g. pDNA and siRNA) are incapable of passively crossing the endothelium, cell membranes and other biological barriers which must be crossed to reach their intracellular targets. A possible solution is the use of ultrasound to burst circulating microbubbles inducing transient permeabilization of surrounding tissues which mediates nucleic acid extravasation and cellular uptake. In this study we report on an optimization of the ultrasound gene delivery technique. Naked pDNA (200 μg) encoding luciferase and SonoVue® microbubbles were co-injected intravenously in mice. The hindlimb skeletal muscles were exposed to ultrasound from a non-focused transducer (1 MHz, 1.25 MPa, PRI 30s) and injection protocols and total amounts as well as ultrasound parameters were systemically varied. Gene expression was quantified relative to a control using a bioluminescence camera system at day 7 after sonication. Bioluminescence ratios in sonicated/control muscles of up to 101× were obtained. In conclusion, we were able to specifically deliver genetic material to the selected skeletal muscles and overall, the use of bolus injections and high microbubble numbers resulted in increased gene expression reflected by stronger bioluminescence signals. Based on our data, bolus injections seem to be required in order to achieve transient highly concentrated levels of nucleic acids and microbubbles at the tissue of interest which upon ultrasound exposure should lead to increased levels of gene delivery. Thus, ultrasound mediated gene delivery is a promising technique for the clinical translation of localized drug delivery. Copyright © 2014 Elsevier B.V. All rights reserved.

From gender identity disorder to gender identity creativity: true gender self child therapy.

Science.gov (United States)

Ehrensaft, Diane

2012-01-01

True gender self child therapy is based on the premise of gender as a web that weaves together nature, nurture, and culture and allows for a myriad of healthy gender outcomes. This article presents concepts of true gender self, false gender self, and gender creativity as they operationalize in clinical work with children who need therapeutic supports to establish an authentic gender self while developing strategies for negotiating an environment resistant to that self. Categories of gender nonconforming children are outlined and excerpts of a treatment of a young transgender child are presented to illustrate true gender self child therapy.

Gender and Boyle's law of gases

CERN Document Server

Potter, Elizabeth

2001-01-01

Gender and Boyle''s Law of GasesElizabeth PotterRe-examines the assumptions and experimental evidence behind Boyle''s Law.Boyle''s Law, which describes the relation between the pressure and volume of a gas, was worked out by Robert Boyle in the mid-1600s. His experiments are still considered examples of good scientific work and continue to be studied along with their historical and intellectual contexts by philosophers, historians, and sociologists. Now there is controversy over whether Boyle''s work was based only on experimental evidence or whether it was influenced by the politics and religious controversies of the time, including especially class and gender politics.Elizabeth Potter argues that even good science is sometimes influenced by such issues, and she shows that the work leading to the Gas Law, while certainly based on physical evidenc...

Clinical applications of 3-dimensional printing in radiation therapy

International Nuclear Information System (INIS)

Zhao, Yizhou; Moran, Kathryn; Yewondwossen, Mammo; Allan, James; Clarke, Scott; Rajaraman, Murali; Wilke, Derek; Joseph, Paul; Robar, James L.

2017-01-01

Three-dimensional (3D) printing is suitable for the fabrication of complex radiotherapy bolus. Although investigated from dosimetric and feasibility standpoints, there are few reports to date of its use for actual patient treatment. This study illustrates the versatile applications of 3D printing in clinical radiation oncology through a selection of patient cases, namely, to create bolus for photon and modulated electron radiotherapy (MERT), as well as applicators for surface high-dose rate (HDR) brachytherapy. Photon boluses were 3D-printed to treat a recurrent squamous cell carcinoma (SCC) of the nasal septum and a basal cell carcinoma (BCC) of the posterior pinna. For a patient with a mycosis fungoides involving the upper face, a 3D-printed MERT bolus was used. To treat an SCC of the nose, a 3D-printed applicator for surface brachytherapy was made. The structures' fit to the anatomy and the radiotherapy treatment plans were assessed. Based on the treatment planning computed tomography (CT), the size of the largest air gap at the interface of the 3D-printed structure was 3 mm for the SCC of the nasal septum, 3 mm for the BCC of the pinna, 2 mm for the mycosis fungoides of the face, and 2 mm for the SCC of the nose. Acceptable treatment plans were obtained for the SCC of the nasal septum (95% isodose to 99.8% of planning target volume [PTV]), the BCC of the pinna (95% isodose to 97.7% of PTV), and the mycosis fungoides of the face (90% isodose to 92.5% of PTV). For the latter, compared with a plan with a uniform thickness bolus, the one featuring the MERT bolus achieved relative sparing of all the organs at risk (OARs) distal to the target volume, while maintaining similar target volume coverage. The surface brachytherapy plan for the SCC of the nose had adequate coverage (95% isodose to 95.6% of clinical target volume [CTV]), but a relatively high dose to the left eye, owing to its proximity to the tumor. 3D printing can be implemented effectively in

Clinical applications of 3-dimensional printing in radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Zhao, Yizhou, E-mail: yizhou.zhao@dal.ca [Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9 (Canada); Moran, Kathryn [Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9 (Canada); Yewondwossen, Mammo; Allan, James; Clarke, Scott [Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9 (Canada); Rajaraman, Murali; Wilke, Derek; Joseph, Paul [Department of Radiation Oncology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9 (Canada); Robar, James L. [Department of Medical Physics, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia B3H 2Y9 (Canada)

2017-07-01

Three-dimensional (3D) printing is suitable for the fabrication of complex radiotherapy bolus. Although investigated from dosimetric and feasibility standpoints, there are few reports to date of its use for actual patient treatment. This study illustrates the versatile applications of 3D printing in clinical radiation oncology through a selection of patient cases, namely, to create bolus for photon and modulated electron radiotherapy (MERT), as well as applicators for surface high-dose rate (HDR) brachytherapy. Photon boluses were 3D-printed to treat a recurrent squamous cell carcinoma (SCC) of the nasal septum and a basal cell carcinoma (BCC) of the posterior pinna. For a patient with a mycosis fungoides involving the upper face, a 3D-printed MERT bolus was used. To treat an SCC of the nose, a 3D-printed applicator for surface brachytherapy was made. The structures' fit to the anatomy and the radiotherapy treatment plans were assessed. Based on the treatment planning computed tomography (CT), the size of the largest air gap at the interface of the 3D-printed structure was 3 mm for the SCC of the nasal septum, 3 mm for the BCC of the pinna, 2 mm for the mycosis fungoides of the face, and 2 mm for the SCC of the nose. Acceptable treatment plans were obtained for the SCC of the nasal septum (95% isodose to 99.8% of planning target volume [PTV]), the BCC of the pinna (95% isodose to 97.7% of PTV), and the mycosis fungoides of the face (90% isodose to 92.5% of PTV). For the latter, compared with a plan with a uniform thickness bolus, the one featuring the MERT bolus achieved relative sparing of all the organs at risk (OARs) distal to the target volume, while maintaining similar target volume coverage. The surface brachytherapy plan for the SCC of the nose had adequate coverage (95% isodose to 95.6% of clinical target volume [CTV]), but a relatively high dose to the left eye, owing to its proximity to the tumor. 3D printing can be implemented effectively in

Evaluation of the effect of bolus administration of 50% dextrose solution on measures of electrolyte and energy balance in postpartum dairy cows.

Science.gov (United States)

Wagner, Sarah A; Schimek, Daniel E

2010-09-01

To determine the effect of IV administration of a bolus of 50% dextrose solution on electrolyte and energy balance and effect of blood collection site on serum electrolyte values in postparturient dairy cows. 24 clinically normal multiparous cows. A bolus of 50% dextrose solution (0.5 L [n=8 cows]), 50% dextrose solution (1.0 L [8]), or saline (0.9% NaCl) solution (1.0 L, control treatment [8]) was administered via jugular venipuncture 5 to 10 days after parturition. Pretreatment and posttreatment blood samples were analyzed for concentrations of calcium, magnesium, phosphorus, potassium, glucose, insulin, beta-hydroxybutyric acid (BHBA), and nonesterified fatty acids. Coccygeal vessel and jugular vein blood samples were obtained prior to treatment, and electrolyte concentrations were compared. Treatment with 50% dextrose decreased phosphorus concentration in serum, compared with the control treatment. Suppression of BHBA and nonesterified fatty acid concentrations following dextrose treatment lasted for dextrose solution may be at risk for hypophosphatemia, and 1 treatment with 0.5 or 1 L of 50% dextrose solution is unlikely to prevent or resolve acetonemia (ketosis). The risk of hypophosphatemia may be underestimated when coccygeal vessel blood samples are used for diagnosis.

SOSIALISASI BUDAYA ADIL GENDER OLEH ORGANISASI GENDER

OpenAIRE

Sumiarti, Sumiarti; Munfarida, Elya

2015-01-01

Abstract: equality and gender justice is a global issue. Along with the awareness of human rights, human beings begin to question and criticize the cultures already established that they perceive as unfair behavior constructor (bias) gender. From this point, then there are many organizations that provoke equality and gender justice. In this paper, the organization is called gender organizations. Gender organizations is a noble mission, to speak out gender equality and justice, but in practice...

Dosing of Milrinone in Preterm Neonates to Prevent Postligation Cardiac Syndrome: Simulation Study Suggests Need for Bolus Infusion.

Science.gov (United States)

Hallik, Maarja; Tasa, Tõnis; Starkopf, Joel; Metsvaht, Tuuli

2017-01-01

Milrinone has been suggested as a possible first-line therapy for preterm neonates to prevent postligation cardiac syndrome (PLCS) through decreasing systemic vascular resistance and increasing cardiac contractility. The optimal dosing regimen, however, is not known. To model the dosing of milrinone in preterm infants for prevention of PLCS after surgical closure of patent ductus arteriosus (PDA). Milrinone time-concentration profiles were simulated for 1,000 subjects using the volume of distribution and clearance estimates based on one compartmental population pharmacokinetic model by Paradisis et al. [Arch Dis Child Fetal Neonatal Ed 2007;92:F204-F209]. Dose optimization was based on retrospectively collected demographic data from neonates undergoing PDA ligation in Estonian PICUs between 2012 and 2014 and existing pharmacodynamic data. The target plasma concentration was set at 150-200 ng/ml. The simulation study used demographic data from 31 neonates who underwent PDA ligation. The median postnatal age was 13 days (range: 3-29) and weight was 760 g (range: 500-2,351). With continuous infusion of milrinone 0.33 μg/kg/min, the proportion of subjects within the desired concentration range was 0% by 3 h, 36% by 6 h, and 61% by 8 h; 99% of subjects exceeded the range by 18 h. The maximum proportion of total simulated concentrations in the target range was attained with a bolus infusion of 0.73 μg/kg/min for 3 h followed by a 0.16-μg/kg/min maintenance infusion. Mathematical simulations suggest that in preterm neonates the plasma time-concentration profile of milrinone can be optimized with a slow loading dose followed by maintenance infusion. © 2016 S. Karger AG, Basel.

Delusions of Gender - Gender Benders

OpenAIRE

Uhlig, Louise; Zampetis, Marios Stylianos; Lochte, Frans; Ahmed, Samira M.; Karlsen, Luna Maria Stjerneby

2014-01-01

“Taking Cordelia Fine’s Delusions of Gender as it point of departure, together with popular gender theories by Simon Baron-Cohen and Louann Brizendine, we raise the following question: how strong is the foundation of biological determinism and how can we decide?” In this project the point of departure is taken in Cordelia Fine’s book Delusions of Gender. Fine brings forth several published scientific studies on gender differences, and she systematically debunks them one by one. This research ...

Gender-Atypical Mental Illness as Male Gender Threat.

Science.gov (United States)

Michniewicz, Kenneth S; Bosson, Jennifer K; Lenes, Joshua G; Chen, Jason I

2016-07-01

The present study examined whether men view gender-atypical (i.e., feminine) psychological disorders as threats to their gender status. Men and women (N = 355) rated their expectations of gender status loss, feelings of distress, and help-seeking intentions in response to 10 different stereotypically masculine and feminine psychological disorders. Men as compared to women expected greater gender status loss for, and reported more distress to, gender-atypical versus gender-typical disorders. Expectations of gender status loss partially mediated the link between participant gender and distress at the thought of gender-atypical disorders. These findings suggest that feminine disorders pose more powerful gender status threats for men than masculine disorders do and that men's expectations of gender status loss for feminine disorders drive their negative reactions to these mental illnesses. The discussion emphasizes the importance of considering the gender-typicality of disorders, and the implications of these findings for clinical interventions. © The Author(s) 2015.

Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis.

Science.gov (United States)

Teo, Jocelyn; Liew, Yixin; Lee, Winnie; Kwa, Andrea Lay-Hoon

2014-05-01

The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit. Copyright © 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

A qualitative feasibility study to inform a randomised controlled trial of fluid bolus therapy in septic shock

Science.gov (United States)

O’Hara, Caitlin B; Canter, Ruth R; Mouncey, Paul R; Carter, Anjali; Jones, Nicola; Nadel, Simon; Peters, Mark J; Lyttle, Mark D; Harrison, David A; Rowan, Kathryn M; Inwald, David; Woolfall, Kerry

2018-01-01

Objective The Fluids in Shock (FiSh) Trial proposes to evaluate whether restrictive fluid bolus therapy (10 mL/kg) is more beneficial than current recommended practice (20 mL/kg) in the resuscitation of children with septic shock in the UK. This qualitative feasibility study aimed to explore acceptability of the FiSh Trial, including research without prior consent (RWPC), potential barriers to recruitment and participant information for a pilot trial. Design Qualitative interview study involving parents of children who had presented to a UK emergency department or been admitted to a paediatric intensive care unit with severe infection in the previous 3 years. Participants Twenty-one parents (seven bereaved) were interviewed 16 (median) months since their child’s hospital admission (range: 1–41). Results All parents said they would have provided consent for the use of their child’s data in the FiSh Trial. The majority were unfamiliar with RWPC, yet supported its use. Parents were initially concerned about the change from currently recommended treatment, yet were reassured by explanations of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the research discussion and content of participant information. Bereaved parents stated that recruiters should not discuss research immediately after a child’s death, but supported a personalised postal ‘opt-out’ approach to consent. Conclusions Findings show that parents whose child has experienced severe infection supported the proposed FiSh Trial, including the use of RWPC. Parents’ views informed the development of the pilot trial protocol and site staff training. Trial registration number ISRCTN15244462—results. PMID:28847877

Perbandingan Efek Pemberian Norepinefrin Bolus Intravena dengan Norepinefrin Infus Kontinu dalam Tatalaksana Hipotensi, Laju Nadi, dan Nilai APGAR pada Seksio Sesarea dengan Anestesi Spinal

Directory of Open Access Journals (Sweden)

Fitri Sepviyanti Sumardi

2015-04-01

Full Text Available Vasopresors are commonly used for the treatment of hypotension in spinal anesthesia for cesarean section. This research aimed to compare intravenous bolus of norepinephrine to continuous infusion of norepinephrine effectiveness in hypotension management in caesarean section patient under spinal anesthesia and their effect on heart rate and APGAR Score, The experimental study was conducted in a double-blind randomized manner to 44 American Society of Anesthesiologist (ASA physical status II pregnant women undergoing cesarean section with spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung within the period of September to -November 2013. The Study subjects were grouped into two groups, the first group received 4 µg intravenous bolus of norepinephrine group (NB and and the second received 8 µg/minute continuous infusion of norepinephrine group (NK. Data were analyzed by t-test, Mann-Whitney test, chi-square and analysis of variance (ANOVA t-test with p0.05. Conclusion from this study is the administration of norepinephrine in both ways can be used for the treatment of hypotension of spinal anesthesia without affecting the heart rate and APGAR score

Increased putamen volume in adults with autism spectrum disorder

Directory of Open Access Journals (Sweden)

Wataru eSato

2014-11-01

Full Text Available Basal ganglia (BG abnormalities are implicated in the pathophysiology of autism spectrum disorder (ASD. However, studies measuring the volume of the entire BG in individuals with ASD have reported discrepant findings, and no study conducted volume measurement of the entire substructures of the BG (the caudate, putamen, nucleus accumbens, and globus pallidus in individuals with ASD. We delineated the BG substructures and measured their volumes in 29 adults with ASD without intellectual disabilities and 29 age- and gender-matched typically developed adult controls. We acquired T1-weighted anatomical images and performed semi-automated delineation and volume measurements of the above-mentioned subregions. Total cerebral volumes, sex, and ages were partialed out. Compared with controls, the putamen was significantly larger in the ASD group. The increased volume of the putamen found in high-functioning adults with ASD suggests that structural or histological abnormalities of the putamen may underlie the pathologies of ASD such as repetitive and stereotyped behaviors and impaired social interactions.

Reducing the radiation dose to the eye lens region during CT brain examination: the potential beneficial effect of the combined use of bolus and a bismuth shield

International Nuclear Information System (INIS)

Lai, C.W.K.; Chan, T.P.; Cheung, H.Y.; Wong, T.H.

2015-01-01

Objective: Computed Tomography (CT) is the leading contributor to medical exposure to ionizing radiation. Although the use of CT brain scans for patients with head injuries and convulsions has shown a tremendous growth, it has raised substantial concerns in the general public because of the risk of radiation-induced cataracts: the current available strategies to reduce the radiation dose to the eye lens region are limited. Therefore, the present research project was initiated with the aim of evaluating the potential benefit of the combined use of bolus and a bismuth shield on reducing the radiation dose to the eye lens region during CT brain examination. Materials and methods: We conducted a series of phantom studies to measure the entrance surface dose (ESD) that is delivered to the eye lens region during CT brain examination under the effect of different scanning and shielding setups. Results: Our results indicated, during CT brain examination: (1) a drastic reduction of 92.5% in the ESD to the eye lens region was found when the CT gantry was tilted from 0 deg. (overall ESD = 30.7 mGy) to 30 deg. cranially (overall ESD = 2.4 mGy), and (2) when the CT gantry was positioned at 0 deg. (the common practice in the clinical setting), the setups with the application of a) a bismuth shield, b) a bismuth shield with a face shield (air gap), c) a bismuth shield with bolus, and d) a bismuth shield with bolus and an air gap can result in an acceptable level of image quality with a smaller overall ESD delivered to the eye lens region (overall ESD = 23.2 mGy, 24 mGy, 21 mGy and 19.9 mGy, respectively) than the setup without the bismuth shield applied (overall ESD = 30.7 mGy). Conclusion: When the primary beam scanning through the eye lens region is unavoidable during CT brain examination, the combined use of a bismuth shield with bolus and a face shield is an easy-to-use and inexpensive shielding setup to reduce the radiation dose delivered to the eye lens region while

MnDPDP enhancement in rabbit liver after intravenous bolus injection and slow infusion

International Nuclear Information System (INIS)

Thorstensen, Oe.; Isberg, B.; Jorulf, H.; Westman, L.; Svahn, U.; Venizelos, N.

1997-01-01

Purpose: To investigate the MR-enhancing effect of mangafodipir trisodium (MnDPDP, Teslascan) in the rabbit liver in relation to dose, mode of administration and imaging window. Material and Methods: MnDPDP was administered to 18 rabbits at a dose of 10 μmol/kg or 20 μmol/kg, as a bolus injection or infusion. MR imaging of the liver was performed at different time intervals. Results: Peak liver enhancement was typically observed 10-30 min after administration and the enhancement declined with a half-time of about 5 h. This pattern was observed in all sequences (SE 400/15, FLASH, and SE 132/10), with both doses and with both rates of administration. The peak enhancement was greater, though not significantly so after 20 μmol/kg than after 10 μmol/kg. A higher relative peak signal was observed with SE 132/10 than with FLASH or SE 400/15. (orig./AJ)

Applications of aerosol inhalation cine-scintigraphy for, clinical investigations of mucociliary transport

International Nuclear Information System (INIS)

Ito, Shinsaku; Mikami, Riichiro; Ryujin, Yoshitada; Imai, Teruhiko; Ohnuki, Masahiro; Narita, Nobuhiro

1984-01-01

Mucociliary transport and cough effect were studied in 10 healthy controls and 116 patients with respiratory diseases using aerosol inhalation cine-scintigraphy which permits visualization of the movement of inhaled aerosols. Additionally, the effectiveness of β-adrenergic stimulant on mucociliary transport was evaluated in 8 normal cases by this method. 1. In healthy controls, the aerosol-bolus moved to the cephalad side rapidly and smoothly in the main bronchus and the trachea, but in many cases of respiratory diseases, we recognized various abnormal patterns such as slow movement, spiral movement, regurgitation etc. We consider that the bolus movements can be used as an index of the mucociliary transport. 2. We found low grade abnormality of bolus movement in cases of atopic bronchial asthma, pulmonary emphysema, silicosis, interstitial pneumonia and asbestosis, but high grade abnormality in cases of bronchiectasis, pulmonary emphysema with chronic bronchitis, mixed or infectious bronchial asthma, chronic bronchitis and especially acute pulmonary infection and diffuse panbronchiolitis. Normal patterns were observed in atopic asthma patients in remission, but abnormal patterns in cases of attack. With larger daily volumes of sputum, the bolus movements showed higher greater abnormality. 3. Bolus movements by coughing were seen most frequently in patients who had produced moderate volumes of sputum and in whom the bolus had stopped at the first carina. Bolus movements by coughing were classified into three groups: expectoration, cephalad movement that stopped halfway, and regurgitation. When the bolus was in the trachea, especially located on the oral side, we observed that expectoration by coughing was more effective. Patients with obstructive pulmonary diseases had lower effciency of expectoration by coughing. 4. We confirmed that terbutaline (β-adrenergic stimulant) accelerated the mucociliary transport. (author)

Study Protocol. ECSSIT – Elective Caesarean Section Syntocinon® Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon® 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section

Directory of Open Access Journals (Sweden)

Montgomery Alan A

2009-08-01

Full Text Available Abstract Background Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4–10 minutes therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. Methods and design A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml. A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. Discussion It is both important and timely that we evaluate the optimal approach to the management

Study Protocol. ECSSIT – Elective Caesarean Section Syntocinon® Infusion Trial. A multi-centre randomised controlled trial of oxytocin (Syntocinon®) 5 IU bolus and placebo infusion versus oxytocin 5 IU bolus and 40 IU infusion for the control of blood loss at elective caesarean section

Science.gov (United States)

Murphy, Deirdre J; Carey, Michael; Montgomery, Alan A; Sheehan, Sharon R

2009-01-01

Background Caesarean section is one of the most commonly performed major operations in women throughout the world. Rates are escalating, with studies from the United States of America, the United Kingdom, China and the Republic of Ireland reporting rates between 20% and 25%. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. The value of routine oxytocics in the third stage of vaginal birth has been well established and it has been assumed that these benefits apply to caesarean delivery as well. A slow bolus dose of oxytocin is recommended following delivery of the baby at caesarean section. Some clinicians use an additional infusion of oxytocin for a further period following the procedure. Intravenous oxytocin has a very short half-life (4–10 minutes) therefore the potential advantage of an oxytocin infusion is that it maintains uterine contractility throughout the surgical procedure and immediate postpartum period, when most primary haemorrhages occur. The few trials to date addressing the optimal approach to preventing haemorrhage at caesarean section have been under-powered to evaluate clinically important outcomes. There has been no trial to date comparing the use of an intravenous slow bolus of oxytocin versus an oxytocin bolus and infusion. Methods and design A multi-centre randomised controlled trial is proposed. The study will take place in five large maternity units in Ireland with collaboration between academics and clinicians in the disciplines of obstetrics and anaesthetics. It will involve 2000 women undergoing elective caesarean section after 36 weeks gestation. The main outcome measure will be major haemorrhage (blood loss >1000 ml). A study involving 2000 women will have 80% power to detect a 36% relative change in the risk of major haemorrhage with two-sided 5% alpha. Discussion It is both important and timely that we evaluate the optimal approach to the management of the third stage at

Concerns of patients actively contemplating total knee replacement: differences by race and gender.

Science.gov (United States)

Chang, Huan J; Mehta, Priya S; Rosenberg, Aaron; Scrimshaw, Susan C

2004-02-15

To examine differences by race/ethnicity and gender in patients' concerns regarding total knee replacement (TKR). Focus groups of patients actively considering TKR were conducted. Discussion included patients' questions and concerns regarding TKR. The software ATLAS.ti was used to tabulate themes by race/ethnicity and gender. Concerns raised by focus group participants were compared with thematic content from patient joint replacement information materials. This comparison used patient literature from 3 high-volume academic TKR centers, the Arthritis Foundation, and the American Academy of Orthopedic Surgeons. All groups shared similar concerns. However, some issues were more prevalent among certain gender and racial groups. For instance, concerns regarding anesthesia were more important to white Americans and concerns regarding recovery were more important to women. Some of these concerns were not addressed in the available patient literature. Different gender and racial subgroups focus on different concerns when considering TKR. These differences may contribute to gender and race/ethnicity disparity seen in TKR use.

Flexibility of Gender Stereotypes: Italian Study on Comparative Gender-consistent and Gender-inconsistent Information

Directory of Open Access Journals (Sweden)

Elisabetta Sagone

2018-05-01

Full Text Available The topic of this study is flexibility in gender stereotyping linked to attribution of toys, socio-cognitive traits, and occupations in 160 Italian children aged 6 to 12 years. We used the Gender Toys Choice, the Gender Traits Choice, and the Gender Jobs Choice, a selected set of colored cards containing masculine and feminine stimuli to assign to a male or female or both male and female silhouette (the flexible-choice technique. In order to verify the change of flexibility in gender stereotyping, we made use of four cartoon stories with male and female characters with typical or atypical traits and performing gender-consistent or gender-inconsistent activities. Results indicated that the exposure to cartoon stories with gender-inconsistent information rather than cartoon stories with gender-consistent information increased flexibility in gender stereotyping, showing age differences in favor of children aged 11-12. Implications in relation to the developmental-constructivist approach were noted.

Gender Roles, Gender (Inequality and Fertility: An Empirical Test of Five Gender Equity Indices

Directory of Open Access Journals (Sweden)

Melinda Mills

2010-01-01

Full Text Available The division of gender roles in the household and societal level gender (inequality have been situated as one of the most powerful factors underlying fertility behaviour. Despite continued theoretical attention to this issue by demographers, empirical research integrating gender roles and equity in relation to fertility remains surprisingly sparse. This paper first provides a brief review of previous research that has examined gender roles and fertility followed by a comparison of six prominent gender equality indices: Gender-related Development Index (GDI, Gender Empowerment Measure (GEM, Gender Gap Index (GGI, Gender Equality Index (GEI, the European Union Gender Equality Index (EU-GEI and the Social Institutions and Gender Index (SIGI. The paper then tests how five of these indices impact fertility intentions and behaviour using a series of multilevel (random-coefficient logistic regression models, applying the European Social Survey (2004/5. The GDI, with its emphasis on human development, adjusted for gender, has the strongest and significant effect on fertility intentions. The EU-GEI, which focuses on the universal caregiver model, uncovers that more equity significantly lowers fertility intentions, but only for women. The remaining indicators show no significant impact. The paper concludes with a reflection and suggestions for future research.

Taxation and Gender Equity: A Comparative Analysis of Direct and ...

International Development Research Centre (IDRC) Digital Library (Canada)

10 juin 2010 ... This groundbreaking volume examines the gender dimensions of tax systems in seven developing and one developed country and is the first systematic treatment of its kind. ... L'importance des services de garde d'enfants pour améliorer les possibilités économiques des femmes. Le 11 août 2017, des ...

Novel diffusion tensor imaging technique reveals developmental streamline volume changes in the corticospinal tract associated with leg motor control.

Science.gov (United States)

Kamson, David O; Juhász, Csaba; Chugani, Harry T; Jeong, Jeong-Won

2015-04-01

Diffusion tensor imaging (DTI) has expanded our knowledge of corticospinal tract (CST) anatomy and development. However, previous developmental DTI studies assessed the CST as a whole, overlooking potential differences in development of its components related to control of the upper and lower extremities. The present cross-sectional study investigated age-related changes, side and gender differences in streamline volume of the leg- and hand-related segments of the CST in children. DTI data of 31 children (1-14 years; mean age: 6±4 years; 17 girls) with normal conventional MRI were analyzed. Leg- and hand-related CST streamline volumes were quantified separately, using a recently validated novel tractography approach. CST streamline volumes on both sides were compared between genders and correlated with age. Higher absolute streamline volumes were found in the left leg-related CST compared to the right (p=0.001) without a gender effect (p=0.4), whereas no differences were found in the absolute hand-related CST volumes (p>0.4). CST leg-related streamline volumes, normalized to hemispheric white matter volumes, declined with age in the right hemisphere only (R=-.51; p=0.004). Absolute leg-related CST streamline volumes showed similar, but slightly weaker correlations. Hand-related absolute or normalized CST streamline volumes showed no age-related variations on either side. These results suggest differential development of CST segments controlling hand vs. leg movements. Asymmetric volume changes in the lower limb motor pathway may be secondary to gradually strengthening left hemispheric dominance and is consistent with previous data suggesting that footedness is a better predictor of hemispheric lateralization than handedness. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Is the gap more than gender? A longitudinal analysis of gender, gender role orientation, and earnings.

Science.gov (United States)

Judge, Timothy A; Livingston, Beth A

2008-09-01

This study investigated the relationships among gender, gender role orientation (i.e., attitudes toward the gendered separation of roles at work and at home), and earnings. A multilevel model was conceptualized in which gender role orientation and earnings were within-individual variables that fluctuate over time (although predictors of between-individual differences in gender role orientation were also considered). Results indicated that whereas traditional gender role orientation was positively related to earnings, gender significantly predicted the slope of this relationship: Traditional gender role orientation was strongly positively associated with earnings for men; it was slightly negatively associated with earnings for women. Occupational segregation partly explained these gender differences. Overall, the results suggest that although gender role attitudes are becoming less traditional for men and for women, traditional gender role orientation continues to exacerbate the gender wage gap.

3D CT cerebral angiography technique using a 320-detector machine with a time–density curve and low contrast medium volume: Comparison with fixed time delay technique

International Nuclear Information System (INIS)

Das, K.; Biswas, S.; Roughley, S.; Bhojak, M.; Niven, S.

2014-01-01

Aim: To describe a cerebral computed tomography angiography (CTA) technique using a 320-detector CT machine and a small contrast medium volume (35 ml, 15 ml for test bolus). Also, to compare the quality of these images with that of the images acquired using a larger contrast medium volume (90 or 120 ml) and a fixed time delay (FTD) of 18 s using a 16-detector CT machine. Materials and methods: Cerebral CTA images were acquired using a 320-detector machine by synchronizing the scanning time with the time of peak enhancement as determined from the time–density curve (TDC) using a test bolus dose. The quality of CTA images acquired using this technique was compared with that obtained using a FTD of 18 s (by 16-detector CT), retrospectively. Average densities in four different intracranial arteries, overall opacification of arteries, and the degree of venous contamination were graded and compared. Results: Thirty-eight patients were scanned using the TDC technique and 40 patients using the FTD technique. The arterial densities achieved by the TDC technique were higher (significant for supraclinoid and basilar arteries, p < 0.05). The proportion of images deemed as having “good” arterial opacification was 95% for TDC and 90% for FTD. The degree of venous contamination was significantly higher in images produced by the FTD technique (p < 0.001%). Conclusion: Good diagnostic quality CTA images with significant reduction of venous contamination can be achieved with a low contrast medium dose using a 320-detector machine by coupling the time of data acquisition with the time of peak enhancement

SU-F-T-387: A Novel Optimization Technique for Field in Field (FIF) Chestwall Radiation Therapy Using a Single Plan to Improve Delivery Safety and Treatment Planning Efficiency

Energy Technology Data Exchange (ETDEWEB)

Tabibian, A; Kim, A; Rose, J; Alvelo, M; Perel, C; Laiken, K; Sheth, N [Bayonne Medical Center, Bayonne, New Jersey (United States)

2016-06-15

Purpose: A novel optimization technique was developed for field-in-field (FIF) chestwall radiotherapy using bolus every other day. The dosimetry was compared to currently used optimization. Methods: The prior five patients treated at our clinic to the chestwall and supraclavicular nodes with a mono-isocentric four-field arrangement were selected for this study. The prescription was 5040 cGy in 28 fractions, 5 mm bolus every other day on the tangent fields, 6 and/or 10 MV x-rays, and multileaf collimation.Novelly, tangents FIF segments were forward planned optimized based on the composite bolus and non-bolus dose distribution simultaneously. The prescription was spilt into 14 fractions for both bolus and non-bolus tangents. The same segments and monitor units were used for the bolus and non-bolus treatment. The plan was optimized until the desired coverage was achieved, minimized 105% hotspots, and a maximum dose of less than 108%. Each tangential field had less than 5 segments.Comparison plans were generated using FIF optimization with the same dosimetric goals, but using only the non-bolus calculation for FIF optimization. The non-bolus fields were then copied and bolus was applied. The same segments and monitor units were used for the bolus and non-bolus segments. Results: The prescription coverage of the chestwall, as defined by RTOG guidelines, was on average 51.8% for the plans that optimized bolus and non-bolus treatments simultaneous (SB) and 43.8% for the plans optimized to the non-bolus treatments (NB). Chestwall coverage of 90% prescription averaged to 80.4% for SB and 79.6% for NB plans. The volume receiving 105% of the prescription was 1.9% for SB and 0.8% for NB plans on average. Conclusion: Simultaneously optimizing for bolus and non-bolus treatments noticeably improves prescription coverage of the chestwall while maintaining similar hotspots and 90% prescription coverage in comparison to optimizing only to non-bolus treatments.

SU-F-T-387: A Novel Optimization Technique for Field in Field (FIF) Chestwall Radiation Therapy Using a Single Plan to Improve Delivery Safety and Treatment Planning Efficiency

International Nuclear Information System (INIS)

Tabibian, A; Kim, A; Rose, J; Alvelo, M; Perel, C; Laiken, K; Sheth, N

2016-01-01

Purpose: A novel optimization technique was developed for field-in-field (FIF) chestwall radiotherapy using bolus every other day. The dosimetry was compared to currently used optimization. Methods: The prior five patients treated at our clinic to the chestwall and supraclavicular nodes with a mono-isocentric four-field arrangement were selected for this study. The prescription was 5040 cGy in 28 fractions, 5 mm bolus every other day on the tangent fields, 6 and/or 10 MV x-rays, and multileaf collimation.Novelly, tangents FIF segments were forward planned optimized based on the composite bolus and non-bolus dose distribution simultaneously. The prescription was spilt into 14 fractions for both bolus and non-bolus tangents. The same segments and monitor units were used for the bolus and non-bolus treatment. The plan was optimized until the desired coverage was achieved, minimized 105% hotspots, and a maximum dose of less than 108%. Each tangential field had less than 5 segments.Comparison plans were generated using FIF optimization with the same dosimetric goals, but using only the non-bolus calculation for FIF optimization. The non-bolus fields were then copied and bolus was applied. The same segments and monitor units were used for the bolus and non-bolus segments. Results: The prescription coverage of the chestwall, as defined by RTOG guidelines, was on average 51.8% for the plans that optimized bolus and non-bolus treatments simultaneous (SB) and 43.8% for the plans optimized to the non-bolus treatments (NB). Chestwall coverage of 90% prescription averaged to 80.4% for SB and 79.6% for NB plans. The volume receiving 105% of the prescription was 1.9% for SB and 0.8% for NB plans on average. Conclusion: Simultaneously optimizing for bolus and non-bolus treatments noticeably improves prescription coverage of the chestwall while maintaining similar hotspots and 90% prescription coverage in comparison to optimizing only to non-bolus treatments.

Effects of the H(2)-receptor antagonist ranitidine on gastric motor function after a liquid meal in healthy humans

DEFF Research Database (Denmark)

Madsen, Jan Lysgård; Graff, J

2008-01-01

, on gastric volume and gastric emptying after a liquid meal in healthy humans. Material and methods. Twelve healthy volunteers participated in a randomized crossover study with 50 mg ranitidine as a bolus intravenously versus no medication. Gastric volume at baseline was determined with single photon emission...... computed tomography (SPECT) after intravenous injection of 99(m)Tc-pertechnetate. After ingestion of a 600-mL liquid meal radiolabelled with (111)In-diethylenetriaminepentaacetic acid, dual-isotope technique with SPECT and planar imaging assessed gastric volume as well as gastric emptying. Results....... Ranitidine did not change gastric volume before the meal, nor at 0 h or 1 h after it. Furthermore, ranitidine did not influence gastric retention of meal components after 0.5 h and 1 h. Conclusions. Intravenous bolus injection of 50 mg ranitidine does not modify gastric volume or gastric emptying after a 600...

A qualitative feasibility study to inform a randomised controlled trial of fluid bolus therapy in septic shock.

Science.gov (United States)

O'Hara, Caitlin B; Canter, Ruth R; Mouncey, Paul R; Carter, Anjali; Jones, Nicola; Nadel, Simon; Peters, Mark J; Lyttle, Mark D; Harrison, David A; Rowan, Kathryn M; Inwald, David; Woolfall, Kerry

2018-01-01

The Fluids in Shock (FiSh) Trial proposes to evaluate whether restrictive fluid bolus therapy (10 mL/kg) is more beneficial than current recommended practice (20 mL/kg) in the resuscitation of children with septic shock in the UK. This qualitative feasibility study aimed to explore acceptability of the FiSh Trial, including research without prior consent (RWPC), potential barriers to recruitment and participant information for a pilot trial. Qualitative interview study involving parents of children who had presented to a UK emergency department or been admitted to a paediatric intensive care unit with severe infection in the previous 3 years. Twenty-one parents (seven bereaved) were interviewed 16 (median) months since their child's hospital admission (range: 1-41). All parents said they would have provided consent for the use of their child's data in the FiSh Trial. The majority were unfamiliar with RWPC, yet supported its use. Parents were initially concerned about the change from currently recommended treatment, yet were reassured by explanations of the current evidence base, fluid bolus therapy and monitoring procedures. Parents made recommendations about the timing of the research discussion and content of participant information. Bereaved parents stated that recruiters should not discuss research immediately after a child's death, but supported a personalised postal 'opt-out' approach to consent. Findings show that parents whose child has experienced severe infection supported the proposed FiSh Trial, including the use of RWPC. Parents' views informed the development of the pilot trial protocol and site staff training. ISRCTN15244462-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Gender of Siblings and Choice of College Major

OpenAIRE

Massimo Anelli; Giovanni Peri

2013-01-01

Find It(opens in a new window)|View at Publisher| Export | Download | Save to list | More... CESifo Economic Studies Volume 61, Issue 1, 2015, Pages 53-71 Gender of siblings and choice of college major (Article) Anelli, M.a , Peri, G.b a Department of Economics, University of California, Davis, One Shields Avenue, Davis, CA, United States b CESifo, Department of Economics, University of California, Davis, One Shields Avenue, Davis, CA, United States View ...

Automatic extraction of forward stroke volume using dynamic 11C-acetate PET/CT

DEFF Research Database (Denmark)

Harms, Hans; Tolbod, Lars Poulsen; Hansson, Nils Henrik

Objectives: Dynamic PET with 11C-acetate can be used to quantify myocardial blood flow and oxidative metabolism, the latter of which is used to calculate myocardial external efficiency (MEE). Calculation of MEE requires forward stroke volume (FSV) data. FSV is affected by cardiac loading conditions......, potentially introducing bias if measured with a separate modality. The aim of this study was to develop and validate methods for automatically extracting FSV directly from the dynamic PET used for measuring oxidative metabolism. Methods: 16 subjects underwent a dynamic 27 min PET scan on a Siemens Biograph...... TruePoint 64 PET/CT scanner after bolus injection of 399±27 MBq of 11C-acetate. The LV-aortic time-activity curve (TAC) was extracted automatically from dynamic PET data using cluster analysis. The first-pass peak was derived by automatic extrapolation of the down-slope of the TAC. FSV...

Activity and toxicity of oxaliplatin and bolus fluorouracil plus leucovorin in pretreated colorectal cancer patients: a phase 2. study

Energy Technology Data Exchange (ETDEWEB)

Ferraresi, V.; Buccilli, A.; Giannarelli, D.; Ciccarese, M. [Regina Elena Cancer Institute, Rome (Italy). Dept. of Medical Oncology; Giampaolo, M.A.; Gabriele, A.; Buccilli, A.; Gamucci, T. [Azienda Sanitaria Locale, Frosinone (Italy). Complex Operative Unit of Medical Oncology

2005-06-15

The aim of the current study was to evaluate the activity and toxicity of a combination of oxaliplatin with bolus fluorouracil and leucovorin in colorectal cancer (CRC) patients pretreated for advanced disease with various schedules including continuous fluorouracil infusion. Thirty consecutive patients with pretreated advanced CRC received oxaliplatin 130 mg/m{sup 2} by 2-h infusion dl, leucovorin 100 mg/m{sup 2} by 1-h infusion followed by fluorouracil 425 mg/m{sup 2} i.v. bolus from day 1 to 3 every 3 weeks for a maximum of 6 cycles. The best overall response rate in an intent-to-treat analysis was 13% (2 complete responses and 2 partial responses) (95% CI, 1.2-25.5%) and 37% of patients obtained stable disease with a tumor growth control rate of 50% (95% CI, 32.1-67.9%). The median progression-free survival was 4.0 months (95% CI, 1.4-6.5 months) and median overall survival was 12.0 months (95% CI, 9.9-14.1 months). The independent prognostic factors for improved overall survival were a good performance status and a response/stabilization of disease to chemotherapy. Severe neutropenia was quite common (43.3% of patients and 14.4% of cycles), although complicated by fever only in one case (3.3% of patients). There was one toxic death. In conclusion, the study combination showed an interesting rate of tumor growth control in a cohort of patients previously treated for advanced disease with various schedules including continuous fluorouracil infusion.

Emotion, gender, and gender typical identity in autobiographical memory.

Science.gov (United States)

Grysman, Azriel; Merrill, Natalie; Fivush, Robyn

2017-03-01

Gender differences in the emotional intensity and content of autobiographical memory (AM) are inconsistent across studies, and may be influenced as much by gender identity as by categorical gender. To explore this question, data were collected from 196 participants (age 18-40), split evenly between men and women. Participants narrated four memories, a neutral event, high point event, low point event, and self-defining memory, completed ratings of emotional intensity for each event, and completed four measures of gender typical identity. For self-reported emotional intensity, gender differences in AM were mediated by identification with stereotypical feminine gender norms. For narrative use of affect terms, both gender and gender typical identity predicted affective expression. The results confirm contextual models of gender identity (e.g., Diamond, 2012 . The desire disorder in research on sexual orientation in women: Contributions of dynamical systems theory. Archives of Sexual Behavior, 41, 73-83) and underscore the dynamic interplay between gender and gender identity in the emotional expression of autobiographical memories.

A Phase 1, Single-center, Double-blind, Placebo-controlled Study in Healthy Subjects to Assess the Safety, Tolerability, Clinical Effects, and Pharmacokinetics-Pharmacodynamics of Intravenous Cyclopropyl-methoxycarbonylmetomidate (ABP-700) after a Single Ascending Bolus Dose.

Science.gov (United States)

Struys, Michel M R F; Valk, Beatrijs I; Eleveld, Douglas J; Absalom, Anthony R; Meyer, Peter; Meier, Sascha; den Daas, Izaak; Chou, Thomas; van Amsterdam, Kai; Campagna, Jason A; Sweeney, Steven P

2017-07-01

Cyclopropyl-methoxycarbonylmetomidate (ABP-700) is a new "soft" etomidate analog. The primary objectives of this first-in-human study were to describe the safety and efficacy of ABP-700 and to determine its maximum tolerated dose. Secondary objectives were to characterize the pharmacokinetics of ABP-700 and its primary metabolite (cyclopropyl-methoxycarbonyl acid), to assess the clinical effects of ABP-700, and to investigate the dose-response and pharmacokinetic/pharmacodynamic relationships. Sixty subjects were divided into 10 cohorts and received an increasing, single bolus of either ABP-700 or placebo. Safety was assessed by clinical laboratory evaluations, infusion-site reactions, continuous monitoring of vital signs, physical examination, adverse event monitoring, and adrenocorticotropic hormone stimulation testing. Clinical effects were assessed with modified observer's assessment of alertness/sedation and Bispectral Index monitoring. Pharmacokinetic parameters were calculated. Stopping criteria were met at 1.00 mg/kg dose. No serious adverse events were reported. Adverse events were dose-dependent and comprised involuntary muscle movement, tachycardia, and ventilatory effects. Adrenocorticotropic hormone stimulation evoked a physiologic cortisol response in all subjects, no different from placebo. Pharmacokinetics were dose-proportional. A three-compartment pharmacokinetic model described the data well. A rapid onset of anesthesia/sedation after bolus administration and also a rapid recovery were observed. A quantitative concentration-effect relationship was described for the modified observer's assessment of alertness/sedation and Bispectral Index. This first-in-human study of ABP-700 shows that ABP-700 was safe and well tolerated after single-bolus injections up to 1.00 mg/kg. Bolus doses of 0.25 and 0.35 mg/kg were found to provide the most beneficial clinical effect versus side-effect profile.

[Gender stereotypes arising in a state of gender awareness].

Science.gov (United States)

Ito, Y

2001-12-01

This study examined the structure of gender stereotypes which might arise in the state of gender awareness that was triggered by social situations where people perceived their gender differences strongly. Out of 1,500 residents in Tokyo aged between 20-60, 342 females and 313 males were randomly chosen and answered the questions about gender consciousness in the state of gender awareness. A factor analysis revealed that "maternity" and "trustworthiness" were the dominant dimensions of gender stereotypes in the state of gender awareness, and that trustworthiness particularly formed the basis of gender stereotypes. Generation differences in gender stereotypes were also revealed between women in their 40 s and 50 s, and between men in their 30 s and 40 s. Generally, power for men and nurture for women were more likely to be perceived in a state of gender awareness.

Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

OpenAIRE

Mohammadreza Moshari; Bahman Malek; Mohammadreza Minator-Sajjadi; Maryam Vosoghian; Mastaneh Dahi; Mahshid Ghasemi; Razieh Shekari

2018-01-01

AbstractBackground: So far, many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In the present study, two different methods of administration (bolus and infusion), were compared.Materials and Methods: Forty patients were randomized in the two groups (A and B) of 20 patients each. All patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (...

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

NARCIS (Netherlands)

Hoekzema, E.; Schagen, S.E.E.; Kreukels, B.P.C.; Veltman, D.J.; Cohen-Kettenis, P.T.; Delemarre-van d Waal, H.A.; Bakkera, J.

2015-01-01

The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

NARCIS (Netherlands)

Hoekzema, Elseline; Schagen, Sebastian E E; Kreukels, Baudewijntje P C; Veltman, Dick J; Cohen-Kettenis, Peggy T; Delemarre-van de Waal, Henriette; Bakker, J.

The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural

Gender Equality and Violent Behavior: How Neighborhood Gender Equality Influences the Gender Gap in Violence

Science.gov (United States)

Lei, Man-Kit; Simons, Ronald L.; Simons, Leslie Gordon; Edmond, Mary Bond

2014-01-01

Using a sample of 703 African American adolescents from the Family and Community Health Study (FACHS) along with census data from the year 2000, we examine the association between neighborhood-level gender equality and violence. We find that boys’ and girls’ violent behavior is unevenly distributed across neighborhood contexts. In particular, gender differences in violent behavior are less pronounced in gender-equalitarian neighborhoods compared to those characterized by gender inequality. We also find that the gender gap narrows in gender-equalitarian neighborhoods because boys’ rates of violence decrease whereas girls’ rates remain relatively low across neighborhoods. This is in stark contrast to the pessimistic predictions of theorists who argue that the narrowing of the gender gap in equalitarian settings is the result of an increase in girls’ violence. In addition, the relationship between neighborhood gender equality and violence is mediated by a specific articulation of masculinity characterized by toughness. Our results provide evidence for the use of gender-specific neighborhood prevention programs. PMID:24672996

Low contrast media volume in pre-TAVI CT examinations.

Science.gov (United States)

Kok, Madeleine; Turek, Jakub; Mihl, Casper; Reinartz, Sebastian D; Gohmann, Robin F; Nijssen, Estelle C; Kats, Suzanne; van Ommen, Vincent G; Kietselaer, Bas L J H; Wildberger, Joachim E; Das, Marco

2016-08-01

To evaluate image quality using reduced contrast media (CM) volume in pre-TAVI assessment. Forty-seven consecutive patients referred for pre-TAVI examination were evaluated. Patients were divided into two groups: group 1 BMI  28 kg/m(2) (n = 18). Patients received a combined scan protocol: retrospective ECG-gated helical CTA of the aortic root (80kVp) followed by a high-pitch spiral CTA (group 1: 70 kV; group 2: 80 kVp) from aortic arch to femoral arteries. All patients received one bolus of CM (300 mgI/ml): group 1: volume = 40 ml; flow rate = 3 ml/s, group 2: volume = 53 ml; flow rate = 4 ml/s. Attenuation values (HU) and contrast-to-noise ratio (CNR) were measured at the levels of the aortic root (helical) and peripheral arteries (high-pitch). Diagnostic image quality was considered sufficient at attenuation values > 250HU and CNR > 10. Diagnostic image quality for TAVI measurements was obtained in 46 patients. Mean attenuation values and CNR (HU ± SD) at the aortic root (helical) were: group 1: 381 ± 65HU and 13 ± 8; group 2: 442 ± 68HU and 10 ± 5. At the peripheral arteries (high-pitch), mean values were: group 1: 430 ± 117HU and 11 ± 6; group 2: 389 ± 102HU and 13 ± 6. CM volume can be substantially reduced using low kVp protocols, while maintaining sufficient image quality for the evaluation of aortic root and peripheral access sites. • Image quality could be maintained using low kVp scan protocols. • Low kVp protocols reduce contrast media volume by 34-67 %. • Less contrast media volume lowers the risk of contrast-induced nephropathy.

Right anterior cingulate cortical thickness and bilateral striatal volume correlate with child behavior checklist aggressive behavior scores in healthy children.

Science.gov (United States)

Ducharme, Simon; Hudziak, James J; Botteron, Kelly N; Ganjavi, Hooman; Lepage, Claude; Collins, D Louis; Albaugh, Matthew D; Evans, Alan C; Karama, Sherif

2011-08-01

The anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and basal ganglia have been implicated in pathological aggression. This study aimed at identifying neuroanatomical correlates of impulsive aggression in healthy children. Data from 193 representative 6- to 18-year-old healthy children were obtained from the National Institutes of Health Magnetic Resonance Imaging Study of Normal Brain Development after a blinded quality control. Cortical thickness and subcortical volumes were obtained with automated software. Aggression levels were measured with the Aggressive Behavior scale (AGG) of the Child Behavior Checklist. AGG scores were regressed against cortical thickness and basal ganglia volumes using first- and second-order linear models while controlling for age, gender, scanner site, and total brain volume. Gender by AGG interactions were analyzed. There were positive associations between bilateral striatal volumes and AGG scores (right: r = .238, p = .001; left: r = .188, p = .01). A significant association was found with right ACC and subgenual ACC cortical thickness in a second-order linear model (p right ACC cortex. An AGG by gender interaction trend was found in bilateral OFC and ACC associations with AGG scores. This study shows the existence of relationships between impulsive aggression in healthy children and the structure of the striatum and right ACC. It also suggests the existence of gender-specific patterns of association in OFC/ACC gray matter. These results may guide research on oppositional-defiant and conduct disorders. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Correlations Between Personality and Brain Structure: A Crucial Role of Gender.

Science.gov (United States)

Nostro, Alessandra D; Müller, Veronika I; Reid, Andrew T; Eickhoff, Simon B

2017-07-01

Previous studies have shown that males and females differ in personality and gender differences have also been reported in brain structure. However, effects of gender on this "personality-brain" relationship are yet unknown. We therefore investigated if the neural correlates of personality differ between males and females. Whole brain voxel-based morphometry was used to investigate the influence of gender on associations between NEO FFI personality traits and gray matter volume (GMV) in a matched sample of 182 males and 182 females. In order to assess associations independent of and dependent on gender, personality-GMV relationships were tested across the entire sample and separately for males and females. There were no significant correlations between any personality scale and GMV in the analyses across the entire sample. In contrast, significant associations with GMV were detected for neuroticism, extraversion, and conscientiousness only in males. Interestingly, GMV in left precuneus/parieto-occipital sulcus correlated with all 3 traits. Thus, our results indicate that brain structure-personality relationships are highly dependent on gender, which might be attributable to hormonal interplays or differences in brain organization between males and females. Our results thus provide possible neural substrates of personality-behavior relationships and underline the important role of gender in these associations. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Gender Differences in Child Aggression: Relations With Gender-Differentiated Parenting and Parents' Gender-Role Stereotypes.

Science.gov (United States)

Endendijk, Joyce J; Groeneveld, Marleen G; van der Pol, Lotte D; van Berkel, Sheila R; Hallers-Haalboom, Elizabeth T; Bakermans-Kranenburg, Marian J; Mesman, Judi

2017-01-01

This longitudinal study examines the association between child gender and child aggression via parents' physical control, moderated by parents' gender-role stereotypes in a sample of 299 two-parent families with a 3-year-old child in the Netherlands. Fathers with strong stereotypical gender-role attitudes and mothers were observed to use more physical control strategies with boys than with girls, whereas fathers with strong counterstereotypical attitudes toward gender roles used more physical control with girls than with boys. Moreover, when fathers had strong attitudes toward gender roles (stereotypical or counterstereotypical), their differential treatment of boys and girls completely accounted for the gender differences in children's aggressive behavior a year later. Mothers' gender-differentiated parenting practices were unrelated to gender differences in child aggression. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

Body mass index and dynamic lung volumes in office workers

International Nuclear Information System (INIS)

Rasool, S.A.; Shirwany, A.K.

2012-01-01

To measure the association of body mass index (BMI) to lung volumes assessed by spirometer. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Physiology and Cell Biology, University of Health Sciences, Lahore, from February to August 2009. Methodology: Two hundred and twenty-five apparently healthy adult office workers of either gender aged > 20 years were recruited. Height and weight were measured and BMI was calculated as kg/m2. Subjects were categorized as normal (BMI=18.5 to 24.9 kg/m2); overweight (BMI=25 to 29.9 kg/m2); and obese Class 1 (BMI=30 to 34.9 kg/m2) on the basis of BMI. Lung volumes were measured by digital spirometer and were reported as percentage of predicted values for forced vital capacity (FVC%), forced expiratory volume in first second (FEV1%) and ratio of FEV1 to FVC (FEV1:FVC). Groups were compared using t-test and ANOVA, correlation was assessed by Pearson's 'r'. Results: Significant differences in lung volumes were found in different BMI categories. Obese subjects had significantly lower FVC% (p < 0.0001), as well as significantly lower FEV1% (p = 0.003) as compared to normal subjects. There were significant linear relationships between obesity and PFTs. BMI had significant negative linear association with FVC% in overweight (r = -0.197) and obese (r = - 0.488); and with FEV1% in obese subjects (r = -0.510). Gender and age had no significant effect on mean values of PFTs. Conclusion: Obese individuals in this sample had significant decline in lung volumes. (author)

Sex/Gender Differences in Cotinine Levels Among Daily Smokers in the Pennsylvania Adult Smoking Study.

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Chen, Allshine; Krebs, Nicolle M; Zhu, Junjia; Sun, Dongxiao; Stennett, Andrea; Muscat, Joshua E

2017-11-01

This study was conducted to determine sex/gender differences in smoke exposure and to quantify the role of potential predictors including puffing behaviors, nicotine dependence, and non-nicotinic factors. The Pennsylvania Adult Smoking Study (PASS) of 332 adult cigarette smokers utilized portable handheld topography devices to capture the smokers' profiles in a naturalistic environment. Sex/gender differences in salivary biomarkers were modeled using ANCOVA to account for measures of dependence (Fagerstrom Test for Nicotine Dependence, nicotine metabolite ratio [3-hydroxycotinine/cotinine]), and nondependence covariates including anthropomorphic factors and stress. The Blinder-Oaxaca method was used to decompose the sex/gender differences in nicotine uptake due to covariates. Men had significantly higher cotinine levels (313.5 ng/mL vs. 255.8 ng/mL, p < 0.01), cotinine +3-hydroxycotinine levels, (0.0787 mol/L vs. 0.0675 mol/L, p = 0.01), puff volumes (52.95 mL vs. 44.77 mL, p < 0.01), and a lower nicotine metabolite ratio (0.396 vs. 0.475, p = 0.01) than women. The mean Fagerström Test for Nicotine Dependence score did not differ between men and women (p = 0.24). Women had a higher mean Hooked on Tobacco Checklist score than men (7.64 vs. 6.87, p < 0.01). In multivariate analysis, nicotine metabolite levels were not significantly different by sex. Decomposition results show that ten predictors can explain 83% of the sex/gender differences in cotinine uptake. Height was the greatest contributor to these differences, followed by average puff volume. Conclusion and Impact: The higher levels of nicotine metabolites in men, compared to women, can be explained by height, weight, puff volume, and nicotine metabolism.

From gender bias to gender awareness in medical education.

Science.gov (United States)

Verdonk, Petra; Benschop, Yvonne W M; de Haes, Hanneke C J M; Lagro-Janssen, Toine L M

2009-03-01

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was 'gender blind' by not considering gender whenever relevant. Secondly, medicine is said to be 'male biased' because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.

Gender Beliefs and Embedded Gendered Values in Preschool

Science.gov (United States)

Emilson, Anette; Folkesson, Anne-Mari; Lindberg, Ingeborg Moqvist

2016-01-01

The aim of this study is to explore practitioners' gender beliefs and how gendered values are embedded in Swedish preschool practice. The research question is: What beliefs about gender and the associated values, can be identified in practitioners' talk when they discuss gender issues? The study is informed by Bronwyn Davies' theoretical ideas…

From Gender Bias to Gender Awareness in Medical Education

Science.gov (United States)

Verdonk, Petra; Benschop, Yvonne W. M.; de Haes, Hanneke C. J. M.; Lagro-Janssen, Toine L. M.

2009-01-01

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was "gender blind" by not considering gender whenever relevant. Secondly,…

Gender identities and gender dysphoria in the Netherlands.

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Kuyper, Lisette; Wijsen, Ciel

2014-02-01

Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15-70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.

Gender differences in macroprolactinomas: a single centre experience

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Khare, Shruti; Lila, Anurag R; Patt, Hiren; Yerawar, Chaitanya; Goroshi, Manjunath; Bandgar, Tushar; Shah, Nalini S

2015-01-01

Macroprolactinomas are the most common functional pituitary tumours. Hypotheses proposed to explain predominance of large tumours in males are: i) diagnostic delay, as hyperprolactinaemia remains under recognised in males and ii) gender-specific difference in tumour proliferation indices. Our study objectives are to compare gender differences in clinical, biochemical, radiological features, management outcomes and cabergoline responsiveness in macroprolactinomas. Drug resistance was defined as failure to achieve prolactin normalisation and >50% reduction in tumour volume with cabergoline (3.5 mg/week dose for minimum 6 months duration). The baseline characteristics of 100 patients (56 females and 44 males) with macroprolactinoma were analysed. Drug responsiveness was analysed in 88 treatment naive patients, excluding 12 post-primary trans-sphenoidal surgery cases. We found that females (30.29±10.39 years) presented at younger mean age than males (35.23±9.91 years) (P4 cm), gender difference in response rate was insignificant. In conclusion, macroprolactinomas are equally prevalent in both sexes. Macroprolactinomas in males predominantly present with symptoms of mass effects, as against females who present with symptoms of hypogonadism. Males harbor larger tumours but are equally cabergoline responsive as those in females. PMID:26682970

From gender bias to gender awareness in medical education

OpenAIRE

Verdonk, P.; Benschop, Y.W.M.; Haes, H. de; Lagro-Janssen, A.L.M.

2009-01-01

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was ‘gender blind’ by not considering gender whenever relevant. Secondly, medicine is said to be ‘male biased’ because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ...

A reference frame for blood volume in children and adolescents

Directory of Open Access Journals (Sweden)

Donckerwolcke Raymond

2006-02-01

Full Text Available Abstract Background Our primary purpose was to determine the normal range and variability of blood volume (BV in healthy children, in order to provide reference values during childhood and adolescence. Our secondary aim was to correlate these vascular volumes to body size parameters and pubertal stages, in order to determine the best normalisation parameter. Methods Plasma volume (PV and red cell volume (RCV were measured and F-cell ratio was calculated in 77 children with idiopathic nephrotic syndrome in drug-free remission (mean age, 9.8 ± 4.6 y. BV was calculated as the sum of PV and RCV. Due to the dependence of these values on age, size and sex, all data were normalised for body size parameters. Results BV normalised for lean body mass (LBM did not differ significantly by sex (p Conclusion LBM was the anthropometric index most closely correlated to vascular fluid volumes, independent of age, gender and pubertal stage.

Age- and gender-specific differences in left and right ventricular cardiac function and mass determined by cine magnetic resonance imaging

International Nuclear Information System (INIS)

Sandstede, J.; Lipke, C.; Beer, M.; Hofmann, S.; Pabst, T.; Kenn, W.; Hahn, D.; Neubauer, S.

2000-01-01

We examined possible age- and gender-specific differences in the function and mass of left (LV) and right (RV) ventricles in 36 healthy volunteers using cine gradient-recalled echo magnetic resonance imaging. Subjects were divided into four groups (nine men and nine women in each): men aged under 45 years (32 ± 7), women aged under 45 (27 ± 6), men aged over 45 (59 ± 8), and women aged over 45 (57 ± 9). Functional analysis of cardiac volume and mass and of LV wall motion was performed by manual segmentation of the endocardial and epicardial borders of the end-diastolic and end-systolic frame; both absolute and normalized (per square meter body surface area) values were evaluated. With age there was a significant decrease in both absolute and normalized LV and RV chamber volumes (EDV, ESV), while LV and RV masses remained unchanged. Gender-specific differences were found in cardiac mass and volume (for men and women, respectively: LV mass, 155 ± 18 and 110 ± 16 g; LV EDV, 118 ± 27 and 96 ± 21 ml; LV ESV, 40 ± 13 and 29 ± 9 ml; RV mass, 52 ± 10 and 39 ± 5 g; RV EDV, 131 ± 28 and 100 ± 23 ml; RV ESV, 53 ± 17 and 33 ± 15 ml). Normalization to body surface area eliminated differences in LV volumes but not those in LV mass, RV mass, or RV function. Functional parameters such as cardiac output and LV ejection fraction showed nonsignificant or only slight differences and were thus largely independent of age and gender. Intra- and interobserver variability ranged between 1.4 % and 5.9 % for all parameters. Cine magnetic resonance imaging thus shows age- and gender-specific differences in cardiac function, and therefore the evaluation of cardiac function in patients should consider age- and gender-matched normative values. (orig.)

Brain volumes in healthy adults aged 40 years and over: a voxel-based morphometry study.

Science.gov (United States)

Riello, Roberta; Sabattoli, Francesca; Beltramello, Alberto; Bonetti, Matteo; Bono, Giorgio; Falini, Andrea; Magnani, Giuseppe; Minonzio, Giorgio; Piovan, Enrico; Alaimo, Giuseppina; Ettori, Monica; Galluzzi, Samantha; Locatelli, Enrico; Noiszewska, Malgorzata; Testa, Cristina; Frisoni, Giovanni B

2005-08-01

Gender and age effect on brain morphology have been extensively investigated. However, the great variety in methods applied to morphology partly explain the conflicting results of linear patterns of tissue changes and lateral asymmetry in men and women. The aim of the present study was to assess the effect of age, gender and laterality on the volumes of gray matter (GM) and white matter (WM) in a large group of healthy adults by means of voxel-based morphometry. This technique, based on observer-independent algorithms, automatically segments the 3 types of tissue and computes the amount of tissue in each single voxel. Subjects were 229 healthy subjects of 40 years of age or older, who underwent magnetic resonance (MR) for reasons other than cognitive impairment. MR images were reoriented following the AC-PC line and, after removing the voxels below the cerebellum, were processed by Statistical Parametric Mapping (SPM99). GM and WM volumes were normalized for intracranial volume. Women had more fractional GM and WM volumes than men. Age was negatively correlated with both fractional GM and WM, and a gender x age interaction effect was found for WM, men having greater WM loss with advancing age. Pairwise differences between left and right GM were negative (greater GM in right hemisphere) in men, and positive (greater GM in left hemisphere) in women (-0.56+/-4.2 vs 0.99+/-4.8; p=0.019). These results support side-specific accelerated WM loss in men, and may help our better understanding of changes in regional brain structures associated with pathological aging.

GENDER EQUALITY AND THE GENDER GAP IN MATHEMATICS.

Science.gov (United States)

Tao, Hung-Lin; Michalopoulos, Christos

2018-03-01

A gender gap has been found in mathematics (boys outperform girls) that has prevailed across countries for many decades. Whether this gap results from nature or nurture has been hotly debated. Using the evidence of PISA 2003 and the gender equality index of 2003, some researchers have argued that an improvement in gender equality reduces the gender gap in mathematics. This study used five waves of country-level PISA data and, controlling for country fixed effects, found no evidence to support this argument. Furthermore, individual data for PISA 2012 and the multilevel data model were used. The conclusion drawn also does not support the argument. In fact, the relationship between gender equality and the gender gap in mathematics vanished after PISA 2003.

Parents' Gender Ideology and Gendered Behavior as Predictors of Children's Gender-Role Attitudes: A Longitudinal Exploration

Science.gov (United States)

Paul Halpern, Hillary; Perry-Jenkins, Maureen

2015-01-01

The current study utilized longitudinal, self-report data from a sample of 109 dual-earner, working-class couples and their 6-year-old children living in the northeastern United States. Research questions addressed the roles of parents’ gender ideology and gendered behaviors in predicting children’s development of gender-role attitudes. It was hypothesized that parents' behavior would be more influential than their ideology in the development of their children's attitudes about gender roles. Parents responded to questionnaires assessing their global beliefs about women's and men's "rightful" roles in society, work preferences for mothers, division of household and childcare tasks, division of paid work hours, and job traditionality. These data were collected at multiple time points across the first year of parenthood, and during a 6-year follow-up. At the final time point, children completed the Sex Roles Learning Inventory (SERLI), an interactive measure that assesses gender-role attitudes. Overall, mothers’ and fathers’ behaviors were better predictors of children’s gender-role attitudes than parents’ ideology. In addition, mothers and fathers played unique roles in their sons’ and daughters’ acquisition of knowledge about gender stereotypes. Findings from the current study fill gaps in the literature on children’s gender development in the family context—particularly by examining the understudied role of fathers in children’s acquisition of knowledge regarding gender stereotypes and through its longitudinal exploration of the relationship between parents’ gender ideologies, parents’ gendered behaviors, and children’s gender-role attitudes. PMID:27445431

Parents' Gender Ideology and Gendered Behavior as Predictors of Children's Gender-Role Attitudes: A Longitudinal Exploration.

Science.gov (United States)

Paul Halpern, Hillary; Perry-Jenkins, Maureen

2016-05-01

The current study utilized longitudinal, self-report data from a sample of 109 dual-earner, working-class couples and their 6-year-old children living in the northeastern United States. Research questions addressed the roles of parents' gender ideology and gendered behaviors in predicting children's development of gender-role attitudes. It was hypothesized that parents' behavior would be more influential than their ideology in the development of their children's attitudes about gender roles. Parents responded to questionnaires assessing their global beliefs about women's and men's "rightful" roles in society, work preferences for mothers, division of household and childcare tasks, division of paid work hours, and job traditionality. These data were collected at multiple time points across the first year of parenthood, and during a 6-year follow-up. At the final time point, children completed the Sex Roles Learning Inventory (SERLI), an interactive measure that assesses gender-role attitudes. Overall, mothers' and fathers' behaviors were better predictors of children's gender-role attitudes than parents' ideology. In addition, mothers and fathers played unique roles in their sons' and daughters' acquisition of knowledge about gender stereotypes. Findings from the current study fill gaps in the literature on children's gender development in the family context-particularly by examining the understudied role of fathers in children's acquisition of knowledge regarding gender stereotypes and through its longitudinal exploration of the relationship between parents' gender ideologies, parents' gendered behaviors, and children's gender-role attitudes.

Hippocampal volumes are important predictors for memory function in elderly women

Directory of Open Access Journals (Sweden)

Adolfsdottir Steinunn

2009-08-01

Full Text Available Abstract Background Normal aging involves a decline in cognitive function that has been shown to correlate with volumetric change in the hippocampus, and with genetic variability in the APOE-gene. In the present study we utilize 3D MR imaging, genetic analysis and assessment of verbal memory function to investigate relationships between these factors in a sample of 170 healthy volunteers (age range 46–77 years. Methods Brain morphometric analysis was performed with the automated segmentation work-flow implemented in FreeSurfer. Genetic analysis of the APOE genotype was determined with polymerase chain reaction (PCR on DNA from whole-blood. All individuals were subjected to extensive neuropsychological testing, including the California Verbal Learning Test-II (CVLT. To obtain robust and easily interpretable relationships between explanatory variables and verbal memory function we applied the recent method of conditional inference trees in addition to scatterplot matrices and simple pairwise linear least-squares regression analysis. Results APOE genotype had no significant impact on the CVLT results (scores on long delay free recall, CVLT-LD or the ICV-normalized hippocampal volumes. Hippocampal volumes were found to decrease with age and a right-larger-than-left hippocampal asymmetry was also found. These findings are in accordance with previous studies. CVLT-LD score was shown to correlate with hippocampal volume. Multivariate conditional inference analysis showed that gender and left hippocampal volume largely dominated predictive values for CVLT-LD scores in our sample. Left hippocampal volume dominated predictive values for females but not for males. APOE genotype did not alter the model significantly, and age was only partly influencing the results. Conclusion Gender and left hippocampal volumes are main predictors for verbal memory function in normal aging. APOE genotype did not affect the results in any part of our analysis.

Use of new tandem cation/anion exchange system with clinical-scale generators provides high specific volume solutions of technetium-99m and rhenium-188

International Nuclear Information System (INIS)

Knapp, F.F. Jr.; Beets, A.L.; Mirzadeh, S.; Guhlke, S.

1998-01-01

In this paper we describe the first application of our simple and inexpensive post-elution tandem cation/anion exchange column system which is based on generator elution with salts of weak acids such as ammonium acetate instead of saline solution to provide very high specific volume solutions of technetium-99m and rhenium-188 from clinical-scale molybdenum-99/technetium-99m generator prepared from low specific activity (n,y) molybdenum-99, and tungsten-188/rhenium-188 generators, respectively. Initial passage of the bolus through a strong cation exchange cartridge converts the ammonium acetate to acetic acid which is essentially not ionized at the acidic pH, allowing specific subsequent amine-type (QMA SepPak TM ) anion exchange cartridge column trapping of the microscopic levels of the pertechnetate or perrhenate. Subsequent elution of the anion cartridge with a small volume ( 500 mCi/mL) from the alumina-based tungsten-188/rhenium-188 generator. (author)

Dilemmas in the Danish Approach to Gender Quotas and Gender Equality

DEFF Research Database (Denmark)

Siim, Birte; Agustin, Lise Rolandsen

The paper addresses the dilemmas, contradictions and paradoxes in the Danish approach to gender quotas and gender equality. Gender theory has presented diverse arguments for gender quota: justice, resources and women’s interests. Gender quota can be understood as a means to achieve gender parity...... and gender justice in all arenas of society political and economic life. The belief in gender theory and research has been that gender quota would and should be a means to achieve equal rights and gender equality. Recently a new discourse and rhetoric of profitability of gender equality within a range...... of institutions from business to higher education has become prominent in many arenas. One example is the Report on gender equality between men and women in the EU, which argues that gender quotas are not only beneficial for women’s rights but also for industry, for society, and for men...

Region-specific reduction in brain volume in young adults with perinatal hypoxic-ischaemic encephalopathy.

Science.gov (United States)

Bregant, Tina; Rados, Milan; Vasung, Lana; Derganc, Metka; Evans, Alan C; Neubauer, David; Kostovic, Ivica

2013-11-01

A severe form of perinatal hypoxic-ischaemic encephalopathy (HIE) carries a high risk of perinatal death and severe neurological sequelae while in mild HIE only discrete cognitive disorders may occur. To compare total brain volumes and region-specific cortical measurements between young adults with mild-moderate perinatal HIE and a healthy control group of the same age. MR imaging was performed in a cohort of 14 young adults (9 males, 5 females) with a history of mild or moderate perinatal HIE. The control group consisted of healthy participants, matched with HIE group by age and gender. Volumetric analysis was done after the processing of MR images using a fully automated CIVET pipeline. We measured gyrification indexes, total brain volume, volume of grey and white matter, and of cerebrospinal fluid. We also measured volume, thickness and area of the cerebral cortex in the parietal, occipital, frontal, and temporal lobe, and of the isthmus cinguli, parahippocampal and cingulated gyrus, and insula. The HIE patient group showed smaller absolute volumetric data. Statistically significant (p right hemisphere, of cortical areas in the right temporal lobe and parahippocampal gyrus, of cortical volumes in the right temporal lobe and of cortical thickness in the right isthmus of the cingulate gyrus were found. Comparison between the healthy group and the HIE group of the same gender showed statistically significant changes in the male HIE patients, where a significant reduction was found in whole brain volume; left parietal, bilateral temporal, and right parahippocampal gyrus cortical areas; and bilateral temporal lobe cortical volume. Our analysis of total brain volumes and region-specific corticometric parameters suggests that mild-moderate forms of perinatal HIE lead to reductions in whole brain volumes. In the study reductions were most pronounced in temporal lobe and parahippocampal gyrus. Copyright © 2013 European Paediatric Neurology Society. All rights reserved.

Gendered education in a gendered world: looking beyond cosmetic solutions to the gender gap in science

Science.gov (United States)