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Sample records for gross total surgical

  1. The impact of gross anatomy laboratory on first year medical students' interest in a surgical career.

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    Pulcrano, Marisa E; Malekzadeh, Sonya; Kumar, Anagha

    2016-09-01

    This study sought to determine the impact of gross anatomy laboratory (GA) on first year medical students' (M1) interest in a surgical career. Secondary objectives included identifying other influences in M1s' career decision making. This prospective study included surveys before and after GA. All M1s enrolled in GA were invited to participate. Sixty students completed both the pre- and post-test surveys. A 5-point Likert-type scale surveyed participants' interests, specific personality traits, experience during the course of GA, and likelihood of pursuing a surgical career. Statistical analysis included Wilcoxon Signed Rank Test and (Polychotomous) Ordinal Logistic Regression Model. Students' desire to work with their hands increased (50 vs. 33.3%) and enjoyment working with instruments and tools similarly increased (50 vs. 41.7%). Likelihood of pursuing a surgical career after gross anatomy increased in 31.7% of students, decreased in 16.7%, and was unchanged in 51.7%. Over 75% of students with a prior interest in surgery and 21% of those who previously felt neutral agreed that they were likely to pursue a career in surgery at the conclusion of the laboratory. Students with a surgeon family member were 0.1976 times as likely to exhibit a positive change in interest (P values 0.024). Gross anatomy may influence up to a third of the class to consider a surgical career, especially those with a prior interest in surgery and those previously feeling ambivalent. Students with a surgeon family member became less likely to enter a surgical career after gross anatomy. Clin. Anat. 29:691-695, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Total ankle replacement - surgical treatment and rehabilitation.

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    Prusinowska, Agnieszka; Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.

  3. Combined arthroscopic gross total synovectomy and radiotherapy for diffuse pigmented villonodular synovitis of the knee: a report of 2 cases

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    Chang, Sei Kyung; Kim, Jae Hwa; Ha, Doo Hoe; Kang, Hae Youn; Chong, So Young; Shin, Hyun Soo [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2006-09-15

    Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving synovial membranes. Natural history and etiology of PVNS are not well known. PVNS presents as localized or diffuse tumor like nodular lesion of the synovial lining of the joint and the synovial spaces adjacent to the joints. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. Standard therapy is surgical resection, but due to the infiltrative growth, the recurrence rate is significantly high. After several relapses surgical treatment of diffuse PVNS becomes difficult and may require amputation of the involved limb. Radiotherapy can provide an effective treatment option for patients with large lesions or lesions which are not suitable for surgery, after incomplete resection to prevent relapses or to avoid amputation. We report 2 cases of diffuse PVNS in the knee joint treated with arthroscopic gross total synovectomy and radiotherapy.

  4. Recommendations for gross examination and sampling of surgical specimens of the spleen.

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    O'Malley, Dennis P; Louissaint, Abner; Vasef, Mohammad A; Auerbach, Aaron; Miranda, Roberto; Brynes, Russell K; Fedoriw, Yuri; Hudnall, S David

    2015-10-01

    This review examines handling and processing of spleen biopsies and splenectomy specimens with the aim of providing the pathologist with guidance in optimizing examination and diagnosis of splenic disorders. It also offers recommendations as to relevant reporting factors in gross examination, which may guide diagnostic workup. The role of splenic needle biopsies is discussed. The International Spleen Consortium is a group dedicated to promoting education and research on the anatomy, physiology, and pathology of the spleen. In keeping with these goals, we have undertaken to provide guidelines for gross examination, sectioning, and sampling of spleen tissue to optimize diagnosis (Burke). The pathology of the spleen may be complicated in routine practice due to a number of factors. Among these are lack of familiarity with lesions, complex histopathology, mimicry within several types of lesions, and overall rarity. To optimize diagnosis, appropriate handling and processing of splenic tissue are crucial. The importance of complete and accurate clinical history cannot be overstated. In many cases, significant clinical history such as previous lymphoproliferative disorders, hematologic disorders, trauma, etc, can provide important information to guide the evaluation of spleen specimens. Clinical information helps plan for appropriate processing of the spleen specimen. The pathologist should encourage surgical colleagues, who typically provide the specimens, to include as much clinical information as possible.

  5. Increased Subventricular Zone Radiation Dose Correlates With Survival in Glioblastoma Patients After Gross Total Resection

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    Chen, Linda [Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland (United States); Duke University School of Medicine, Durham, North Carolina (United States); Guerrero-Cazares, Hugo [Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland (United States); Ye, Xiaobu [Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University, Baltimore, Maryland (United States); Ford, Eric [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); McNutt, Todd; Kleinberg, Lawrence [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland (United States); Lim, Michael; Chaichana, Kaisorn [Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland (United States); Quinones-Hinojosa, Alfredo, E-mail: aquinon2@jhmi.edu [Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland (United States); Redmond, Kristin, E-mail: kjanson3@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, Maryland (United States)

    2013-07-15

    Purpose: Neural progenitor cells in the subventricular zone (SVZ) have a controversial role in glioblastoma multiforme (GBM) as potential tumor-initiating cells. The purpose of this study was to examine the relationship between radiation dose to the SVZ and survival in GBM patients. Methods and Materials: The study included 116 patients with primary GBM treated at the Johns Hopkins Hospital between 2006 and 2009. All patients underwent surgical resection followed by adjuvant radiation therapy with intensity modulated radiation therapy (60 Gy/30 fractions) and concomitant temozolomide. Ipsilateral, contralateral, and bilateral SVZs were contoured on treatment plans by use of coregistered magnetic resonance imaging and computed tomography. Multivariate Cox regression was used to examine the relationship between mean SVZ dose and progression-free survival (PFS), as well as overall survival (OS). Age, Karnofsky Performance Status score, and extent of resection were used as covariates. The median age was 58 years (range, 29-80 years). Results: Of the patients, 12% underwent biopsy, 53% had subtotal resection (STR), and 35% had gross total resection (GTR). The Karnofsky Performance Status score was less than 90 in 54 patients and was 90 or greater in 62 patients. The median ipsilateral, contralateral, and bilateral mean SVZ doses were 48.7 Gy, 34.4 Gy, and 41.5 Gy, respectively. Among patients who underwent GTR, a mean ipsilateral SVZ dose of 40 Gy or greater was associated with a significantly improved PFS compared with patients who received less than 40 Gy (15.1 months vs 10.3 months; P=.028; hazard ratio, 0.385 [95% confidence interval, 0.165-0.901]) but not in patients undergoing STR or biopsy. The subgroup of GTR patients who received an ipsilateral dose of 40 Gy or greater also had a significantly improved OS (17.5 months vs 15.6 months; P=.027; hazard ratio, 0.385 [95% confidence interval, 0.165-0.895]). No association was found between SVZ radiation dose and PFS

  6. Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom

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    Lucas Crociati Meguins

    2015-11-01

    Full Text Available Objective To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.Method A retrospective study was conducted with patients with temporal low-grade gliomas (LGG.Results Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years. The mean age at seizure onset was 25.7 ± 9.2 (11-66 years. Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6% were Engel I; seventeen (26.2% Engel II; four (6.2% Engel III and two (3.1% Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6% with total resection and in only 3 (33.3% patients with partial resection.Conclusion Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

  7. Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom.

    Science.gov (United States)

    Meguins, Lucas Crociati; Adry, Rodrigo Antônio Rocha da Cruz; Silva Júnior, Sebastião Carlos da; Pereira, Carlos Umberto; Oliveira, Jean Gonçalves de; Morais, Dionei Freitas de; Araújo Filho, Gerardo Maria de; Marques, Lúcia Helena Neves

    2015-11-01

    To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome. A retrospective study was conducted with patients with temporal low-grade gliomas (LGG). Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection. Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

  8. Total ankle replacement – surgical treatment and rehabilitation

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    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  9. Surgical voice restoration after total laryngectomy: An overview

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    B Elmiyeh

    2010-01-01

    Full Text Available Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient′s physical, functional, and emotional health, and may result in a decreased quality of life (QOL. Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

  10. Urinary carnitine excretion in surgical patients on total parenteral nutrition.

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    Tanphaichitr, V; Lerdvuthisopon, N

    1981-01-01

    Urinary free and total carnitine excretions were measured in 41 normal adults and seven surgical patients on fat-free total parenteral nutrition for 8 to 45 days. The means (+/-SEM) of urinary free and total carnitine excretion in normal adults were 162 +/- 19 and 328 +/- 28 micrometers/days, respectively. All of the patients exhibited protein-calorie malnutrition with a mean carnitine intake of 11.6 +/- 1.5 micrometers/day. Under this stringent carnitine economy with the adequate supply of lysine and methionine, urinary total carnitine excretion significantly reduced to 127 to 162 micrometers/day. This probably reflects the carnitine biosynthetic rate. However, during the periods of operation and/or infection, urinary total carnitine excretion significantly increased 2- to 7-fold that of normal levels. Significant positive correlation was found between the two forms of urinary carnitine and total nitrogen excretions. Serum free and total carnitine levels in patients were significantly higher than normal adults. Such findings can be explained by the endocrine responses to the stress phenomenon and indicate a catabolic response of skeletal muscle in which most of the body carnitine resides. This can impair their carnitine status.

  11. Total bilateral hip arthroplasty in one surgical procedure

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    Popović Zoran

    2007-01-01

    Full Text Available Background/Aim. Primary coxarthrosis occurs often in older population. There is possibility of implanting both endoprothesis simultaneously in bilateral coxarthrosis which decreases hospitalization and reduces the expenses and possibility of complication that can occur during general anesthesia. The most serious indications for bilateral total hip arthroplasty in one procedure are younger patients with serious bilateral osteoarthrosis of the hips, without added diseases. Absolute contraindication is found in patients with persistent ductus arteriosus and septal defect. The aim of this study was to point out the possibility and advantages of a single-staged bilateral hip arthroplasty and introducing it in our orthopedic practice. Methods. The procedure was accomplished in 19 patients. The standard total hip arthroplasty surgical technique was performed, followed by the usual antibiotic and anticoagulant therapy. Results. Only one complication - acetabular part instability we recorded, followed by luxation that was surgically managed. Conclusion. This procedure can be performed routinely in selected population and should be reserved for major medical centers capable to provide adequate postoperative care.

  12. Total ankle replacement through a lateral approach: surgical tips

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    Usuelli Federico Giuseppe

    2016-01-01

    Full Text Available Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS ankle and hindfoot scores, visual analogue scale (VAS pain score, and the Short Form Health Survey (SF-12 questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001. The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001. The Physical and Mental Health Composite Scale scores (PCS and MCS of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001 and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001, respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants.

  13. Total ankle replacement through a lateral approach: surgical tips

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    Usuelli, Federico Giuseppe; Indino, Cristian; Maccario, Camilla; Manzi, Luigi; Salini, Vincenzo

    2016-01-01

    Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants. PMID:27855774

  14. [Pineal region tumors in children: is gross-total resection necessary? A single-center experience].

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    López-Aguilar, Enrique; Garza-González, María del Carmen; Ortiz-Azpilcueta, Mariana; Sepúlveda-Vildósola, Ana Carolina; Rioscovian-Soto, Ana; de la Cruz-Yañez, Hermilo; Betanzos-Cabrera, Yadira

    2015-01-01

    Introducción: la supervivencia de los niños con tumores de la región pineal se ha incrementado en la última década; estos tienen una evolución insidiosa asociada con los desórdenes endocrinológicos y una alta morbilidad y mortalidad, sobre todo después de la resección. El objetivo es reportar la supervivencia, la morbilidad y mortalidad según el tipo de cirugía, la histología y el tratamiento en un grupo de niños con tumores de la región pineal. Métodos: estudio retrospectivo que incluyó a todos los pacientes con diagnóstico de tumor de la región pineal menores de 17 años de edad que acudieron en un periodo de 10 años a un hospital de pediatría. Se realizó una revisión histopatológica, se determinó la extensión de la resección y se estimó la supervivencia. Resultados: se incluyeron 46 pacientes, 36 de los cuales tenían expediente completo y material de patología adecuado. La resección total se realizó en 24 (66.6 %) y biopsia en 12 (33.3 %); fallecieron 23 pacientes (88 %) y fue el desequilibrio hidroelectrolítico la causa de 14 defunciones (60 %) y la progresión tumoral la causa de las 9 defunciones restantes (39.1 %). La sobrevida a 10 años de los pacientes tratados con resección total y biopsia fue del 52 y 75 %, respectivamente, con una p = 0.7; se presentaron alteraciones endocrinológicas en 13 (36.1%) pacientes de los cuales a 10 (76.9 %) se les realizó la resección de la tumoración. Conclusión: los tumores de la región pineal en niños se pueden tratar con biopsia diagnóstica seguida de tratamiento adyuvante con quimioterapia y radioterapia.

  15. Vascular anatomy of the patella: implications for total knee arthroplasty surgical approaches.

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    Lazaro, Lionel E; Cross, Michael B; Lorich, Dean G

    2014-06-01

    Iatrogenic disruption of the patellar vascular supply has been identified as a possible contributing factor to the commonly reported patellofemoral complications following total knee arthroplasty (TKA). We performed an anatomic cadaveric study evaluating the extra-osseous vascular anatomy of the patella, and correlated our findings to routine TKA surgical dissection to determine how to better preserve patellar vascularity. In twenty-one cadaveric knees arterial cannulas were placed proximally and distally to the patella. A polyurethane compound was then injected producing a visible arterial network. Specimens underwent gross dissection. In all 21 specimens, the supreme genicular (SGA), medial/lateral superior genicular (MSGA/LSGA), medial/lateral inferior genicular and anterior tibial recurrent arteries communicate forming a peripatellar anastomotic ring supplying the intraosseous patellar system. Both the SGA (24%) and MSGA (76%) demonstrated dual medial ring contribution. Relating the arterial location to common TKA exposures suggested severe compromise of patellar vascularity. The medial sided vessels seem to contribute more significantly to the peripatellar anastomotic ring when compared to the lateral sided vessels. Careful soft tissue management has the potential to preserve key vascular structures that could maintain the intraosseous vascular supply to the patella. Understanding the anatomic locations of major arterial systems around the knee joint can potentially help during hemostasis, and can minimize blood loss during TKA. Recognition of major arterial systems around the knee joint has the potential to minimize iatrogenic disruption of the vascular supply and the complications that can follow (patella devascularization and blood lost). Copyright © 2014 Elsevier B.V. All rights reserved.

  16. The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency.

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    Smith, Maxwell L; Wilkerson, Trent; Grzybicki, Dana M; Raab, Stephen S

    2012-09-01

    Few reports have documented the effectiveness of Lean quality improvement in changing anatomic pathology patient safety. We used Lean methods of education; hoshin kanri goal setting and culture change; kaizen events; observation of work activities, hand-offs, and pathways; A3-problem solving, metric development, and measurement; and frontline work redesign in the accessioning and gross examination areas of an anatomic pathology laboratory. We compared the pre- and post-Lean implementation proportion of near-miss events and changes made in specific work processes. In the implementation phase, we documented 29 individual A3-root cause analyses. The pre- and postimplementation proportions of process- and operator-dependent near-miss events were 5.5 and 1.8 (P < .002) and 0.6 and 0.6, respectively. We conclude that through culture change and implementation of specific work process changes, Lean implementation may improve pathology patient safety.

  17. Carnitine deficiency in surgical neonates receiving total parenteral nutrition.

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    Tibboel, D; Delemarre, F M; Przyrembel, H; Bos, A P; Affourtit, M J; Molenaar, J C

    1990-04-01

    Carnitine plays a key role in the oxidation of fatty acids. Most solutions for parenteral nutrition do not contain carnitine. Because endogenous carnitine synthesis is insufficient in newborns, they are prone to developing a carnitine deficiency when they are dependent on total parenteral nutrition (TPN). Stimulated by the clinical observation of manifest clinical symptoms of carnitine deficiency in one patient, a study of 13 consecutive neonates who received TPN for over 2 weeks was begun. Their plasma carnitine levels before and during carnitine supplementation were determined. All patients had a carnitine intake far below the recommended minimal need of 11 mumol/kg per day. Although only three of them clearly showed clinical symptoms described as carnitine deficiency, carnitine supplementation for all neonates receiving TPN for over 2 weeks is recommended.

  18. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

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    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  19. [Analysis of key vision position technologies in robot assisted surgical system for total knee replacement].

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    Zhao, Zijian; Liu, Yuncai; Wu, Xiaojuan; Liu, Hongjian

    2008-02-01

    Robot assisted surgery is becoming a widely popular technology and is now entering the total knee replacement. The development of total knee replacement and the operation system structure are introduced in this paper. The vision position technology and the related calibration technology, which are very important, are also analyzed. The experiments of error analysis in our WATO system demonstrate that the position and related calibration technologies have a high precision and can satisfy surgical requirement.

  20. A review of rapid prototyped surgical guides for patient-specific total knee replacement.

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    Krishnan, S P; Dawood, A; Richards, R; Henckel, J; Hart, A J

    2012-11-01

    Improvements in the surgical technique of total knee replacement (TKR) are continually being sought. There has recently been interest in three-dimensional (3D) pre-operative planning using magnetic resonance imaging (MRI) and CT. The 3D images are increasingly used for the production of patient-specific models, surgical guides and custom-made implants for TKR. The users of patient-specific instrumentation (PSI) claim that they allow the optimum balance of technology and conventional surgery by reducing the complexity of conventional alignment and sizing tools. In this way the advantages of accuracy and precision claimed by computer navigation techniques are achieved without the disadvantages of additional intra-operative inventory, new skills or surgical time. This review describes the terminology used in this area and debates the advantages and disadvantages of PSI.

  1. Peritendinous calcinosis of calcaneus tendon associated with dermatomyositis: correlation between conventional radiograph, ultrasound, magnetic resonance imaging and gross surgical pathology; Calcinose peritendinea do tendao calcaneo associada a dermatomiosite: correlacao entre radiografia convencional, ultra-sonografia, ressonancia magnetica e macroscopia cirurgica

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    Rosa, Ana Claudia Ferreira; Gomide, Lidyane Marques de Paula; Lemes, Marcella Stival [Universidade Federal de Goias (UFG), Goiana, GO (Brazil). Faculdade de Medicina. Hospital das Clinicas; Costa, Edegmar Nunes; Rocha, Valney Luiz da [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Ortopedia; Machado, Marcio Martins; Santos Junior, Rubens Carneiro dos; Barros, Nestor de; Cerri, Giovanni Guido [Universidade Federal de Goias (UFG), Goiania, GO (Brazil). Faculdade de Medicina. Dept. de Radiologia; Sernik, Renato Antonio [Sao Paulo Univ., SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Nunes, Rodrigo Alvarenga [Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG (Brazil). Faculdade de Ciencias Medicas; Albieri, Alexandre Daher [Hospital de Acidentados de Goiania, GO (Brazil)

    2006-01-15

    Interstitial calcinosis is an uncommon condition in which there is either localized or widely disseminated deposition of calcium in the skin, subcutaneous tissues, muscles, and tendons. Calcinosis is often associated with collagen diseases, scleroderma and dermatomyositis. The authors report a case of interstitial calcinosis associated with dermatomyositis studied with conventional radiograph, ultrasound and magnetic resonance imaging, and correlate the imaging findings with the results of surgical pathology gross examination. (author)

  2. MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches

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    Agten, Christoph A.; Sutter, Reto; Pfirrmann, Christian W.A. [Balgrist University Hospital, Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Dora, Claudio [Balgrist University Hospital, Orthopedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2017-03-15

    To compare soft-tissue changes after total hip arthroplasty with posterior, direct-lateral, anterolateral, or anterior surgical approaches. MRI of 120 patients after primary total hip arthroplasty (30 per approach) were included. Each MRI was assessed by two readers regarding identification of surgical access, fatty muscle atrophy (Goutallier classification), tendon quality (0 = normal, 1 = tendinopathy, 2 = partial tear, 3 = avulsion), and fluid collections. Readers were blinded to the surgical approach. Surgical access was correctly identified in all cases. The direct lateral approach showed highest Goutallier grades and tendon damage for gluteus minimus muscle (2.07-2.67 and 2.00-2.77; p = 0.017 and p = 0.001 for readers 1 and 2, respectively) and tendon (2.30/1.67; p < 0.0005 for reader 1/2), and the lateral portion of the gluteus medius tendon (2.77/2.20; p < 0.0005 for reader 1/2). The posterior approach showed highest Goutallier grades and tendon damage for external rotator muscles (1.97-2.67 and 1.57-2.40; p < 0.0005-0.006 for reader 1/2) and tendons (1.41-2.45 and 1.93-2.76; p < 0.0005 for reader 1/2). The anterolateral and anterior approach showed less soft tissue damage. Fluid collections showed no differences between the approaches. MRI is well suited to identify surgical approaches after THA. The anterior and anterolateral approach showed less soft tissue damage compared to the posterior and direct lateral approach. (orig.)

  3. Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications.

    Science.gov (United States)

    O'Gorman, T; MacDonald, N; Mould, T; Cutner, A; Hurley, R; Olaitan, A

    2009-01-01

    To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.

  4. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.

    Science.gov (United States)

    Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O

    2017-06-01

    Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

    2017-01-01

    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  6. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls.

    Science.gov (United States)

    Barg, Alexej; Knupp, Markus; Henninger, Heath B; Zwicky, Lukas; Hintermann, Beat

    2012-12-01

    Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.

  7. A novel computer-assisted surgical technique for revision total knee arthroplasty.

    Science.gov (United States)

    Marcacci, Maurilio; Nofrini, Laura; Iacono, Francesco; Di Martino, Alessandro; Bignozzi, Simone; Lo Presti, Mirco

    2007-12-01

    Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the intervention, and provides the surgeon with tools to analyse and modify the proposed plan and to accurately reproduce it on the patient. Although we performed few cases with this navigated procedure, early results obtained demonstrated to be very promising.

  8. Surgical Repair of Total Anomalous Pulmonary Venous Connection in a Neonate With Mosaic Trisomy 8.

    Science.gov (United States)

    Hasegawa, Tomomi; Oshima, Yoshihiro; Sato, Yumi; Tanaka, Akiko

    2016-03-01

    Trisomy 8 mosaicism is a relatively rare chromosomal abnormality and has extremely variable phenotype with a wide range of clinical manifestations. Although no well-defined criteria for cardiac surgical indications are available for patients with mosaic trisomy 8, we present a case of hypoplastic left heart syndrome with total anomalous pulmonary venous connection (TAPVC) in a neonate with mosaic trisomy 8. Although primary sutureless repair of TAPVC with concomitant bilateral pulmonary artery banding was performed successfully in this case, the indications for cardiac surgery in patients with mosaic trisomy 8 should be carefully individualized. The entire dialog with parents and family, including the process of informed consent, is of great importance.

  9. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique.

    Science.gov (United States)

    Koulouvaris, Panagiotis; Stafylas, Kosmas; Sculco, Thomas; Xenakis, Theodore

    2008-10-01

    Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.

  10. Design of a Quality Control Program for the Measurement of Gross Alpha and Gross Beta Activities (LMPR-CIEMAT); Diseno del Control de Calidad de las Medidas de Actividad Alfa-Beta Total (LMPR-CIEMAT)

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez, A.; Yague, L.; Gasco, C.; Navarro, N.; Higueras, E.; Noguerales, C.

    2010-10-21

    In accordance with international standards, general requirements for testing laboratories have to include a quality system for planning, implementing, and assessing the work performed by the organization and for carrying out required quality assurance and quality control. The purpose of internal laboratory quality control is to monitor performance, identify problems, and initiate corrective actions. This report describes the internal quality control to monitor the gross alpha and beta activities determination. Identification of specific performance indicators, the principles that govern their use and statistical means of evaluation are explained. Finally, calculation of alpha and beta specific activities, uncertainties and detection limits are performed. (Author) 10 refs.

  11. Totally laparoscopic hepatectomy exposing the vessels around the tumor intended to secure the surgical margin.

    Science.gov (United States)

    Honda, Goro; Kurata, Masanao; Okuda, Yukihiro; Kobayashi, Shin; Sakamoto, Katsunori

    2014-04-01

    Anatomical hepatectomy (AH) is basically not required for metastatic tumors in terms of oncology, but is required for hepatocellular carcinoma [1-5]; however, the surgeon cannot secure the surgical margin by palpation via a laparoscopic approach. Therefore, AH or partial hepatectomy exposing the vessels around the tumor (PHev) is often better for deep-seated or invisible lesions [6, 7] because unexpected exposure of the tumor on the cutting plane can be avoided by creating a cutting plane on the side of exposed vessels. From August 2008 to December 2012, we performed totally laparoscopic AH or PHev for 29 patients (AH in 21 patients and PHev in 8 patients) to secure the surgical margin of metastatic tumors [8, 9]. The median operative time was 329 (range 147-519) min, with median blood loss of 141 (range 5-430) g. Conversion was performed for one patient whose stump of the Glissonean branch was positive in a frozen section. Additional hepatectomy was performed via an open approach. Postoperative morbidity rate was 20.7 % (peroneal palsy in two patients, ileus in one patient, biloma in one patient, and pulmonary embolism in one patient). Mortality was zero. The median length of hospital stay after surgery was 9 (range 4-21) days. Only one patient, who underwent extended posterior sectorectomy for a 4.2-cm tumor developing close to the right main Glissonean pedicle, had a microscopically positive margin, because the tumors were exposed on the cutting plane. The embedded video demonstrates hepatectomy of the dorsal half-segment of the right anterior sector, during which the liver was divided at the anterior fissure [10] and the border between the anterior and posterior sector. Totally laparoscopic hepatectomy exposing the vessels around the tumor can be performed safely and is useful to secure the surgical margin in patients with a metastatic tumor.

  12. Modified surgical techniques for total alloplastic temporomandibular joint replacement: One institution's experience.

    Science.gov (United States)

    ShanYong, Zhang; Liu, Huan; Yang, Chi; Zhang, XiaoHu; Abdelrehem, Ahmed; Zheng, JiSi; Jiao, ZiXian; Chen, MinJie; Qiu, YaTing

    2015-07-01

    To present three modified techniques of total alloplastic temporomandibular joint replacement (TMJ TJR) and to evaluate the outcomes regarding prosthesis stability and heterotopic bone formation. A total of 15 patients (19 joints), treated with the Biomet stock prosthesis from May 2006 to May 2013, were retrospectively analyzed. Surgical procedures were performed with the following three modifications: bone grafting of the glenoid fossa; salvage of TMJ discs; and harvesting of retro-mandibular subcutaneous fats. The glenoid fossa depth was measured preoperatively by Surgicase 5.0 software. All patients were evaluated by radiographic examination and surgical observation. The fossa was grafted with an autogenous bone in 15 joints (78.9%). In 4 joints (21.1%), only bone repair was performed. Radiographic evaluation revealed a good integration between the autogenous and host bones. All patients showed postoperative occlusal stability. In 5 joints (26.3%), the discs were salvaged. Both bleeding and operation time were reduced. Fat grafts were harvested in 17 joints (89.5%), in which there were no abnormalities in the periprosthetic bone structure. In 2 joints (10.5%), with no fat grafting, heterotopic bone formation was found. The modified techniques of TJR help to improve prostheses stability, reducing heterotopic bone formation and avoiding additional scars. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: A case series

    Directory of Open Access Journals (Sweden)

    Abd Elmaksoud M. Abd Elmaksoud

    2015-06-01

    Conclusions: Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.

  14. Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability

    Science.gov (United States)

    Denard, Patrick J.; Dai, Xuesong; Burkhart, Stephen S.

    2015-01-01

    Purpose: Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation. Materials and Methods: A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with 25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method. Results: Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013). Conclusion: Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation. Level of evidence: Level III, retrospective comparative study. PMID:25709237

  15. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery using computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Wolford, Larry M

    2015-02-01

    Combined orthognathic and total joint reconstruction cases can be predictably performed in 1 stage. Use of virtual surgical planning can eliminate a significant time requirement in preparation of concomitant orthognathic and temporomandibular joint (TMJ) prostheses cases. The concomitant TMJ and orthognathic surgery-computer-assisted surgical simulation technique increases the accuracy of combined cases. In order to have flexibility in positioning of the total joint prosthesis, recontouring of the lateral aspect of the rami is advantageous.

  16. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    Science.gov (United States)

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  17. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    Directory of Open Access Journals (Sweden)

    Hintermann Beat

    2011-10-01

    Full Text Available Abstract Background Simultaneous osteoarthritis (OA of the ankle joint complicates primary total knee arthroplasty (TKA. In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week and hospital stay (12 days of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.

  18. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter?

    Science.gov (United States)

    Petis, Stephen M; Howard, James L; Lanting, Brent A; Marsh, Jacquelyn D; Vasarhelyi, Edward M

    2016-01-01

    The purposes of this study were to determine the impact of surgical approach on costs of total hip arthroplasty (THA) from a hospital perspective and to provide an updated cost estimation of THA. A prospective, microcosting analysis was performed on 118 patients undergoing a THA through an anterior, lateral, or posterior approach. We determined that overall costs (intraoperative costs and hospital stay) were significantly less for the anterior ($7300.22; 95% confidence interval [CI], 7064.49-7535.95) vs lateral ($7853.10; 95% CI, 7577.29-8128.91; P = .031) and anterior vs posterior approach ($8287.46; 95% CI, 7906.42-8668.51; P costs from a hospital perspective.

  19. Isolation and characterization of human articular chondrocytes from surgical waste after total knee arthroplasty (TKA)

    Science.gov (United States)

    Gradišnik, Lidija; Gorenjak, Mario; Vogrin, Matjaž

    2017-01-01

    Background Cartilage tissue engineering is a fast-evolving field of biomedical engineering, in which the chondrocytes represent the most commonly used cell type. Since research in tissue engineering always consumes a lot of cells, simple and cheap isolation methods could form a powerful basis to boost such studies and enable their faster progress to the clinics. Isolated chondrocytes can be used for autologous chondrocyte implantation in cartilage repair, and are the base for valuable models to investigate cartilage phenotype preservation, as well as enable studies of molecular features, nature and scales of cellular responses to alterations in the cartilage tissue. Methods Isolation and consequent cultivation of primary human adult articular chondrocytes from the surgical waste obtained during total knee arthroplasty (TKA) was performed. To evaluate the chondrogenic potential of the isolated cells, gene expression of collagen type 2 (COL2), collagen 1 (COL1) and aggrecan (ACAN) was evaluated. Immunocytochemical staining of all mentioned proteins was performed to evaluate chondrocyte specific production. Results Cartilage specific gene expression of COL2 and ACAN has been shown that the proposed protocol leads to isolation of cells with a high chondrogenic potential, possibly even specific phenotype preservation up to the second passage. COL1 expression has confirmed the tendency of the isolated cells dedifferentiation into a fibroblast-like phenotype already in the second passage, which confirms previous findings that higher passages should be used with care in cartilage tissue engineering. To evaluate the effectiveness of our approach, immunocytochemical staining of the evaluated chondrocyte specific products was performed as well. Discussion In this study, we developed a protocol for isolation and consequent cultivation of primary human adult articular chondrocytes with the desired phenotype from the surgical waste obtained during TKA. TKA is a common and very

  20. Isolation and characterization of human articular chondrocytes from surgical waste after total knee arthroplasty (TKA

    Directory of Open Access Journals (Sweden)

    Jakob Naranda

    2017-03-01

    Full Text Available Background Cartilage tissue engineering is a fast-evolving field of biomedical engineering, in which the chondrocytes represent the most commonly used cell type. Since research in tissue engineering always consumes a lot of cells, simple and cheap isolation methods could form a powerful basis to boost such studies and enable their faster progress to the clinics. Isolated chondrocytes can be used for autologous chondrocyte implantation in cartilage repair, and are the base for valuable models to investigate cartilage phenotype preservation, as well as enable studies of molecular features, nature and scales of cellular responses to alterations in the cartilage tissue. Methods Isolation and consequent cultivation of primary human adult articular chondrocytes from the surgical waste obtained during total knee arthroplasty (TKA was performed. To evaluate the chondrogenic potential of the isolated cells, gene expression of collagen type 2 (COL2, collagen 1 (COL1 and aggrecan (ACAN was evaluated. Immunocytochemical staining of all mentioned proteins was performed to evaluate chondrocyte specific production. Results Cartilage specific gene expression of COL2 and ACAN has been shown that the proposed protocol leads to isolation of cells with a high chondrogenic potential, possibly even specific phenotype preservation up to the second passage. COL1 expression has confirmed the tendency of the isolated cells dedifferentiation into a fibroblast-like phenotype already in the second passage, which confirms previous findings that higher passages should be used with care in cartilage tissue engineering. To evaluate the effectiveness of our approach, immunocytochemical staining of the evaluated chondrocyte specific products was performed as well. Discussion In this study, we developed a protocol for isolation and consequent cultivation of primary human adult articular chondrocytes with the desired phenotype from the surgical waste obtained during TKA. TKA is a

  1. Gross motor control

    Science.gov (United States)

    Gross motor control is the ability to make large, general movements (such as waving an arm or lifting a leg). ... Gross motor control is a milestone in the development of an infant. Infants develop gross motor control before they develop ...

  2. Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty.

    Science.gov (United States)

    Schirm, Andreas C; Jeffcote, Benjamin O; Nicholls, Rochelle L; Jakob, Hilaire; Kuster, Markus S

    2011-06-01

    Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs. Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2mm and the force measurements repeated. Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90° of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs. The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.

  3. Muscle damage during minimally invasive surgical total knee arthroplasty traditional versus optimized subvastus approach.

    Science.gov (United States)

    Rossi, Roberto; Maiello, Alessio; Bruzzone, Matteo; Bonasia, Davide Edoardo; Blonna, Davide; Castoldi, Filippo

    2011-08-01

    Decreased muscle damage is reported as an advantage of minimally invasive surgical (MIS) approaches in total knee arthroplasty (TKA). The purpose of this study was to evaluate the anatomy of vastus medialis obliquus (VMO) tendon at its patellar insertion as well as to determine the amount and location of muscle damage comparing traditional subvastus approach and optimized subvastus approach. TKAs were performed in ten human cadavers (20 knees). In each specimen, one knee underwent the traditional subvastus approach and the contralateral knee the optimized subvastus approach. The risk of tearing and damaging the VMO muscle during the traditional subvastus approach is significantly higher (70% of the cases) compared to the optimized technique (30%). The amount of damage to the VMO muscle using the traditional subvastus approach was: 80% of the muscle's width in two cases, 60% in three cases, and 30% in two. The damage created by the optimized subvastus approach occurred along the edge of the tendon and the first fibers of the VMO muscle close to the muscle-tendon junction (less than 20% of muscle's width). Clinical studies are needed to determine the functional implications of these findings.

  4. [Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation].

    Science.gov (United States)

    Courant, O; Letessier, E; Moutel, M G; Hamy, A; Paineau, J; Visset, J

    1993-01-01

    Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

  5. Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.

    Science.gov (United States)

    Florschutz, Anthony V; Parsley, Brian S; Shapiro, Irving M

    2015-04-01

    Greater documentation of patient history and clinical course is crucial for identifying factors that can influence surgical outcomes. The Centers for Medicare and Medicaid Services have already begun public reporting of hospital data on readmission, complication, and infection rates and will soon launch a website to make physician-specific outcomes data public. The orthopaedic community has the opportunity to lead the way in ensuring that adequate and accurate data is collected to facilitate appropriate comparisons that are based on patients' true risk of complications and the complexity of treatment. Several studies have reported a link between oral pathogens and periprosthetic infection, although it remains unclear whether organisms unique to dental tissues are also present in osteoarthritic joints and tissues affected by periprosthetic joint infection. The American Academy of Orthopaedic Surgeons and the American Dental Association are aware of these concerns and have created guidelines for antibiotic prophylaxis in patients who have undergone total hip or knee arthroplasty and require high-risk dental procedures. Because these guidelines have received considerable criticism, recommendations that are based on scientific and case-controlled clinical studies and provide effective guidance on this important subject are needed.

  6. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain

    DEFF Research Database (Denmark)

    Skou, S. T.; Roos, E. M.; Simonsen, O.;

    2016-01-01

    BACKGROUND: The objective was to compare the effect of total knee replacement (TKR) followed by a 3-month non-surgical treatment with the non-surgical treatment alone in reducing pain sensitization and other pain-related measures in patients with knee osteoarthritis. METHODS: One hundred patients...... were randomized to (1) TKR followed by a non-surgical treatment of neuromuscular exercise, education, diet, insoles and pain medication or (2) the non-surgical treatment alone. Outcomes assessed at baseline and after 3 months were as follows: (1) pain sensitization assessed as pressure-pain thresholds...... no significant between-group differences in change in the pain-related measures from baseline to 3 months (p = 0.15-0.27). Both groups improved in most of the pain-related measures (p treatment is more effective in reducing localized and spreading...

  7. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation.

    Science.gov (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M

    2013-12-01

    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery.

  8. An Examination of the Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

    Science.gov (United States)

    Montez-Ray, Natasha Dawn

    2011-01-01

    As patients prepare for total-knee arthroplasty surgery, they have numerous expectations related to their long-term recovery and function. This research discerned whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective…

  9. Efficacy of multimodal, systematic non-surgical treatment of knee osteoarthritis for patients not eligible for a total knee replacement

    DEFF Research Database (Denmark)

    Skou, Soren Thorgaard; Roos, Ewa M.; Laursen, Mogens Berg

    2012-01-01

    in a randomised controlled study. The purpose of this randomised controlled study is to examine if an optimised, combined non-surgical treatment programme results in greater improvements in pain, function and quality of life in comparison with usual care in patients with KOA who are not eligible for total knee...

  10. Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review.

    Science.gov (United States)

    Baert, I A C; Lluch, E; Mulder, T; Nijs, J; Noten, S; Meeus, M

    2016-02-01

    The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR.

  11. Total hip replacement in an ipsilateral above-the-knee amputation: surgical technique, rehabilitation, and review of the literature.

    Science.gov (United States)

    Malagelada, Francesc; Coll Rivas, Moisès; Jiménez Obach, Albert; Auleda, Jaume; Guirao, Lluis; Pleguezuelos, Eulogio

    2013-03-01

    In this article, we present a case report of a 62-year-old patient who previously underwent an above-the-knee amputation for vascular disease and we performed a total hip replacement on him because of hip osteoarthritis. As the only postoperative complication, the patient developed a methicillin-resistant Staphylococcus aureus surgical site infection, which was successfully treated. The surgical technique and the postoperative rehabilitation program are described in detail in an attempt to detect and face the challenges that patients with major lower limb amputations may present. The literature is reviewed and all known cases of hip replacements in amputees are presented.

  12. NM Gross Receipts Baseline

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  13. Surgical and pathomorphological results of total mesorectumectomy by using waterjet dissection technique in patients with rectal cancer

    Directory of Open Access Journals (Sweden)

    D. V. Sidorov

    2016-01-01

    Full Text Available Background. The paper presents our own experience of using a waterjet dissector ERBEJET2® in the course of surgical interventions for colorectal cancer. This experience is unique for Russia.Materials and methods. Waterjet dissection method associated with total  mesorectumectomy was used by us in 20 patients suffering from rectal cancer. An average age of patients was 59.2 ± 13.9 years. In all the patients surgeries were performed for adenogenic colorectal cancer, morphologically verified at the preoperative stage. Resected preparations were studied on morphological level. For comparison, two control groups of 20 patients were selected, in which the rectum mobilization was performed by using monopolar coagulator and harmonic scalpel. The studied groups were matched by gender, age, location and the tumor extent. All the surgeries were performed by one surgical team.Results. Results of the study demonstrated advantages of waterjet dissection when performing total mesorectumectomy due to a minimum depth of tissue damage on the lateral margin of resection.Conclusion. Waterjet dissectors have taken their place in the extensive list of tools used when performing surgical interventions for colorectal cancer, that allows to expect an improvement of functional and oncological results of the surgical treatment.

  14. Gross National Happiness

    DEFF Research Database (Denmark)

    Giri, Krishna Prasad; Kjær-Rasmussen, Lone Krogh

    This paper investigates practices related to the ideology of infusing Gross National Happiness (GNH) into school curriculum, the effectiveness of the meditation and mind training and the implication of GNH for school environment. It also explores how GNH ambience has been managed and practiced...... of Gross National Happiness and Educating for Gross National happiness....

  15. Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: A case series.

    Science.gov (United States)

    Abd Elmaksoud, Abd Elmaksoud M; Farahat, Iman G; Kamel, Mahmoud M

    2015-06-01

    Total thyroidectomy is indicated in most cases with postcricoid carcinoma, circumferential hypopharyngeal carcinoma and in advanced laryngeal carcinoma. Persistent hypoparathyroidism is a frequent complication after total thyroidectomy which is difficult to manage unlike hypothyroidism. This study was to assess the feasibility of parathyroid gland autotranplantation after total thyroidectomy in advanced carcinomas and their effectiveness in preventing persistent hypoparathyroidism. This study included 26 patients with hypopharyngeal and laryngeal carcinoma presented to National Cancer Institute, Cairo University. Total thyroidectomy and total parathyroid gland excision were performed as a part of adequate oncologic surgical procedure. The parathyroid glands were identified, resected and stored in iced saline. Histological confirmation was necessary before implantation into separated muscle pockets in the anterior forearm muscles. Regular samples were drawn to assess serum parathormone and calcium levels. All patients experienced hypocalcaemia within 1-5 days after operation. Only one patient experienced parathyroid graft failure while the remaining patients were normocalcemic during follow up after surgery, indicating functioning parathyroid grafts. Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.

  16. The influence of surgical technique on early posttransplant atrial fibrillation – comparison of biatrial, bicaval, and total orthotopic heart transplantation

    Science.gov (United States)

    Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Erbel, Christian; Gleissner, Christian A; Darche, Fabrice F; Thomas, Dierk; Bruckner, Tom; Katus, Hugo A; Doesch, Andreas O

    2017-01-01

    Purpose Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. Patients and methods This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. Results A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (Pvalvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. Conclusion Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012). PMID:28331331

  17. Total temporomandibular joint prosthesis as a surgical option for severe mouth opening restriction. A case report of a bilateral intervention.

    Science.gov (United States)

    Guarda-Nardini, L; Manfredini, D; Berrone, S; Ferronato, G

    2007-01-01

    Several conservative treatment approaches to the disorders of the temporomandibular joint (TMJ) have been described in the literature. Nonetheless, in a minority of cases not respondent to reversible conservative therapies a surgical approach to the TMJ is needed. In recent years, a total temporomandibular joint replacement with alloplastic prosthesis have been introduced as a treatment option in the presence of a severely damaged or mutilated joint, mainly resulting from severe joint diseases, as in the case of complex inflammatory-degenerative diseases, or failure of previous surgeries. The present paper described a case report of a bilateral temporomandibular joint replacement intervention in a female patient with severe mouth opening restriction and pain in the TMJ area. Also, a discussion of the potential indications for TMJ replacement has been provided, along with the description of the surgical procedure.

  18. Surgical time and complications of total transvaginal (total-NOTES, single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

    Directory of Open Access Journals (Sweden)

    M.A.M. Silva

    2015-06-01

    Full Text Available The recently developed minimally invasive techniques of ovariohysterectomy (OVH have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group, while 13 underwent single-port laparoscopic-assisted (SPLA group and 15 were submitted to conventional OVH (OPEN group. Intra-operative period was divided into 7 stages: (1 access to abdominal cavity; (2 pneumoperitoneum; approach to the right (3 and left (4 ovarian pedicle and uterine body (5; (6 abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7 inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes and SPLA (23.1±4.0 minutes groups were shorter than in the OPEN group (34.0±6.4 minutes (P<0.05. The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

  19. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women

    National Research Council Canada - National Science Library

    Yu, C.K.H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary...

  20. Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

    Science.gov (United States)

    Kaklamanos, Ioannis; Flessas, Ioannis; Zoulamoglou, Menelaos; Katsoulas, Theodoros; Birbas, Konstantinos; Troupis, Theodoros; Mariolis-Sapsakos, Theodoros

    2017-01-01

    Abstract Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies. PMID:28458845

  1. Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results

    NARCIS (Netherlands)

    Capanna, R.; Totti, F.; Geest, I.C.M. van der; Muller, D.A.

    2015-01-01

    HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a

  2. The Current State of Screening and Decolonization for the Prevention of Staphylococcus aureus Surgical Site Infection After Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Weiser, Mitchell C; Moucha, Calin S

    2015-09-01

    The most common pathogens in surgical site infections after total hip and knee arthroplasty are methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and coagulase-negative staphylococci. Patients colonized with MSSA or MRSA have an increased risk for a staphylococcal infection at the site of a total hip or knee arthroplasty. Most colonized individuals who develop a staphylococcal infection at the site of a total hip or total knee arthroplasty have molecularly identical S. aureus isolates in their nares and wounds. Screening and nasal decolonization of S. aureus can potentially reduce the rates of staphylococcal surgical site infection after total hip and total knee arthroplasty.

  3. Surgical and oncological outcome of total laparoscopic radical hysterectomy in obese women with early-stage cervical cancer.

    Science.gov (United States)

    Moss, Esther Louise; Balega, Janos; Chan, Kiong K; Singh, Kavita

    2012-01-01

    To evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m) and nonobese (BMI obese, BMI >30 kg/m, or nonobese, BMI hysterectomy cases performed before the introduction of the TLRH. A total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2-13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3-42 months). She belonged to the nonobese group. The TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

  4. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women.

    Science.gov (United States)

    Yu, C K H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

  5. Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling.

    Science.gov (United States)

    Edelman, Eric R; van Kuijk, Sander M J; Hamaekers, Ankie E W; de Korte, Marcel J M; van Merode, Godefridus G; Buhre, Wolfgang F F A

    2017-01-01

    For efficient utilization of operating rooms (ORs), accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT) per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT) and other variables relevant to TPT. We extracted data from a Dutch benchmarking database of all surgeries performed in six academic hospitals in The Netherlands from 2012 till 2016. The final dataset consisted of 79,983 records, describing 199,772 h of total OR time. Potential predictors of TPT that were included in the subsequent analysis were eSCT, patient age, type of operation, American Society of Anesthesiologists (ASA) physical status classification, and type of anesthesia used. First, we computed the predicted TPT based on a previously described fixed ratio model for each record, multiplying eSCT by 1.33. This number is based on the research performed by van Veen-Berkx et al., which showed that 33% of SCT is generally a good approximation of anesthesia-controlled time (ACT). We then systematically tested all possible linear regression models to predict TPT using eSCT in combination with the other available independent variables. In addition, all regression models were again tested without eSCT as a predictor to predict ACT separately (which leads to TPT by adding SCT). TPT was most accurately predicted using a linear regression model based on the independent variables eSCT, type of operation, ASA classification, and type of anesthesia. This model performed significantly better than the fixed ratio model and the method of predicting ACT separately. Making use of these more accurate predictions in planning and sequencing algorithms may enable an increase in utilization of ORs, leading to significant financial and productivity related benefits.

  6. Affect of surgical approaches on functional results of total hip arthroplasty in early postoperative period

    Directory of Open Access Journals (Sweden)

    D. V. Andreyev

    2013-01-01

    Full Text Available Minimally invasive approaches implies a less soft tissue damage and, therefore, more rapid recovery of the patient in the early postoperative period. The present study is a comparison of minimally invasive and standard approaches using biomechanical analysis of standing and walking patients before and after total hip arthroplasty, as well as an analysis of clinical outcomes in the early postoperative period. Fifty patients undergoing primary total hip arthroplasty using a minimally invasive and conventional techniques were divided into three groups. The first group consisted of patients operated on using the MIS AL (modified minimally invasive approach Watson-Jones (n = 17, the second - MDM (minimally invasive approach to the modified Mueller (n = 16 and in the third - with the use of transgluteal conventional approach by Harding (n = 17. The estimation of biomechanical parameters in static and dynamic patients before surgery and at 8-10 days after surgery. Also assessed clinical outcome postoperative visual analogue scale (VAS and Harris scale on day 10, 6 and 12 weeks and 1 year. When comparing the three groups of patients stabilometry best results were observed in groups of minimally invasive approaches MIS AL and MDM. When comparing the three groups significantly better (a moderate increase in the duration of the step, rolling the contralateral limb and a slight increase in the duration of the step the operated limb by increasing the duration of the roll-over were identified in the minimally invasive group MIS AL and MDM. In assessing the scale of Harris in the early postoperative period, higher rates were observed in groups of minimally invasive approaches. A year after the operation functional results become similar in all groups.

  7. Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling

    Directory of Open Access Journals (Sweden)

    Eric R. Edelman

    2017-06-01

    Full Text Available For efficient utilization of operating rooms (ORs, accurate schedules of assigned block time and sequences of patient cases need to be made. The quality of these planning tools is dependent on the accurate prediction of total procedure time (TPT per case. In this paper, we attempt to improve the accuracy of TPT predictions by using linear regression models based on estimated surgeon-controlled time (eSCT and other variables relevant to TPT. We extracted data from a Dutch benchmarking database of all surgeries performed in six academic hospitals in The Netherlands from 2012 till 2016. The final dataset consisted of 79,983 records, describing 199,772 h of total OR time. Potential predictors of TPT that were included in the subsequent analysis were eSCT, patient age, type of operation, American Society of Anesthesiologists (ASA physical status classification, and type of anesthesia used. First, we computed the predicted TPT based on a previously described fixed ratio model for each record, multiplying eSCT by 1.33. This number is based on the research performed by van Veen-Berkx et al., which showed that 33% of SCT is generally a good approximation of anesthesia-controlled time (ACT. We then systematically tested all possible linear regression models to predict TPT using eSCT in combination with the other available independent variables. In addition, all regression models were again tested without eSCT as a predictor to predict ACT separately (which leads to TPT by adding SCT. TPT was most accurately predicted using a linear regression model based on the independent variables eSCT, type of operation, ASA classification, and type of anesthesia. This model performed significantly better than the fixed ratio model and the method of predicting ACT separately. Making use of these more accurate predictions in planning and sequencing algorithms may enable an increase in utilization of ORs, leading to significant financial and productivity related

  8. Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital.

    Science.gov (United States)

    Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Huang, Susan S

    2013-11-01

    Public reporting of surgical site infections (SSIs) by hospitals is largely limited to infections detected during surgical hospitalizations or readmissions to the same facility. SSI rates may be underestimated if patients with SSIs are readmitted to other hospitals. We assessed the impact of readmissions to other facilities on hospitals' SSI rates following primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). This was a retrospective cohort study of all patients who underwent primary THA or TKA at California hospitals between 1 January 2006 and 31 December 2009. SSIs were identified using ICD-9-CM diagnosis codes predictive of SSI assigned at any California hospital within 365 days of surgery using a statewide repository of hospital data that allowed tracking of patients between facilities. We used statewide data to estimate the fraction of each hospital's THA and TKA SSIs identified at the operative hospital versus other hospitals. A total of 91 121 THA and 121 640 TKA procedures were identified. Based on diagnosis codes, SSIs developed following 2214 (2.3%) THAs and 2465 (2.0%) TKAs. Seventeen percent of SSIs would have been missed by operative hospital surveillance alone. The proportion of hospitals' SSIs detected at nonoperative hospitals ranged from 0% to 100%. Including SSIs detected at nonoperative hospitals resulted in better relative ranking for 61% of THA hospitals and 61% of TKA hospitals. Limiting SSI surveillance to the operative hospital caused varying degrees of SSI underestimation and substantially impacted hospitals' relative rankings, suggesting that alternative methods for comprehensive postdischarge surveillance are needed for accurate benchmarking.

  9. 肘关节置换术操作技术的进展%The progress of the surgical technique of total elbow replacement

    Institute of Scientific and Technical Information of China (English)

    查晔军; 蒋协远

    2016-01-01

    Total elbow replacement is designed for the elbow joint articular surface damage and degenerative joint changes, but in recent years, it is widely used in the treatment of the distal humeral articular comminuted fracture in elderly patients. The purpose is to provide a stable, painless elbow joint with good functions. Total elbow replacement is a dififcult operation with its special surgical indications, requiring rich surgical experience. Even if the surgical technique is mature, there are still a lot of controversies in the surgical indication, prosthesis selection, surgical approach, condylar management and the disposal of the ulnar nerve. Based on the literature reviewed and the author’s experience, this paper analyzes some disputes. Although many scholars have conducted many prospective controlled studies, there are still some authors with different views, requiring prospective randomized controlled studies with a greater number of cases to clarify.

  10. Loovkirjutamist õpetab Philip Gross

    Index Scriptorium Estoniae

    2011-01-01

    T.S. Elioti luulepreemia laureaat Philip Gross on Tallinna Ülikooli talvekooli rahvusvahelise kursuse "Poetry: A Conversation between Words and Silence" läbiviija. Oma seminarides keskendub ta lisaks loovkirjutamisele ka loova lugemise vajadusele

  11. Gross Sales Tax Collections

    Data.gov (United States)

    City of Jackson, Mississippi — This data is captured directly from the MS Department of Revenue and specific to the City of Jackson. It is compiled from Gross Sales Tax reported by taxpayers each...

  12. Bariatric surgery prior to total joint arthroplasty may not provide dramatic improvements in post-arthroplasty surgical outcomes.

    Science.gov (United States)

    Inacio, Maria C S; Paxton, Elizabeth W; Fisher, David; Li, Robert A; Barber, Thomas C; Singh, Jasvinder A

    2014-07-01

    This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n = 69), those with bariatric surgery >2 years prior to TJA, Group 2 (n = 102), those with surgery within 2 years of TJA, and Group 3 (n = 11,032), those without bariatric surgery. In Group 1, 2.9% (95% CI 0.0-6.9%) had complications within 1 year compared to 5.9% (95% CI 1.3%-10.4%) in Group 2, and 4.1% (95% CI 3.8%-4.5%) in Group 3. Ninety-day readmission (7.2%, 95% CI 1.1%-13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes.

  13. Bariatric Surgery Prior to Total Joint Arthroplasty May Not Provide Dramatic Improvements In Post Arthroplasty Surgical Outcomes

    Science.gov (United States)

    Paxton, Elizabeth W.; Fisher, David; Li, Robert A.; Barber, Thomas C.; Singh, Jasvinder A.

    2014-01-01

    This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n=69), those with bariatric surgery >2 years prior to TJA, Group 2 (n=102), those with surgery within 2 years of TJA, and Group 3 (n=11,032), those without bariatric surgery. In Group 1, 2.9% (95%CI 0.0–6.9%) had complications within 1 year compared to 5.9% (95%CI 1.3–10.4%) in Group 2, and 4.1% (95%CI 3.8–4.5%) in Group 3. 90-day readmission (7.2%, 95%CI 1.1–13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes. PMID:24674730

  14. [From the first face replants operations to the first total face transplant: the history of surgical prowess].

    Science.gov (United States)

    Pirnay, P; Herve, C; Meningaud, J-P

    2011-04-01

    Composite tissue allografts of the face were considered as science-fiction just a decade ago. They have become wonderful realities in our hospitals. Face transplantation is one of the great scientific adventures of the 21(th) century that history will remember. Physicians dreamed to give a new face to disfigured patients. Allografts of the face have become a reality thanks to breakthroughs in anatomy and plastic surgery, HLA system research, microsurgery, neurology, and immunosuppressive molecules. In 2010, two teams performed the first total face transplants in the world. They represent technical milestones in the history of transplantation. These face transplants, which have raised a lot of controversy and ethical questions, open the way for other surgical perspectives, allowing medicine to write new history, and show that progress is also made through transgression.

  15. Reconstruction of a deficient patella in revision total knee arthroplasty: results of a new surgical technique using transcortical wiring.

    Science.gov (United States)

    Seo, Jai-Gon; Moon, Young-Wan; Lee, Byung-Hoon; Kim, Sang-Min

    2015-02-01

    This study aimed to report the results of a novel surgical technique for the reconstruction of a deficient patella during revision total knee arthroplasty (TKA). Twenty-eight patients (30 knees) with a deficient patella were treated with an onlay-type prosthesis and bone-augmenting procedure, using acrylic bone cement and transcortical wiring. The technique was indicated when the thickness of remnant patella was less than 8mm with variable amounts of the peripheral rim. Mean follow-up period was 36.6months (range, 24 to 55months).The respective mean Knee Society scores for knee and function improved from 34.2 and 23 points, preoperatively to 73.5 and 61 points, at final follow-up. One patient experienced patellar fracture 1week after surgery. There were no complications associated with implanted hardware. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Total hip arthroplasty vs. osteosynthesis in acute complex acetabular fractures in the elderly: Evaluation of surgical management and outcomes

    Directory of Open Access Journals (Sweden)

    Serafino Carta

    2017-01-01

    Full Text Available Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification were treated. The patients were divided into two groups. The total hip arthoplasty (THA group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12 health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

  17. Validating the Rett Syndrome Gross Motor Scale.

    Science.gov (United States)

    Downs, Jenny; Stahlhut, Michelle; Wong, Kingsley; Syhler, Birgit; Bisgaard, Anne-Marie; Jacoby, Peter; Leonard, Helen

    2016-01-01

    Rett syndrome is a pervasive neurodevelopmental disorder associated with a pathogenic mutation on the MECP2 gene. Impaired movement is a fundamental component and the Rett Syndrome Gross Motor Scale was developed to measure gross motor abilities in this population. The current study investigated the validity and reliability of the Rett Syndrome Gross Motor Scale. Video data showing gross motor abilities supplemented with parent report data was collected for 255 girls and women registered with the Australian Rett Syndrome Database, and the factor structure and relationships between motor scores, age and genotype were investigated. Clinical assessment scores for 38 girls and women with Rett syndrome who attended the Danish Center for Rett Syndrome were used to assess consistency of measurement. Principal components analysis enabled the calculation of three factor scores: Sitting, Standing and Walking, and Challenge. Motor scores were poorer with increasing age and those with the p.Arg133Cys, p.Arg294* or p.Arg306Cys mutation achieved higher scores than those with a large deletion. The repeatability of clinical assessment was excellent (intraclass correlation coefficient for total score 0.99, 95% CI 0.93-0.98). The standard error of measurement for the total score was 2 points and we would be 95% confident that a change 4 points in the 45-point scale would be greater than within-subject measurement error. The Rett Syndrome Gross Motor Scale could be an appropriate measure of gross motor skills in clinical practice and clinical trials.

  18. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis.

    Science.gov (United States)

    Qin, Charles D; Helfrich, Mia M; Fitz, David W; Hardt, Kevin D; Beal, Matthew D; Manning, David W

    2017-09-01

    Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ(2) tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty.

    Science.gov (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H

    2017-08-01

    Background and purpose - Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods - We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5-0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation - Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

  20. Multiregional estimation of gross internal migration flows.

    Science.gov (United States)

    Foot, D K; Milne, W J

    1989-01-01

    "A multiregional model of gross internal migration flows is presented in this article. The interdependence of economic factors across all regions is recognized by imposing a non-stochastic adding-up constraint that requires total inmigration to equal total outmigration in each time period. An iterated system estimation technique is used to obtain asymptotically consistent and efficient parameter estimates. The model is estimated for gross migration flows among the Canadian provinces over the period 1962-86 and then is used to examine the likelihood of a wash-out effect in net migration models. The results indicate that previous approaches that use net migration equations may not always be empirically justified."

  1. Understanding the surgical pitfalls in total mesorectal excision: Investigating the histology of the perirectal fascia and the pelvic autonomic nerves.

    Science.gov (United States)

    Kraima, A C; West, N P; Treanor, D; Magee, D R; Bleys, R L A W; Rutten, H J T; van de Velde, C J H; Quirke, P; DeRuiter, M C

    2015-12-01

    Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located part of the rectum in en-bloc cadaveric specimens and the University Medical Center Utrecht (UMCU) pelvic dataset, and describe implications for TME. Four donated human adult cadaveric specimens (two males, two females) were obtained through the Leeds GIFT Research Tissue Programme. Paraffin-embedded blocks were produced and serially sectioned at 50 and 250 μm intervals. Whole mount sections were stained with haematoxylin & eosin, Masson's trichrome and Millers' elastin. Additionally, the UMCU pelvic dataset including digitalised cryosections of a female pelvis in three axes was studied. The mid and lower rectum were surrounded by a multi-layered perirectal fascia, of which the mesorectal fascia (MRF) and parietal fascia bordered the 'holy plane'. There was no extra constant fascia forming a potential surgical plane. Nerves ran laterally to the MRF. More caudally, the mesorectal fat strongly reduced and the MRF approached the rectal muscularis propria. The MRF had a variable appearance in terms of thickness and completeness, most prominently at the anterolateral lower rectum. Dissection onto the MRF allows nerve preservation in TME. Rectal surgeons are challenged in doing so as the MRF varies in thickness and shows gaps, most prominently at the anterolateral lower rectum. At this site, the risk of entering the mesorectum is great and may result in an incomplete specimen. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The role of other stakeholders than the surgeon in relation to surgical site infections following total joint replacement.

    Science.gov (United States)

    Stuyts, Bart; Van den Eeden, Elke; Fennema, Peter

    2015-12-01

    In contemporary orthopaedics, surgical site infections (SSIs) can have significant negative consequences for both patients and the healthcare system overall. To date, most efforts at combating the risk of SSIs have focused on the role of the surgeon, yet recent data suggest that a more expansive approach is warranted. The current review offers an overview of the most-relevant factors associated with SSIs in orthopaedic surgery, and the crucial role that the full surgical staff can play in addressing them.

  3. Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia: A Prospective Cohort Study of Surgical Outcomes and Follow-Up of 42 Patients

    NARCIS (Netherlands)

    Bouman, M.B.; Sluis, W.B. van der; Buncamper, M.E.; Ozer, M.; Mullender, M.G.; Meijerink, W.J.H.J.

    2016-01-01

    BACKGROUND: In young transgender women previously treated with puberty-suppressing hormones, penoscrotal hypoplasia can make penoscrotal inversion vaginoplasty unfeasible. The aim of this study was to prospectively assess surgical outcomes and follow-up of total laparoscopic sigmoid vaginoplasty as

  4. Glutamine-supplemented total parenteral nutrition attenuates plasma interleukin-6 in surgical patients with lower disease severity

    Institute of Scientific and Technical Information of China (English)

    Ming-Tsan Lin; Sung-Pao Kung; Sung-Ling Yeh; Koung-Yi Liaw; Ming-Yang Wang; Ming-Liang Kuo; Po-Houng Lee; Wei-Jao Chen

    2005-01-01

    AIM: To evaluate whether the effect of Gln dipeptideenriched total parenteral nutrition (TPN) on postoperative cytokine alteration depended on the disease severity of surgical patients.METHODS: Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg per d) and isocaloric(30 kcal/kg per d) TPN for 6 d. Control group (Conv)using conventional TPN solution received 1.5 g amino adds/kg per day, whereas the test group received 0.972 g amino acids/kg per day and 0.417 g L-alanyl-L-glutamine(Ala-Gln)/kg per day. Blood samples were collected on d 1 and d 6 postoperatively for plasma interleukin (IL)-2,IL-6, IL-8, and interferon (IFN)-γ analysis.RESULTS: Plasma IL-2 and IFN-γ were not detectable.IL-6 concentrations were significantly lower on the 6th postoperative day in the Ala-Gln group than those in the Conv group in patients with APACHE Ⅱ≤6, whereas no difference was noted in patients with APACHE Ⅱ>6. There was no difference in IL-8 levels between the two groups.No difference in cumulative nitrogen balance was observed on d 2-5 after the operation between the two groups(Ala-Gln -3.2±1.6 g vs Conv -6.5±2.7 g). A significant inverse correlation was noted between plasma IL-6 levels and cumulative nitrogen balance postoperatively in the Ala-Gln group, whereas no such correlation was observed in the Conv group.CONCLUSION: TPN supplemented with Gln dipeptide had no effect on plasma IL-8 levels after surgery. However,Gln supplementation had a beneficial effect on decreasing systemic IL-6 production after surgery in patients with low admission illness severity, and lower plasma IL-6 may improve nitrogen balance in patients with abdominal surgery when Gln was administered.

  5. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal

    Directory of Open Access Journals (Sweden)

    Jörn Kircher

    2010-10-01

    Full Text Available Jörn Kircher, Christoph Ziskoven, Thilo Patzer, Daniela Zaps, Bernd Bittersohl, Rüdiger KrauspeUniversity Hospital, Orthopaedic Department, Heinrich-Heine University Düsseldorf, Düsseldorf, GermanyAbstract: The complete rupture of the pectoralis major tendon is an uncommon injury but has become increasingly common among athletes in recent years. This may be due to a higher number of individuals taking part in high-impact sports and weightlifting as well as the use of anabolic substances, which can make muscles and tendons vulnerable to injury. In recent literature, there are only few recommendations to rely on conservative treatment alone, but there are a number of reports and case series recommending early surgical intervention. Comparing the results of the two treatment regimens, there is clear evidence for a superior outcome after surgical repair with better cosmesis, better functional results, regaining of muscle power, and return to sports compared with the conservative treatment. In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes.Keywords: pectoralis major, rupture, athlete, conservative treatment, surgical treatment, steroid, tendon, sports injury

  6. The efficacy of 12 weeks non-surgical treatment for patients not eligible for total knee replacement

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Rasmussen, Sten; Laursen, Mogens Berg

    2015-01-01

    secondary care with knee OA, confirmed by radiography (Kellgren-Lawrence grade ≥1), but not eligible for a TKR. The 12-week non-surgical treatment program consisted of individualized progressed neuromuscular exercise, patient education, insoles, dietary advice and prescription of pain medication...

  7. Gross decontamination experiment report

    Energy Technology Data Exchange (ETDEWEB)

    Mason, R.; Kinney, K.; Dettorre, J.; Gilbert, V.

    1983-07-01

    A Gross Decontamination Experiment was conducted on various levels and surfaces of the TMI - Unit 2 reactor building in March 1982. The polar crane, D-rings, missile shields, refueling canals, refueling bridges, equipment, and elevations 305' and 347'-6'' were flushed with low pressure water. Additionally, floor surfaces on elevation 305' and floor surfaces and major pieces of equipment on elevation 347'-6'' were sprayed with high pressure water. Selective surfaces were decontaminated with a mechanical scrubber and chemicals. Strippable coating was tested and evaluated on equipment and floor surfaces. The effectiveness, efficiency, and safety of several decontamination techniques were established for the large, complex decontamination effort. Various decontamination equipment was evaluated and its effectiveness was documented. Decontamination training and procedures were documented and evaluated, as were the support system and organization for the experiment.

  8. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  9. A Study to Compare the Quality of Surgical Field Using Total Intravenous Anesthesia (with Propofol) versus Inhalational Anesthesia (with Isoflurane) for Functional Endoscopic Sinus Surgeries

    Science.gov (United States)

    Aujla, K. S.; Kaur, Manbir; Gupta, Ruchi; Singh, Sukhjinder; Bhanupreet; Tavleen

    2017-01-01

    Background and Objectives: Functional endoscopic sinus surgery (FESS) being a delicate technique, intraoperative bleeding is one of the major challenges. Even a little bleeding can adversely affect the surgeon's ability to visualize the region to be operated. General anesthesia is preferred over topical anesthesia in FESS. This study was conducted to compare the surgical field using total intravenous anesthesia (TIVA) with propofol and inhalational anesthesia with isoflurane for FESS. Secondary outcomes such as intraoperative blood loss and the incidence of perioperative complications were also recorded. Subjects and Methods: A total of sixty patients in the age group of 16–60 years with physical status American Society of Anesthesiologists Classes I and II, undergoing FESS were randomly divided into two groups of thirty each after taking informed consent and approval from the Hospital Ethics Committee. Thirty patients in Group I: received isoflurane-based inhalational anesthesia and other Thirty patients in Group II: were administered TIVA with propofol. Various parameters were recorded and statistically analyzed. Results: There was improved quality of surgical field at the end of surgery in the Group II as compared to Group I. Total blood loss during surgery and incidence of intraoperative complications were less in Group II as compared to Group I. Conclusion: This study concludes that in FESS, using TIVA with propofol decreases blood loss and the incidence of complications during surgery in addition to providing good quality of surgical field.

  10. Activity level of gross α and gross β in airborne aerosol samples around the Qinshan NPP

    Institute of Scientific and Technical Information of China (English)

    CHEN Bin; YE Jida; CHEN Qianyuan; WU Xiaofei; SONG Weili; WANG Hongfeng

    2007-01-01

    The monitoring results of gross α and gross β activity from 2001 to 2005 for environmental airborne aerosol samples around the Qinshan NPP base are presented in this paper. A total of 170 aerosol samples were collected from monitoring sites of Caichenmen village, Qinlian village, Xiajiawan village and Yangliucun village around the Qinshan NPP base. The measured specific activity of gross α and gross β are in the range of 0.02 ~ 0.38 mBq/m3 and 0.10 ~ 1.81 mBq/m3, respectively, with an average of 0.11 mBq/m3 and 0.45mBq/m3, respectively. They are lower than the average of 0.15 mBq/m3 and 0.52mBq/m3, of reference site at Hangzhou City. It is indicated that the specific activity of gross α and gross β for environmental aerosol samples around the Qinshan NPP base had not been increased in normal operating conditions of the NPP.

  11. [Laparoscopic total hysterectomy after radiochemotherapy in an obese woman with neuroendocrine carcinoma of the cervix: surgical and anesthesiological aspects].

    Science.gov (United States)

    Deffieux, X; Plantevin, F; Castaigne, D; Haie-Meder, C; Lhommé, C; Duvillard, P; Pomel, C

    2005-04-01

    Massive obesity is an important risk factor in gynaecologic surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important perioperative morbidity. We describe the first reported case of an obese woman (Body Mass Index = 55 kg/m2) with stage IIA neuroendocrine carcinoma of the cervix treated by laparoscopy after radiochemotherapy. After a complete response to radiochemotherapy, the patient underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The laparoscopic procedure was performed with a low-pressure pneumoperitoneum. She was discharged at day 2. No major complication was observed. Surgical and anesthesiological laparoscopic management in obese women are discussed.

  12. Surgical treatment for male prolactinoma

    Science.gov (United States)

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi

    2017-01-01

    Abstract A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index. Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases PMID:28079813

  13. Recorrência na área do traqueostoma após laringectomia total Surgical stoma recurrence after total laringectomy

    Directory of Open Access Journals (Sweden)

    Andre Luis Sartini

    2007-02-01

    Full Text Available O desenvolvimento da recorrência na área do traqueostoma em pacientes laringectomizados é uma das evoluções mais sérias do carcinoma epidermóide de laringe. Os fatores mais comumente associados a esta patologia são a extensão infraglótica do tumor laríngeo e a traqueostomia prévia à laringectomia. OBJETIVO: Identificar achados de exame clínico de pacientes laringectomizados relacionados com a possível gênese desta recorrência. FORMA DE ESTUDO: Estudo descritivo retrospectivo. CASUÍSTICA E MÉTODOS: Foram analisados 47 pacientes laringectomizados em nosso hospital devido ao carcinoma epidermóide de laringe entre 1995 e 2004 e avaliado o número de recorrências, bem como os fatores de risco relacionados. RESULTADOS: A recorrência na área do traqueostoma desenvolveu-se em cinco (10,6% destes pacientes. Não houve correlação estatística entre a invasão infraglótica do tumor ou traqueostomia prévia com a recorrência na área do traqueostoma. CONCLUSÃO: A recorrência na área do traqueostoma continua sendo uma das evoluções fatais do câncer laríngeo, não sendo possível neste estudo identificar fatores relacionados com esta recorrência. Novos estudos com casuísticas maiores e longos períodos de seguimento são necessários no futuro para melhor compreensão desta patologia.Stoma recurrence after total laryngectomy is one of the most severe developments of squamous cell carcinoma of the larynx. Risk factors most strongly implicated in stoma recurrence have been subglottic invasion by the laryngeal tumor and tracheotomy prior to laryngectomy. AIM: Study the clinical findings of patients who underwent total laryngectomy and evaluate the probable risk factors to the development of stoma recurrence. STUDY DESIGN: Descriptive and retrospective study MATERIALS AND METHODS: We studied data from 47 patients who underwent total laryngectomy for the treatment of laryngeal cancer between 1995 and 2004 and evaluated

  14. Emerging trends in the outsourcing of medical and surgical care.

    Science.gov (United States)

    Boyd, Jennifer B; McGrath, Mary H; Maa, John

    2011-01-01

    As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.

  15. The development and validation of a multivariable model to predict whether patients referred for total knee replacement are suitable surgical candidates at the time of initial consultation.

    Science.gov (United States)

    Churchill, Laura; Malian, Samuel J; Chesworth, Bert M; Bryant, Dianne; MacDonald, Steven J; Marsh, Jacquelyn D; Giffin, J Robert

    2016-12-01

    In previous studies, 50%-70% of patients referred to orthopedic surgeons for total knee replacement (TKR) were not surgical candidates at the time of initial assessment. The purpose of our study was to identify and cross-validate patient self-reported predictors of suitability for TKR and to determine the clinical utility of a predictive model to guide the timing and appropriateness of referral to a surgeon. We assessed pre-consultation patient data as well as the surgeon's findings and post-consultation recommendations. We used multivariate logistic regression to detect self-reported items that could identify suitable surgical candidates. Patients' willingness to undergo surgery, higher rating of pain, greater physical function, previous intra-articular injections and patient age were the factors predictive of patients being offered and electing to undergo TKR. The application of the model developed in our study would effectively reduce the proportion of nonsurgical referrals by 25%, while identifying the vast majority of surgical candidates (> 90%). Using patient-reported information, we can correctly predict the outcome of specialist consultation for TKR in 70% of cases. To reduce long waits for first consultation with a surgeon, it may be possible to use these items to educate and guide referring clinicians and patients to understand when specialist consultation is the next step in managing the patient with severe osteoarthritis of the knee.

  16. A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Ryosuke Desaki

    2014-01-01

    Full Text Available For pancreatic ductal adenocarcinoma (PDAC of the head and/or body invading the splenic artery (SA, we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR. We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66 and PD-SAR (n=18. Most patients were treated by preoperative chemoradiotherapy (CRT. Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P=0.538, despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

  17. PVC Gross Profit Climbed

    Institute of Scientific and Technical Information of China (English)

    Peter Zong

    2007-01-01

    @@ China has nearly 150 PVC (polyvinyl chloride) manufacturers operated in 2006. Here seventeen publicly listed companies are discussed, representing 25% of the national total output (8.23 million tons).

  18. Popliteal pseudoaneurysm after total knee arthroplasty secondary to intraoperative arterial injury with a surgical pin: review of the literature.

    Science.gov (United States)

    Sandoval, Enrique; Ortega, Francisco Javier; García-Rayo, Manuel Ramón; Resines, Carlos

    2008-12-01

    Pseudoaneurysms of the popliteal artery after total knee arthroplasty are rare. Although many possible explanations are proposed in the literature, no intimate mechanism of injury to the artery is previously described. We report on a case of popliteal pseudoaneurysm after a total knee arthroplasty that presented clinically on the second postoperative day. Open vascular surgery with resection of the pseudoaneurysm and end-to-end bypass of contralateral saphena vein graft was successfully performed. At the time of the surgery, a hole was clearly identified on the anterior wall of the popliteal artery due to a perforation with a pin used during the knee arthroplasty. The patient had no further complications.

  19. Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.

    Science.gov (United States)

    Olsen, Margaret A; Tian, Fang; Wallace, Anna E; Nickel, Katelin B; Warren, David K; Fraser, Victoria J; Selvam, Nandini; Hamilton, Barton H

    2017-02-01

    To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.

  20. Understanding the surgical pitfalls in total mesorectal excision : Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

    NARCIS (Netherlands)

    Kraima, A. C.; West, N. P.; Treanor, D.; Magee, D. R.; Bleys, R. L A W; Rutten, H. J T; Van De Velde, C. J H; Quirke, P.; Deruiter, M. C.

    2015-01-01

    Aim Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located

  1. Comparison of Robotic vs. Standard Surgical Procedure on Postoperative Nursing Care of Women Undergoing Total Abdominal Hysterectomy.

    Science.gov (United States)

    Best, Janie; Day, Luanne; Ingram, Lori; Musgrave, Barbara; Rushing, Holli; Schooley, Brenda

    2014-01-01

    This exploratory study was conducted to determine if the postoperative course is different for women undergoing robotic-assisted total abdominal hysterectomy (TAH) compared to women undergoing traditional (open) TAH. This study adds to the evidence regarding potential benefits and complications of robotic-assisted gynecologic surgery, and identifies specific areas for further research.

  2. The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Overgaard, Søren; Schønheyder, Henrik Carl;

    2015-01-01

    BACKGROUND AND PURPOSE: It has been suggested that the risk of prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA) may be underestimated if based only on arthroplasty registry data. We therefore wanted to estimate the "true" incidence of PJI in THA using several data...

  3. Understanding the surgical pitfalls in total mesorectal excision : Investigating the histology of the perirectal fascia and the pelvic autonomic nerves

    NARCIS (Netherlands)

    Kraima, A. C.; West, N. P.; Treanor, D.; Magee, D. R.; Bleys, R. L A W; Rutten, H. J T; Van De Velde, C. J H; Quirke, P.; Deruiter, M. C.

    2015-01-01

    Aim Excellent understanding of fasciae and nerves surrounding the rectum is necessary for total mesorectal excision (TME). However, fasciae anterolateral to the rectum and surrounding the low rectum are still poorly understood. We studied the perirectal fascia enfolding the extraperitoneally located

  4. Gross job flows and firms

    OpenAIRE

    Scott Schuh; Robert K. Triest

    1999-01-01

    This paper extends the work of Dunne, Roberts, and Samuelson [3] and Davis, Haltiwanger, and Schuh [2] on gross job flows among manufacturing plants. Gross job creation, destruction, and reallocation have been shown to be important in understanding the birth, growth, and death of plants, and the relation of plant life cycles to the business cycle. However, little is known about job flows between firms or how job flows among plants occur within firms (corporate restructuring). We use informati...

  5. Impact of obesity on early surgical and oncologic outcomes after total gastrectomy with "over-D1" lymphadenectomy for gastric cancer.

    Science.gov (United States)

    Pata, Giacomo; Solaini, Leonardo; Roncali, Stefano; Pasini, Mario; Ragni, Fulvio

    2013-05-01

    The purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with "over-D1" dissection for gastric cancer. Data on 161 patients undergoing total gastrectomy between 2005 and 2011 were reviewed. Patients were grouped into three categories by BMI: BMI obese patients; 15.6 %) and matched for the analysis of perioperative and cancer-related outcomes. Operative time was longer for obese patients. Medical (mainly pulmonary) and surgical (mainly bleeding and wound infection) complications occurred more frequently in overweight/obese subjects. However, they were mostly managed conservatively (grade I-II in the Clavien-Dindo classification). The overall postoperative mortality was 0.9 %. Multivariate analysis identified the American Society of Anesthesiologists score and splenectomy, but not obesity, as independent risk factors for postoperative complications. The median number of lymph nodes retrieved differed significantly from group to group: obese 21 (IQR 18-26), versus overweight 24, versus normal weight 28 (p = 0.031). No difference was found in lymph node ratio and cancer-related parameters. Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.

  6. Custom titanium sleeve for surgical treatment of mechanically assisted crevice corrosion in the well-fixed, noncontemporary stem in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Thomas Leibiger

    2015-12-01

    Full Text Available Adverse local tissue reaction associated with total hip replacement may occur when mechanically assisted crevice corrosion occurs at metal-metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy. Complete removal of components may be associated with significant morbidity; when components are well fixed and in acceptable position, it may be appropriate to consider modular rather than complete revision. We have diagnosed mechanically assisted crevice corrosion in total hip arthroplasty patients with noncontemporary but well-fixed femoral components and found that modular conversion to a ceramic femoral head to remove a source of CoCr corrosion and fretting products was only possible by having a custom titanium sleeve manufactured. Surgical implantation with a revision style Biolox ceramic head (CeramTec, Plochingen, Germany was then achieved.

  7. Morbilidad y mortalidad en conducto ileal y su relación con nutrición parenteral total postoperatoria Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    G. González Ávila

    2006-08-01

    Full Text Available Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel. Sujetos: Ciento catorce pacientes consecutivos tratados con cistectomía radical y conducto ileal entre enero de 2000 a Junio de 2004. Intervenciones: Ochenta y un pacientes recibieron nutrición parenteral total postoperatoria durante un promedio de 9.2 días y 33 controles recibieron solución glucosada 5% + salina 0.9%. Principales resultados y mediciones: Treinta y seis (31.6% pacientes se complicaron y once murieron (9.6%.Las principales complicaciones relacionadas con muerte fueron quirúrgicas. Después de un análisis multivariado de regresión logística, y de acuerdo al riesgo e intervención nutricional se encontró en el grupo con desnutrición grave una reducción importante (RR=0.09, IC95%=0.02-0.33,p=0.008 en la frecuencia de muerte temprana. La dehiscencia de anastomosis en presencia de sepsis abdominal fue el factor predictor más importante de muerte temprana(RR=5.0; IC95%=1.45-17-3; p=0.007. Conclusiones: El grupo sin desnutrición o con desnutrición leve no se beneficia de la nutrición parenteral total postoperatoria.Background: The frequency of complications and early death in patients with hyponutrition and total radical cystectomy with ileal duct is high. The role of artificial nutritional support on short-term outcomes is still controversial. Objective: to determine whether total parenteral nutrition reduces the frequency of complications and death when it is administered during the immediate post-surgical period. Design

  8. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit.

    Science.gov (United States)

    Conlisk, Noel; Howie, Colin R; Pankaj, Pankaj

    2017-08-01

    Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project study B-04 to radical mastectomy versus total mastectomy and radiotherapy versus total mastectomy alone.

    Science.gov (United States)

    Deutsch, Melvin; Land, Stephanie; Begovic, Mirsada; Sharif, Saima

    2008-03-15

    To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-04. Between 1971 and 1974, the NSABP protocol B-04 randomized 1,665 eligible patients with resectable breast cancer to either (1) the Halstead-type radical mastectomy; (2) total mastectomy and radiotherapy to the chest wall, axilla, supraclavicular region, and internal mammary nodes if by clinical examination axillary nodes were involved by tumor; and (3) for patients with a clinically uninvolved axilla, a third arm, total mastectomy alone. Measurements of the ipsilateral and contralateral arm circumferences were to be performed every 3 months. There was at least one recorded measurement of arm circumferences for 1,457 patients (87.5% of eligible patients). There were 674 women (46.3%) who experienced arm edema at some point during the period of follow-up until February 1976. For radical mastectomy patients, total mastectomy and radiotherapy patients, and total mastectomy patients alone, arm edema was recorded at least once in 58.1%, 38.2%, and 39.1% of patients, respectively (pmastectomy, including those whose treatment plans do not include axillary dissection or postoperative radiotherapy, suffer an appreciable incidence of arm edema.

  10. On a question of Gross

    Science.gov (United States)

    Banerjee, Abhijit

    2007-03-01

    Using the notion of weighted sharing of sets we prove two uniqueness theorems which improve the results proved by Fang and Qiu [H. Qiu, M. Fang, A unicity theorem for meromorphic functions, Bull. Malaysian Math. Sci. Soc. 25 (2002) 31-38], Lahiri and Banerjee [I. Lahiri, A. Banerjee, Uniqueness of meromorphic functions with deficient poles, Kyungpook Math. J. 44 (2004) 575-584] and Yi and Lin [H.X. Yi, W.C. Lin, Uniqueness theorems concerning a question of Gross, Proc. Japan Acad. Ser. A 80 (2004) 136-140] and thus provide an answer to the question of Gross [F. Gross, Factorization of meromorphic functions and some open problems, in: Proc. Conf. Univ. Kentucky, Lexington, KY, 1976, in: Lecture Notes in Math., vol. 599, Springer, Berlin, 1977, pp. 51-69], under a weaker hypothesis.

  11. The efficacy of brotzman physiotherapy protocol on pain and knee range of motion in post surgical total knee arthroplasty subjects with obesity

    Directory of Open Access Journals (Sweden)

    K Narasimha sridhar

    2013-04-01

    Full Text Available Background:To evaluate the efficacy of Brotzman physiotherapy protocol on pain and knee range of motion in post surgical T.K.A subjects with obesity and normal BMI . Materials and Methods:30 subjects were divided into two groups based on BMI. The group I having normal BMI (18.5 – 24.9 and group II having BMI more than 30. Both groups received Brotzman physiotherapy protocols for duration of 30 - 45 minutes, 1 se ssion per day, 6 days per week for a total of 6 weeks. Results:After 6 weeks treatment period, the subjects in thegroup I were compared with the subjects in the group II. Group I had shown a significant difference with outcome measures at 0.05 level.Conclusion:The study shows that there is a marginal significance ofBROTZMAN physiotherapy protocol in TKA subjects with obesity regarding relief of pain, improvement of knee ROM and WOMAC indx.

  12. The use of ketamine, xylazine and midazolam combination for total intravenous anesthesia (TIVA in surgical removal of abdominal testis at stallion

    Directory of Open Access Journals (Sweden)

    Bojan D. Toholj

    2014-10-01

    Full Text Available Equine veterinarians frequently anesthetize horses. In majority of cases performing short-term anesthesia (duration, 20 minutes. But there is substantial need for long term anesthesia. The aim of this work is to present our experience with a long term and short term total intravenous anesthesia in horses. In this paper we are presenting results of anesthesia monitoring of a horse undergoing surgical remove of an abdominal testis (complete abdominal cryptorchid. Sedation of the horse was conducted with xylazine, 1.0 mg/kg, iv, and midazolam 0.06 mg/kg, iv. The total anesthesia was induced using a combination of ketamine 2.2mg/kg/iv, and midazolam 0.1 mg/kg/iv. After induction the horse was restrained and anesthesia was maintained with continuous intravenous drip of a combination of drugs mixed in infusion bottle with midazolam (0.002 mg/kg/min, ketamine (0.03 mg/kg/min, and xylazine (0.016 mg/kg/min. Additional ketamine (0.03 mg/kg and midazolam 0.03 mg/kg/iv was administered if the horse moved its head or limbs during the procedure. The duration of anesthesia was 90 minutes. During this time cardiopulmonary parameters and reflexes were monitored continuously.The recovery of anesthesia was 30 minutes and horse stood on the first attempt 40 minutes. Midazolam, ketamine, and xylazine in combination produced TIVA in this horse and can be used for short term, middle term, and longer lasting surgical procedures in the field.

  13. [Assessing the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection in patients undergoing total cystectomy with urinary diversion using intestine].

    Science.gov (United States)

    Kanamaru, Sojun; Tsuchihashi, Kazunari; Makino, Yuki; Shimizu, Yosuke; Ito, Noriyuki

    2014-11-01

    We assessed the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection (SSI) in patients undergoing total cystectomy with urinary diversion using the intestine. We reviewed the clinical charts of 43 consecutive patients who underwent total cystectomy with urinary diversion using the intestine from February 2006 to March 2011 at Nishi-Kobe Medical Center. All patients received intravenous prophylactic antibiotics before and throughout surgery as well as for three days after surgery. Skin closure was performed with interrupted vertical mattress sutures with 2-0 nylon on the first 22 patients (mattress group), and with interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous closed suction drain on the remaining 21 patients (subcuticular buried suture with subcutaneous drain; SBD group). SSI occurred in 7 (31.8%) patients in the mattress group, but did not affect any patient in the SBD group. We compared risk factors for SSI between the groups, and found that the method of skin closure was significant risk factor for SSI (P = 0.005). We concluded that interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous suction drain is effective for prevention of SSI in total cystectomy with urinary diversion using the intestine.

  14. Samuel D. Gross: the nestor of American surgery.

    Science.gov (United States)

    Toledo-Pereyra, Luis H

    2006-01-01

    Samuel David Gross (1805-1884) represented the most notable surgeon of his generation and was honored with the title of "The Nestor of American Surgeon" by surgeon biographer Isaac Minis Hays. Of Pennsylvania Dutch stock, he was born on the family farm near Easton, Pennsylvania. He attended Wilkebarré Academy and Lawrenceville High School, noted private institutions of the day. He apprenticed under Doctor Joseph K. Swift of Easton and later with Professor George McClellan while in Philadelphia. In 1828, he graduated from Jefferson Medical College and remained for a short time in Philadelphia. Professor Gross focused his professional pursuits in the cities of Easton (1830-1833), Cincinnati (1833-1840), Louisville (1840-1856), and Philadelphia (1856-1882). He retired from Jefferson Medical College two years before his death in 1884. Samuel D. Gross' contributions to surgery were numerous and diverse. He was recognized as a prolific author of classic texts of pathology, surgery, and history, an educator, a leader, a surgical researcher, and a pioneer surgeon practitioner. His influence in national affairs was immense, and his recognition as a respected surgeon was unmatched. He remains the most distinguished surgeon of his times. History values him as a hard working, honest, highly competent, and committed individual. His capacity for work and his dedication to a single cause were unrivaled. Doctor Gross integrated the best that surgery could give to future generations of surgical professionals.

  15. Preoperative Management of Surgical Patients by “Shortened Fasting Time”: A Study on the Amount of Total Body Water by Multi-Frequency Impedance Method

    Directory of Open Access Journals (Sweden)

    Hideki Taniguchi, Toshio Sasaki, Hisae Fujita

    2012-01-01

    Full Text Available Aim: Preoperative fasting is an established procedure to be practiced for patients before surgery, but optimal preoperative fasting time still remains controversial. The aim of this study was to investigate the effect of “shortened preoperative fasting time” on the change in the amount of total body water (TBW in elective surgical patients. TBW was measured by multi-frequency impedance method.Methods: The patients, who were scheduled to undergo surgery for stomach cancer, were divided into two groups of 15 patients each. Before surgery, patients in the control group were managed with conventional preoperative fasting time, while patients in the “enhanced recovery after surgery (ERAS” group were managed with “shortened preoperative fasting time” and “reduced laxative medication.” TBW was measured on the day before surgery and the day of surgery before entering the operating room. Defecation times and anesthesia-related vomiting and aspiration were monitored.Results: TBW values on the day of surgery showed changes in both groups as compared with those on the day before surgery, but the rate of change was smaller in the ERAS group than in the control group (2.4±6.8% [12 patients] vs. −10.6±4.6% [14 patients], p<0.001. Defecation times were less in the ERAS group. Vomiting and aspiration were not observed in either group.Conclusion: The results suggest that preoperative management with “shorted preoperative fasting time” and “reduced administration of laxatives” is effective in the maintenance of TBW in elective surgical patients.

  16. Finding of IDH1 R132H mutation in histologically non-neoplastic glial tissue changes surgical strategies, a case report

    DEFF Research Database (Denmark)

    Søndergaard, Christian Baastrup; Scheie, David; Sehested, Astrid Marie

    2017-01-01

    but with an IDH1 mutation. Due to the IDH1 R132H mutation, the patient was diagnosed with diffuse astrocytoma WHO grade II and underwent successful gross total resection of this near-eloquently located tumor. CONCLUSION: This case exemplifies how inclusion of immunohistochemistry in tumor classification alters...... surgical strategy and might improve accuracy and time to diagnosis....

  17. NM Gross Receipts July - December 2012

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  18. NM Gross Receipts January - June 2014

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  19. NM Gross Receipts January - June 2012

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  20. NM Gross Receipts January - June 2013

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  1. NM Gross Receipts January - June 2011

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  2. NM Gross Receipts July - December 2013

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico's gross receipts tax districts as identified on the "Gross Receipts Tax Rate Schedule" published by the Taxation and...

  3. A case report of surgical management of hemangiopericytoma at the foramen magnum.

    Science.gov (United States)

    Arai, Nobuhiko; Takahashi, Satoshi; Mami, Hatano; Tokuda, Yukina; Yoshida, Kazunari

    2017-01-01

    Hemangiopericytoma (HPC) is a highly vascularized mesenchymal tumor known for its high rates of recurrence and metastasis. The extent of tumor removal is known to be the most trustful prognostic factor. Skull base HPCs are challenging to treat because of the difficulty of the surgical approach and proximity to vital vascular and neuronal structures. We successfully treated a case of HPC at the ventral foramen magnum through surgical gross tumor removal via a far-lateral transcondylar approach. A 38-year-old male complained of neck pain and bilateral paresthesia of his shoulders for 2 months, for which he was referred to our hospital. A magnetic resonance image (MRI) showed a 20 mm diameter mass at the ventral foramen magnum, which compressed his medulla oblongata. The tumor was gross totally removed via a far-lateral transcondylar approach. During the surgery, marked bleeding disturbed the surgical field until the main feeding artery from the direction of the dura mater was coagulated and cut. A relatively wide surgical field and a transcondylar approach were helpful to control the bleeding. The pathological examination revealed the tumor to be a HPC. After an uneventful recovery period of 9 days, the patient was discharged without neurological sequelae. We successfully and completely removed an HPC near the foramen magnum, employing a wide surgical field and a transcondylar approach to help control bleeding. When the tumor is suspected preoperatively to be a hemangiocytoma or vascular-rich tumor, a surgical approach that can secure a wide surgical field should be selected.

  4. Gross anatomy of network security

    Science.gov (United States)

    Siu, Thomas J.

    2002-01-01

    Information security involves many branches of effort, including information assurance, host level security, physical security, and network security. Computer network security methods and implementations are given a top-down description to permit a medically focused audience to anchor this information to their daily practice. The depth of detail of network functionality and security measures, like that of the study of human anatomy, can be highly involved. Presented at the level of major gross anatomical systems, this paper will focus on network backbone implementation and perimeter defenses, then diagnostic tools, and finally the user practices (the human element). Physical security measures, though significant, have been defined as beyond the scope of this presentation.

  5. Protocol of an expertise based randomized trial comparing surgical Venae Sectio versus radiological Puncture of Vena Subclavia for insertion of Totally Implantable Access Port in oncological patients

    Directory of Open Access Journals (Sweden)

    Radeleff Boris

    2008-10-01

    Full Text Available Abstract Background Totally Implantable Access Ports (TIAP are being extensively used world-wide and can be expected to gain further importance with the introduction of new neoadjuvant and adjuvant treatments in oncology. Two different techniques for the implantation can be selected: A direct puncture of a central vein and the utilization of a Seldinger device or the surgical Venae sectio. It is still unclear which technique has the optimal benefit/risk ratio for the patient. Design A single-center, expertise based randomized, controlled superiority trial to compare two different TIAP implantation techniques. 100 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective implantation of a TIAP under local anesthesia who signed the informed consent will be included. The primary endpoint is the primary success rate of the randomized technique. Control Intervention: Venae Sectio will be employed to insert a TIAP by a surgeon; Experimental intervention: Punction of V. Subclavia will be used to place a TIAP by a radiologist. Duration of study: Approximately 10 months, follow up time: 90 days. Organisation/Responsibility The PORTAS 2 – Trial will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and Good Clinical Practice (GCP. The Center of Clinical Trials at the Department of Surgery, University Hospital Heidelberg is responsible for design and conduct of the trial including randomization and documentation of patients' data. Data management and statistical analysis will be performed by the independent Institute for Medical Biometry and Informatics (IMBI, University of Heidelberg. Trial Registration The trial is registered at ClinicalTrials.gov (NCT00600444.

  6. A quantitative assessment of the total inward leakage of NaCl aerosol representing submicron-size bioaerosol through N95 filtering facepiece respirators and surgical masks.

    Science.gov (United States)

    Rengasamy, Samy; Eimer, Benjamin C; Szalajda, Jonathan

    2014-01-01

    Respiratory protection provided by a particulate respirator is a function of particle penetration through filter media and through faceseal leakage. Faceseal leakage largely contributes to the penetration of particles through a respirator and compromises protection. When faceseal leaks arise, filter penetration is assumed to be negligible. The contribution of filter penetration and faceseal leakage to total inward leakage (TIL) of submicron-size bioaerosols is not well studied. To address this issue, TIL values for two N95 filtering facepiece respirator (FFR) models and two surgical mask (SM) models sealed to a manikin were measured at 8 L and 40 L breathing minute volumes with different artificial leak sizes. TIL values for different size (20-800 nm, electrical mobility diameter) NaCl particles representing submicron-size bioaerosols were measured using a scanning mobility particle sizer. Efficiency of filtering devices was assessed by measuring the penetration against NaCl aerosol similar to the method used for NIOSH particulate filter certification. Results showed that the most penetrating particle size (MPPS) was ∼45 nm for both N95 FFR models and one of the two SM models, and ∼350 nm for the other SM model at sealed condition with no leaks as well as with different leak sizes. TIL values increased with increasing leak sizes and breathing minute volumes. Relatively, higher efficiency N95 and SM models showed lower TIL values. Filter efficiency of FFRs and SMs influenced the TIL at different flow rates and leak sizes. Overall, the data indicate that good fitting higher-efficiency FFRs may offer higher protection against submicron-size bioaerosols.

  7. Effect of temperate climate tree species on gross ammonification, gross nitrification and N2O formation

    Science.gov (United States)

    Brüggemann, N.; Rosenkranz, P.; Papen, H.; Butterbach-Bahl, K.

    2003-04-01

    Microbial nitrogen turnover processes in the soil, like ammonification, nitrification and denitrification, play an important role in the formation of nitrous oxide (N2O): (i) ammonification, because it releases nitrogen from organic material in the form of ammonium (NH4+), which in turn can serve as substrate for nitrification; (ii) nitrification itself (i.e. the turnover of NH4+ to nitrate, NO3-), during which nitric oxide (NO) and N2O can be released as by-products at varying ratios; (iii) denitrification, in which NO3- serves as electron acceptor and is converted to molecular nitrogen (N2) via NO and N2O as intermediates, that can also be partially lost to the atmosphere. Temperate forest soils are a substantial source of atmospheric N2O contributing up to 10% to the total atmospheric N2O budget. However, this figure is afflicted with a huge uncertainty due to a number of factors governing the soil N2O formation, consumption, release and uptake, which are not fully understood at present. To one of these factors belongs the influence of the tree species on nitrogen turnover processes in the soil and the formation of N trace gases related with them. The aim of the present work was to analyse this tree species effect for the temperate climate region. For this purpose the effect of five different temperate tree species, having the same age and growing on the same soil in direct vicinity to each other, on gross ammonification and gross nitrification as well as on N2O formation was investigated. The trees (common beech, Fagus sylvatica; pedunculate oak, Quercus robur; Norway spruce, Picea abies; Japanese larch, Larix leptolepis; mountain pine, Pinus mugo) were part of a species trial in Western Jutland, Denmark, established in 1965 on a former sandy heathland. Samples from the soil under these five tree species were taken in spring and in summer 2002, respectively, differentiating between organic layer and mineral soil. The gross rates of ammonification as well of

  8. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  9. Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors.

    Science.gov (United States)

    Englot, Dario J; Han, Seunggu J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-04-01

    Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. To assess how the extent of temporal lobe resection influences seizure outcome. We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age seizure outcome. Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.

  10. Current usage and future trends in gross digital photography in Canada.

    Science.gov (United States)

    Horn, Christopher L; DeKoning, Lawrence; Klonowski, Paul; Naugler, Christopher

    2014-01-14

    The purpose of this study was to assess the current usage, utilization and future direction of digital photography of gross surgical specimens in pathology laboratories across Canada. An online survey consisting of 23 multiple choice and free-text questions regarding gross digital photography was sent out to via email to laboratory staff across Canada involved in gross dissection of surgical specimens. Sixty surveys were returned with representation from most of the provinces. Results showed that gross digital photography is utilized at most institutions (90.0%) and the primary users of the technology are Pathologists (88.0%), Pathologists' Assistants (54.0%) and Pathology residents (50.0%). Most respondents felt that there is a definite need for routine digital imaging of gross surgical specimens in their practice (80.0%). The top two applications for gross digital photography are for documentation of interesting/ complex cases (98.0%) and for teaching purposes (84.0%). The main limitations identified by the survey group are storage space (42.5%) and security issues (40.0%). Respondents indicated that future applications of gross digital photography mostly include teaching (96.6%), presentation at tumour boards/ clinical rounds (89.8%), medico-legal documentation (72.9%) and usage for consultation purposes (69.5%). The results of this survey indicate that pathology staff across Canada currently utilizes gross digital images for regular documentation and educational reasons. They also show that the technology will be needed for future applications in teaching, consultation and medico-legal purposes.

  11. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  12. A survey of gross alpha and gross beta activity in soil samples in Kinta District, Perak, Malaysia.

    Science.gov (United States)

    Lee, Siak Kuan; Wagiran, Husin; Ramli, Ahmad Termizi

    2014-12-01

    The objective of this study was to determine the gross alpha and gross beta activity concentrations from the different soil types found in the Kinta District, Perak, Malaysia. A total of 128 soil samples were collected and their dose rates were measured 1 m above the ground. Gross alpha and gross beta activity measurements were carried out using gas flow proportional counter, Tennelec Series 5 LB5500 Automatic Low Background Counting System. The alpha activity concentration ranged from 15 to 9634 Bq kg(-1) with a mean value of 1558±121 Bq kg(-1). The beta activity concentration ranged from 142 to 6173 Bq kg(-1) with a mean value of 1112±32 Bq kg(-1). High alpha and beta activity concentrations are from the same soil type. The results of the analysis show a strong correlation between the gross alpha activity concentration and dose rate (R = 0.92). The data obtained can be used as a database for each soil type.

  13. Effect of physical therapy frequency on gross motor function in children with cerebral palsy.

    Science.gov (United States)

    Park, Eun-Young

    2016-06-01

    [Purpose] This study attempted to investigate the effect of physical therapy frequency based on neurodevelopmental therapy on gross motor function in children with cerebral palsy. [Subjects and Methods] The study sample included 161 children with cerebral palsy who attended a convalescent or rehabilitation center for disabled individuals or a special school for children with physical disabilities in South Korea. Gross Motor Function Measure data were collected according to physical therapy frequency based on neurodevelopmental therapy for a period of 1 year. [Results] The correlation between physical therapy frequency and Gross Motor Function Measure scores for crawling and kneeling, standing, walking, running and jumping, and rolling, and the Gross Motor Function Measure total score was significant. The differences in gross motor function according to physical therapy frequency were significant for crawling, kneeling, standing, and Gross Motor Function Measure total score. The differences in gross motor function according to frequency of physical therapy were significant for standing in Gross Motor Function Classification System Level V. [Conclusion] Intensive physical therapy was more effective for improving gross motor function in children with cerebral palsy. In particular, crawling and kneeling, and standing ability showed greater increases with intensive physical therapy.

  14. Effect of physical therapy frequency on gross motor function in children with cerebral palsy

    Science.gov (United States)

    Park, Eun-Young

    2016-01-01

    [Purpose] This study attempted to investigate the effect of physical therapy frequency based on neurodevelopmental therapy on gross motor function in children with cerebral palsy. [Subjects and Methods] The study sample included 161 children with cerebral palsy who attended a convalescent or rehabilitation center for disabled individuals or a special school for children with physical disabilities in South Korea. Gross Motor Function Measure data were collected according to physical therapy frequency based on neurodevelopmental therapy for a period of 1 year. [Results] The correlation between physical therapy frequency and Gross Motor Function Measure scores for crawling and kneeling, standing, walking, running and jumping, and rolling, and the Gross Motor Function Measure total score was significant. The differences in gross motor function according to physical therapy frequency were significant for crawling, kneeling, standing, and Gross Motor Function Measure total score. The differences in gross motor function according to frequency of physical therapy were significant for standing in Gross Motor Function Classification System Level V. [Conclusion] Intensive physical therapy was more effective for improving gross motor function in children with cerebral palsy. In particular, crawling and kneeling, and standing ability showed greater increases with intensive physical therapy. PMID:27390440

  15. Pathology Gross Photography: The Beginning of Digital Pathology.

    Science.gov (United States)

    Rampy, B Alan; Glassy, Eric F

    2015-06-01

    The underutilized practice of photographing anatomic pathology specimens from surgical pathology and autopsies is an invaluable benefit to patients, clinicians, pathologists, and students. Photographic documentation of clinical specimens is essential for the effective practice of pathology. When considering what specimens to photograph, all grossly evident pathology, absent yet expected pathologic features, and gross-only specimens should be thoroughly documented. Specimen preparation prior to photography includes proper lighting and background, wiping surfaces of blood, removing material such as tubes or bandages, orienting the specimen in a logical fashion, framing the specimen to fill the screen, positioning of probes, and using the right-sized scale.

  16. Evaluation of gross radioactivity in foodstuffs

    Energy Technology Data Exchange (ETDEWEB)

    Zorer, Oezlem Selcuk; Oeter, Cigdem [Yuzuncu Yil Univ., Van (Turkey). Dept. of Chemistry

    2015-05-15

    The paper presents the results of radiological investigations of food products sampled in the summer and fall of 2011 and 2012 in different parts of Van, Turkey. Gross radioactivity measurements in food products were evaluated. Food items were divided into eight groups: (1) water, (2) fish, (3) cheese products, (4) fruits, (5) vegetables, (6) herbs, (7) walnut and (8) rock salt. The levels of the gross alpha and gross beta radioactivity in all food samples varied widely ranging from 0.070 to 10.885 Bq/g and from 0.132 to 48.285 Bq/g on dry mass basis, respectively. In one sample, gross alpha and gross beta activity concentrations were found to be relatively high according to the other samples and in all samples, the gross alpha radioactivity was measured lower than the gross beta radioactivity. The gross α and gross β activities were measured by using α/β counter of the multi-detector low background system (PIC MPC-9604).

  17. 婴儿完全性肺静脉异位连接的外科治疗%Surgical therapy of infants with total anomalous pulmonary venous connection

    Institute of Scientific and Technical Information of China (English)

    彭帮田; 张岩伟; 艾峰; 程兆云; 范太兵

    2014-01-01

    Objective To retrospectively summarize the strategies and effects of surgical therapy on infants with total anomalous pulmonary venous connection (TAPVC).Methods From January 2007 to April 2012,41 cases of infants with TAPVC were chosen.They were performed with surgical repairing with general anesthesia by hypothermic cardiopulmonary bypass.Twenty seven cases were treated by supracardiac anastomosis and 3 cases were treated by intracardiac anastomosis,among which 11 cases were treated by autologous pericardical expand anastomosis.As for intracardiac type,7 cases were cured by means of connecting pulmonary vein to coronary sinus,and then by cutting arterial septum and coronary sinus upper wall in the mouth of pulmonary vein,and finally using artificial materials to reconstruct interatrial septum to expand the left artrium; 1 case by linking pulmonary vein to right atrium roof,then the patients were remedied by expanding the interatrial septum defect and giving intracardiac patch.In terms of infracardiac type,2 cases were treated by cutting the pulmonary vein behind the right atrium in lengthways,and connecting the pulmonary vein to the left artrium by longitudinal anastomosis.Results Thirty-nine cases survived the operations,of whom the clinical symptoms disappeared and their physical growth improved obviously without cardiac dysfunction.Only 2 cases died in the early period (mortality rate 4.8%),1 of which died from sudden cardiac arrest as the result of pulmonary arterial hypertension crisis and 1 from low cardiac output as the result of left heart maldevelopment.The outpatient follow-up found no death case,but one case was operated twice,with no short and medium-term anastomosis stricture.Conclusions TAPVC,as an independant abnormality located in a normal heart,can be cured in babyhood with ideal effects and perfect prognosis.%目的 回顾性总结婴儿完全性肺静脉异位连接外科治疗的策略和效果.方法 2007年1月至2012年4月共收治婴

  18. Measures of Gross National Happiness

    Directory of Open Access Journals (Sweden)

    Ruut Veenhoven

    2010-02-01

    Full Text Available Happiness is rising on the political agenda and this calls for measures of how well nations perform in creating great happiness for a great number, analogous to measures of success in creating wealth, such as GDP. Happiness is defined as subjective enjoyment of one’s life as-a-whole and this can be measured using self-reports. Question on happiness are currently used in large scale surveys of the general population in nations. As a result we have now comparable data on happiness in 144 contemporary nations and time-series of 25 years and longer on 11 developed nations. These data can be aggregated in different ways: If the aim is simply greater happiness for a greater number of citizens, Average happiness (AH is an appropriate measure. If the focus is on enduring happiness, it is better to combine average happiness with longevity in an index of Happy Life Years (HLY. If the aim is to reduce disparity among citizens a relevant indicator is the Inequality of Happiness (IH in the nations as measured with the standard deviation. Average and dispersion can also be combined in an index of Inequality-Adjusted Happiness (IAH. Comparison across nations shows sizable differences on all these measures of gross national happiness and these differences correspond with societal characteristics that can be influenced by policy makers, such as freedom and justice. Comparison over time shows major improvement during the last decade.

  19. Effects of land use change on soil gross nitrogen transformation rates in subtropical acid soils of Southwest China.

    Science.gov (United States)

    Xu, Yongbo; Xu, Zhihong

    2015-07-01

    Land use change affects soil gross nitrogen (N) transformations, but such information is particularly lacking under subtropical conditions. A study was carried out to investigate the potential gross N transformation rates in forest and agricultural (converted from the forest) soils in subtropical China. The simultaneously occurring gross N transformations in soil were quantified by a (15)N tracing study under aerobic conditions. The results showed that change of land use types substantially altered most gross N transformation rates. The gross ammonification and nitrification rates were significantly higher in the agricultural soils than in the forest soils, while the reverse was true for the gross N immobilization rates. The higher total carbon (C) concentrations and C / N ratio in the forest soils relative to the agricultural soils were related to the greater gross N immobilization rates in the forest soils. The lower gross ammonification combined with negligible gross nitrification rates, but much higher gross N immobilization rates in the forest soils than in the agricultural soils suggest that this may be a mechanism to effectively conserve available mineral N in the forest soils through increasing microbial biomass N, the relatively labile organic N. The greater gross nitrification rates and lower gross N immobilization rates in the agricultural soils suggest that conversion of forests to agricultural soils may exert more negative effects on the environment by N loss through NO3 (-) leaching or denitrification (when conditions for denitrification exist).

  20. The Mechanics of Gross Moist Stability

    Directory of Open Access Journals (Sweden)

    Zeljka Fuchs

    2009-08-01

    Full Text Available The gross moist stability relates the net lateral outflow of moist entropy or moist static energy from an atmospheric convective region to some measure of the strength of the convection in that region. If the gross moist stability can be predicted as a function of the local environmental conditions, then it becomes the key element in understanding how convection is controlled by the large-scale flow. This paper provides a guide to the various ways in which the gross moist stability is defined and the subtleties of its calculation from observations and models. Various theories for the determination of the gross moist stability are presented and its roles in current conceptual models for the tropical atmospheric circulation are analyzed. The possible effect of negative gross moist stability on the development and dynamics of tropical disturbances is currently of great interest.

  1. Gross and Microscopic Lesions in Corals from Micronesia.

    Science.gov (United States)

    Work, T M; Aeby, G S; Hughen, K A

    2016-01-01

    The authors documented gross and microscopic morphology of lesions in corals on 7 islands spanning western, southern, and eastern Micronesia, sampling 76 colonies comprising 30 species of corals among 18 genera, with Acropora, Porites, and Montipora dominating. Tissue loss comprised the majority of gross lesions sampled (41%), followed by discoloration (30%) and growth anomaly (29%). Of 31 cases of tissue loss, most lesions were subacute (48%), followed by acute and chronic (26% each). Of 23 samples with discoloration, most were dark discoloration (40%), with bleaching and other discoloration each constituting 30%. Of 22 growth anomalies, umbonate growth anomalies composed half, with exophytic, nodular, and rugose growth anomalies composing the remainder. On histopathology, for 9 cases of dark discoloration, fungal infections predominated (77%); for 7 bleached corals, depletion of zooxanthellae from the gastrodermis made up a majority of microscopic diagnoses (57%); and for growth anomalies other than umbonate, hyperplasia of the basal body wall was the most common microscopic finding (63%). For the remainder of the gross lesions, no single microscopic finding constituted >50% of the total. Host response varied with the agent present on histology. Fragmentation of tissues was most often associated with algae (60%), whereas necrosis dominated (53%) for fungi. Two newly documented potentially symbiotic tissue-associated metazoans were seen in Porites and Montipora. Findings of multiple potential etiologies for a given gross lesion highlight the importance of incorporating histopathology in coral disease surveys. This study also expands the range of corals infected with cell-associated microbial aggregates.

  2. Gross and microscopic lesions in corals from Micronesia

    Science.gov (United States)

    Work, Thierry M.; Aeby, Greta S.; Hughen, Konrad A.

    2015-01-01

    The authors documented gross and microscopic morphology of lesions in corals on 7 islands spanning western, southern, and eastern Micronesia, sampling 76 colonies comprising 30 species of corals among 18 genera, with Acropora, Porites, and Montipora dominating. Tissue loss comprised the majority of gross lesions sampled (41%), followed by discoloration (30%) and growth anomaly (29%). Of 31 cases of tissue loss, most lesions were subacute (48%), followed by acute and chronic (26% each). Of 23 samples with discoloration, most were dark discoloration (40%), with bleaching and other discoloration each constituting 30%. Of 22 growth anomalies, umbonate growth anomalies composed half, with exophytic, nodular, and rugose growth anomalies composing the remainder. On histopathology, for 9 cases of dark discoloration, fungal infections predominated (77%); for 7 bleached corals, depletion of zooxanthellae from the gastrodermis made up a majority of microscopic diagnoses (57%); and for growth anomalies other than umbonate, hyperplasia of the basal body wall was the most common microscopic finding (63%). For the remainder of the gross lesions, no single microscopic finding constituted >50% of the total. Host response varied with the agent present on histology. Fragmentation of tissues was most often associated with algae (60%), whereas necrosis dominated (53%) for fungi. Two newly documented potentially symbiotic tissue-associated metazoans were seen in Porites and Montipora. Findings of multiple potential etiologies for a given gross lesion highlight the importance of incorporating histopathology in coral disease surveys. This study also expands the range of corals infected with cell-associated microbial aggregates.

  3. Surgical Assisting

    Science.gov (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  4. Ossified spinal meningiomas: Clinical and surgical features.

    Science.gov (United States)

    Alafaci, Concetta; Grasso, Giovanni; Granata, Francesca; Salpietro, Francesco M; Tomasello, Francesco

    2016-03-01

    Meningiomas constitute 25% of primary spinal tumors and predominantly involve the thoracic spinal cord. Although calcifications are commonly seen in intracranial meningiomas, gross calcifications are observed in only 1-5% of all spinal meningiomas. We report the clinical findings, surgical strategy and histological features of 9 patients with ossified spinal meningiomas (OSMs). Clinical and surgical features of 9 patients with ossified spinal meningiomas were retrospectively reviewed. There were 8 women and 1 man with a mean age of 59 years. In 7 patients, the lesions were localized in the thoracic segment of the spine while in 2 patients in the lower cervical segment. All patients presented with weakness of the lower limbs and hypoesthesia below the site level of the lesion. Only 2 patients presented with urinary incontinence. Gross-total resection of the tumor was achieved in 6 patients while in 3 a subtotal removal of the meningioma was obtained. In all patients the postoperative course was uneventful. Six patients presented with a significant neurological improvement while in 3 patients a mild improvement was observed. Microscopically, all tumors showed typical histological pattern of ossified meningioma. OSMs are amenable to surgery if the complete removal can be achieved. Because of their hard-rock consistency complete resection can be challenging. In difficult cases, subtotal removal can be advised and follow-up imaging is mandatory. Overall, the risk of long-term recurrence of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy?

    Science.gov (United States)

    Sanz Mengibar, Jose Manuel; Santonja-Medina, Fernando; Sanchez-de-Muniain, Paloma; Canteras-Jordana, Manuel

    2016-03-01

    Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.

  6. The future of gross anatomy teaching.

    Science.gov (United States)

    Malamed, S; Seiden, D

    1995-01-01

    A survey of U.S. departments of anatomy, physiology, and biochemistry shows that 39% of the respondent anatomy departments reported declines in the numbers of graduate students taking the human gross anatomy course. Similarly, 42% of the departments reported decreases in the numbers of graduate students teaching human gross anatomy. These decreases were greater in anatomy than in physiology and in biochemistry. The percentages of departments reporting increases in students taking or teaching their courses was 6% for human gross anatomy and 0% to 19% for physiology and biochemistry courses. To reverse this trend the establishment of specific programs for the training of gross anatomy teachers is advocated. These new teachers will be available as the need for them is increasingly recognized in the future.

  7. FUZZY ECCENTRICITY AND GROSS ERROR IDENTIFICATION

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The dominant and recessive effect made by exceptional interferer is analyzed in measurement system based on responsive character, and the gross error model of fuzzy clustering based on fuzzy relation and fuzzy equipollence relation is built. The concept and calculate formula of fuzzy eccentricity are defined to deduce the evaluation rule and function of gross error, on the base of them, a fuzzy clustering method of separating and discriminating the gross error is found. Utilized in the dynamic circular division measurement system, the method can identify and eliminate gross error in measured data, and reduce measured data dispersity. Experimental results indicate that the use of the method and model enables repetitive precision of the system to improve 80% higher than the foregoing system, to reach 3.5 s, and angle measurement error is less than 7 s.

  8. Validating the Rett Syndrome Gross Motor Scale

    DEFF Research Database (Denmark)

    Downs, Jenny; Stahlhut, Michelle; Wong, Kingsley;

    2016-01-01

    Rett syndrome is a pervasive neurodevelopmental disorder associated with a pathogenic mutation on the MECP2 gene. Impaired movement is a fundamental component and the Rett Syndrome Gross Motor Scale was developed to measure gross motor abilities in this population. The current study investigated...... the validity and reliability of the Rett Syndrome Gross Motor Scale. Video data showing gross motor abilities supplemented with parent report data was collected for 255 girls and women registered with the Australian Rett Syndrome Database, and the factor structure and relationships between motor scores, age...... and genotype were investigated. Clinical assessment scores for 38 girls and women with Rett syndrome who attended the Danish Center for Rett Syndrome were used to assess consistency of measurement. Principal components analysis enabled the calculation of three factor scores: Sitting, Standing and Walking...

  9. Acute lymphoblastic leukemia presenting with gross hematuria

    OpenAIRE

    Kalbani, Naifain Al; Weitzman, Sheila; Abdelhaleem, Mohamed; Carcao, Manuel; Abla, Oussama

    2007-01-01

    A case of a six-year-old boy presenting with gross hematuria is reported. Investigations revealed the etiology of the hematuria to be thrombocytopenia in the setting of newly diagnosed acute lymphoblastic leukemia. The diagnosis of leukemia was confirmed by bone marrow examination. The patient’s hematuria completely resolved with platelet transfusions. Although thrombocytopenia is a very common presenting feature of acute lymphoblastic leukemia, gross hematuria is exceedingly rare. Thus, thro...

  10. The San Andreas fault experiment. [gross tectonic plates relative velocity

    Science.gov (United States)

    Smith, D. E.; Vonbun, F. O.

    1973-01-01

    A plan was developed during 1971 to determine gross tectonic plate motions along the San Andreas Fault System in California. Knowledge of the gross motion along the total fault system is an essential component in the construction of realistic deformation models of fault regions. Such mathematical models will be used in the future for studies which will eventually lead to prediction of major earthquakes. The main purpose of the experiment described is the determination of the relative velocity of the North American and the Pacific Plates. This motion being so extremely small, cannot be measured directly but can be deduced from distance measurements between points on opposite sites of the plate boundary taken over a number of years.

  11. PREDICTION OF GROSS FEED EFFICIENCY IN ITALIAN HOLSTEIN FRIESIAN BULLS

    Directory of Open Access Journals (Sweden)

    Raffaella Finocchiaro

    2015-09-01

    Full Text Available The aim of this study was to predict gross feed efficiency of Italian Holstein Friesian bulls selected for production, functional and type traits. A total of 12,238 bulls, from the April 2015 genetic evaluation, were used. Predicted daily gross feed efficiency (pFE was obtained as ratio between milk yield (MY and predicted dry matter intake (pDMI. Phenotypic trend for MY, predicted body weight (pBW and pFE were calculated by the bull birth year. The results suggest that pFE can be successfully selected to increase profitability of dairy cattle using the current milk recording system. Direct measurements on DMI should be considered to confirm results of pFE obtained in the present study.

  12. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques

    NARCIS (Netherlands)

    van de Groes, S.A.W.; De Waal Malefijt, M.C.; Verdonschot, Nicolaas Jacobus Joseph

    2014-01-01

    Background: Some follow-up studies of highflexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implantfixation is dependant on two interfaces: the cement–implant and the cement–bone interface. The present finite-element model (FEM) is the first

  13. Probability of mechanical loosening of the femoral component in high flexion total knee arthroplasty can be reduced by rather simple surgical techniques

    NARCIS (Netherlands)

    Groes, S.A.W. van de; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2014-01-01

    BACKGROUND: Some follow-up studies of high flexion total knee arthoplasties report disturbingly high incidences of femoral component loosening. Femoral implant fixation is dependant on two interfaces: the cement-implant and the cement-bone interface. The present finite-element model (FEM) is the

  14. A comparative study between total contact casting and conventional dressings in the non-surgical management of diabetic plantar foot ulcers.

    Science.gov (United States)

    Ganguly, Suparno; Chakraborty, Koustubh; Mandal, Pankaj Kumar; Ballav, Ambar; Choudhury, Subhankar; Bagchi, Subrata; Mukherjee, Satinath

    2008-04-01

    Of all non-traumatic amputations 50% occur in Diabetics, mostly as a final outcome of foot ulcers. A major biomechanical factor in the causation of foot ulcers in persons with diabetes mellitus is elevated peak plantar pressure. Offloading the ulcer area in the form of equalisation of pressure across the plantar surface can accelerate healing of the ulcer. Total contact casting is one such method of offloading, and this study attempts to investigate the advantages of the above method as compared to conventional dressings in the physiatric management of the depth--ischaemia grades 1A, 1B, 2A, 2B neuropathic plantar ulcers in a diabetic patient. The outcome measure was the time taken for complete resolution of the ulcers. Of the 29 patients in Category A treated with total contact casting involving a total of 39 foot ulcers, 36 healed, which was statistically significant (p ulcers healing in Category B consisting of 26 patients treated by conventional dressings alone. Total contact casting is an effective, rapid, economical, ambulatory and outpatient--based method for the treatment of diabetic foot ulcers.

  15. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection.

    Science.gov (United States)

    Koh, Dean Chi-Siong; Tsang, Charles Bih-Shou; Kim, Seon-Hahn

    2011-06-01

    The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vinci® system with a fourth arm extension. The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. The standard da Vinci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with short-term outcomes similar to those of

  16. Concurrent Validity of Preschooler Gross Motor Quality Scale with Test of Gross Motor Development-2

    Science.gov (United States)

    Sun, Shih-Heng; Sun, Hsiao-Ling; Zhu, Yi-Ching; Huang, Li-chi; Hsieh, Yueh-Ling

    2011-01-01

    Preschooler Gross Motor Quality Scale (PGMQ) was recently developed to evaluate motor skill quality of preschoolers. The purpose of this study was to establish the concurrent validity of PGMQ using Test of Gross Motor Development-2 (TGMD-2) as the gold standard. One hundred and thirty five preschool children aged from three to six years were…

  17. BOREAS HYD-8 Gross Precipitation Data

    Science.gov (United States)

    Fernandes, Richard; Hall, Forrest G. (Editor); Knapp, David E. (Editor); Smith, David E. (Technical Monitor)

    2000-01-01

    The Boreal Ecosystem-Atmosphere Study (BOREAS) Hydrology (HYD)-08 team made measurements of surface hydrological processes at the Southern Study Area-Old Black Spruce (SSA-OBS) Tower Flux site to support its research into point hydrological processes and the spatial variation of these processes. Data collected may be useful in characterizing canopy interception, drip, throughfall, moss interception, drainage, evaporation, and capacity during the growing season at daily temporal resolution. This particular data set contains the gross precipitation measurements for July to August 1996. Gross precipitation is the precipitation that falls that is not intercepted by tree canopies. These data are stored in ASCII text files. The HYD-08 gross precipitation data are available from the Earth Observing System Data and Information System (EOSDIS) Oak Ridge National Laboratory (ORNL) Distributed Active Archive Center (DAAC). The data files are available on a CD-ROM (see document number 20010000884).

  18. 7 CFR 1424.7 - Gross payable units.

    Science.gov (United States)

    2010-01-01

    ...) Biodiesel producers will be eligible for payments on gross payable units for all biodiesel production from... rates. Unless otherwise determined by CCC, gross payable units for biodiesel production from eligible... biodiesel production gross payable units. (3) Adding the APP and BPP to determine biodiesel gross...

  19. The Gross conjecture over rational function fields

    Institute of Scientific and Technical Information of China (English)

    OUYANG; Yi

    2005-01-01

    We study the Gross conjecture for the cyclotomic function field extension k(∧f)/k where k = Fq(t) is the rational function field and f is a monic polynomial in Fq[t].We prove the conjecture in the Fermat curve case(i.e., when f = t(t - 1)) by a direct calculation. We also prove the case when f is irreducible, which is analogous to the Weil reciprocity law. In the general case, we manage to show the weak version of the Gross conjecture here.

  20. Morbilidad y mortalidad en conducto ileal y su relación con nutrición parenteral total postoperatoria Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition

    OpenAIRE

    G. González Ávila; H. Rodríguez Ovalle; J. A. Rojas Barrera

    2006-01-01

    Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel....

  1. Pre-surgical integration of FMRI and DTI of the sensorimotor system in transcortical resection of a high-grade insular astrocytoma

    Directory of Open Access Journals (Sweden)

    Chelsea eEkstrand

    2016-03-01

    Full Text Available Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI and diffusion tensor imaging (DTI, to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis.

  2. Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Gambhir, A. K.; Bale, L.; Pradhan, N.; Porter, M. L.

    2004-01-01

    BACKGROUND: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice. METHODS: A total of 86 surgeons from 26 hospitals were included in a questionnaire study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%. CONCLUSIONS: This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices

  3. Tratamento cirúrgico das dissecções de aorta tipo A utilizando parada cardiocirculatória total com hipotermia profunda Surgical treatment of type A aortic dissections utilizing total cardiocirculatory arrest with deep hypothermia

    OpenAIRE

    Luciano Cabral Albuquerque; Marco Antônio Goldani; Juremir João Goldani; Ricardo Medeiros Piantá; Rubens Lorentz Araújo; João Batista Petracco

    1993-01-01

    No período de julho de 1986 a julho de 1993, 22 pacientes portadores de dissecção de aorta tipo A foram tratados cirurgicamente utilizando-se parada cardiocirculatória (PCC) total sob hipotermia profunda (18ºC), dos quais 15 apresentavam dissecção aguda e 7 dissecção crônica. Em 14 casos (64%) a aorta ascendente foi reconstruída utilizando-se enxerto reto de Dacron, com troca valvar aórtica em 5 pacientes e ressuspensão valvar aórtica em 2; a reconstrução do arco aórtico foi empregada em 8 ca...

  4. Complex saddles in the Gross-Witten-Wadia matrix model

    CERN Document Server

    Álvarez, Gabriel; Medina, Elena

    2016-01-01

    We give an exhaustive characterization of the complex saddle point configurations of the Gross-Witten-Wadia matrix model in the large-N limit. In particular, we characterize the cases in which the saddles accumulate in one, two, or three arcs, in terms of the values of the coupling constant and of the fraction of the total unit density that is supported in one of the arcs, and derive an explicit condition for gap closing associated to nonvacuum saddles. By applying the idea of large-N instanton we also give direct analytic derivations of the weak-coupling and strong-coupling instanton actions.

  5. Gross Revenue risk in Swiss dairy farming

    NARCIS (Netherlands)

    Benni, El N.; Finger, R.

    2013-01-01

    This study investigated how agricultural policy reforms, including market liberalization and market deregulation, have influenced gross revenue risk of Swiss dairy producers using farm-level panel data between 1990 and 2009. Based on detrended data, variance decomposition was applied to assess how o

  6. Gross Revenue risk in Swiss dairy farming

    NARCIS (Netherlands)

    Benni, El N.; Finger, R.

    2013-01-01

    This study investigated how agricultural policy reforms, including market liberalization and market deregulation, have influenced gross revenue risk of Swiss dairy producers using farm-level panel data between 1990 and 2009. Based on detrended data, variance decomposition was applied to assess how

  7. Primary total knee replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register.

    Science.gov (United States)

    Malik, M. H. A.; Chougle, A.; Pradhan, N.; Gambhir, A. K.; Porter, M. L.

    2005-01-01

    INTRODUCTION: In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Association for Surgery of the Knee (BASK) to provide a basis for regional and national auditable standards: we have compared practice in the North West of England to this document to ascertain adherence to this guide to best practice. MATERIALS AND METHODS: A direct comparison of data held on the North West Hip Arthroplasty Register for 2001/2002 and BASK/BOA guidelines was performed. 86 surgeons from 26 hospitals were included in the study. RESULTS: A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. 42.2% of respondents routinely used exhaust suits and 68.1% of respondents routinely used impermeable disposable gowns. All surgeons use some form of anti-thromboembolic prophylaxis; 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin. 93.7% of surgeons routinely use antibiotic-loaded cement. The PFC and Kinemax prostheses were the most commonly used prostheses. Interestingly, 97.7% of all first-choice implants were cemented. Only 2 surgeons used uncemented total knee replacement. 69.8% of surgeons used a posterior cruciate retaining design. A midline longitudinal skin incision is used by 87.2% of surgeons, a medial longitudinal skin incision by 7.0% and a lateral longitudinal skin incision by 5.8% of surgeons. A medial parapatellar capsular incision is preferred by 91.9% with the remainder using mid vastus or trivector retaining capsulotomy. Closure of capsulotomies is performed in flexion by 65.1% and in extension by 34.9%. In patients with osteoarthritis, 38.4% routinely resurfaced the patella, 34.9% never resurfaced the patella and 26.7% selectively resurfaced. This was in direct contrast to

  8. Surgical Management of Intramedullary Spinal Cord Tumors: Surgical Resection and Prognosis

    Institute of Scientific and Technical Information of China (English)

    Gui-huai Wang; Gui-huai Wang; Chung-cheng Wang; Chung-cheng Wang

    2003-01-01

    BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas.Radical resection for IMSCTs remains challenging.Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors.METHODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection during the past 4 years in our institute.The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 hemangioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics.A gross-total resection (> 95%) was achieved in 25 surgical procedures.Subtotal resections (80-95%) were performed in 4 cases.There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved, and 3 deteriorated.Patients with either no deficit or only mild deficit before surgery were rarely impaired by the procedure, reinforcing the importance of early diagnosis and treatment.The major determinant of long-term survival was histological composition of the tumor.Patients in whom an IMSCT was only partially resected (< 80%) fared significantly worse.CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection plus radiotherapy.The optimal therapy for patients with high-grade glioma is yet to be determined.For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor.For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult, and thus, removal is not the goal of surgery.The carbon dioxide laser is particularly useful during surgery for this lesion.

  9. Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total Risk factors analysis in the surgical repair of complete atrioventricular septal defect

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi

    1993-06-01

    Full Text Available Pacientes com defeito septal atrioventricular de forma total (DSAVT freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce. Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade, peso, sexo, ano da operação, presença de síndrome de Down, grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli, emprego de parada circulatória e técnica de correção (1 x 2 retalhos. Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que, independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.Patients with complete atrioventricular septal defects (CAVSD frequently present with severe heart failure which cannot be controllable medically and pulmonary hypertension in infancy. Just a small number survives without early surgical treatment. For this reason

  10. The surgical cooperation and nurse strategy in total arch replacement combined with stented elephant trunk implantation%主动脉全弓置换联合支架象鼻手术的手术配合及护理

    Institute of Scientific and Technical Information of China (English)

    印建榕

    2011-01-01

    Objective To explore the surgical cooperation with traveling nurse in total arch replacement combined with stented elephant trunk implantation for Stanford A aortic dissection, and discuss the nursing strategy in perioperative. Methods The effect of tour nursing with 15 patients who were operated total arch replacement combined with stented elephant trunk implantation in cardiopulmonary bypass, and how to collaborate with traveling nurse better were analyzed. Results All the cases were operated successfully, the cooperation between instrument nurse and traveling nurse were very good, the patients returned to intensive care unit safely after operation. Conclusion The nurse should acquaint the information of patients before operation, know the process of surgery, get fully prepared before surgery, to ensure the surgical process to go smoothly.%目的 探讨主动脉全弓置换联合支架象鼻术治疗主动脉夹层的手术配合及护理.方法 分析15例在体外循环下行主动脉全弓置换联合支架象鼻术手术的器械配合及巡回护理的效果.结果 本组病例均顺利完成手术,术中器械及巡回护士配合达到预期的效果,患者术后安返监护室.结论 手术室护士术前必须充分了解患者的病情,熟悉手术操作过程,做好术前各种准备,术中才能配合默契,有利于手术的顺利进行.

  11. Imaging and surgical outcomes of spinal tumors in 18 dogs and one cat

    Science.gov (United States)

    Caliskan, Murat; Can, Pinar; Vural, Sevil Atalay; Algin, Oktay; Ahlat, Ozan

    2016-01-01

    Clinical and magnetic resonance imaging (MRI) findings, histological appearances and surgical outcomes of 18 dogs and one cat with spinal tumors are presented. Medical records of the cases admitted for spinal disorders were reviewed, and cases of spinal tumors that were diagnosed by MRI and confirmed by histological examination were included in this study. T1 weighted, T2 weighted and contrast enhanced T1 weighted images were taken and interpreted to evaluate the spinal tumors. The tumors were diagnosed as: meningioma (n = 6), ependymoma (n = 1), nerve sheath tumor (n = 4), metastatic spinal tumor (n = 3), osteosarcoma (n = 2), osteoma (n = 1), rhabdomyosarcoma (n = 1), and nephroblastoma (n = 1). Thirteen cases underwent surgical operation and the remaining six cases were euthanized at the request of the owners. The neurological status of the surgical cases did not deteriorate, except for one dog that showed ependymoma in the early period after the operation. These results indicate the potential for surgical gross total tumor removal of vertebral tumors to provide better quality of life and surgical collection of histological specimens for definitive diagnosis. For effective case management, dedicated MRI examination is important to accurate evaluation of the spinal tumors, and surgical treatment is useful for extradural and intradural-extramedullary spinal tumors. PMID:26645333

  12. Noncommutative complex Grosse-Wulkenhaar model

    CERN Document Server

    Hounkonnou, Mahouton Norbert

    2012-01-01

    This paper stands for an application of the noncommutative (NC) Noether theorem, given in our previous work [AIP Proc 956 (2007) 55-60], for the NC complex Grosse-Wulkenhaar model. It provides with an extension of a recent work [Physics Letters B 653 (2007) 343-345]. The local conservation of energy-momentum tensors (EMTs) is recovered using improvement procedures based on Moyal algebraic techniques. Broken dilatation symmetry is discussed. NC gauge currents are also explicitly computed.

  13. Determination of respiration, gross nitrification and denitrification in soil profile using BaPS system

    Institute of Scientific and Technical Information of China (English)

    CHEN Shu-tao; HUANG Yao

    2006-01-01

    A facility of BaPS (Barometric Process Separation) was used to determine soil respiration, gross nitrification and denitrification in a winter wheat field with depths of 0-7, 7-14 and 14-21 cm. N2O production was determined by a gas chromatograph. Crop root mass and relevant soil parameters were measured. Results showed that soil respiration and gross nitrification decreased with the increase of soil depth, while denitrification did not change significantly. In comparison with no-plowing plot, soil respiration increased significantly in plowing plot, especially in the surface soil of 0-7 cm, while gross nitrification and denitrification rates were not affected by plowing. Cropping practice in previous season was found to affect soil gross nitrification in the following wheat-growing season. Higher gross nitrification rate occurred in the filed plot with preceding crop of rice compared with that of maize for all the three depths of 0-7, 7-14 and 14-21 cm. A further investigation indicated that the nitrification for all the cases accounted for about 76% of the total nitrogen transformation processes of nitrification and denitrification and the N2O production correlated with nitrification significantly, suggesting that nitrification is a key process of soil N2O production in the wheat field. In addition, the variations of soil respiration and gross nitrification were exponentially dependent on root mass (P<0.001).

  14. ASSETS ADMITTED TO COVER GROSS TECHNICAL RESERVES CASE STUDY: INSURANCE – REINSURANCE COMPANY ASTRA SA

    Directory of Open Access Journals (Sweden)

    IRINELA – CONSTANTINA BADEA

    2015-12-01

    Full Text Available The aim of this paper is to analyze the asset structure and the coverage of gross technical reserves of the Insurance – Reinsurance Company Astra SA, for the period 2003 – 2014. Insurance companies are required to constitute technical reserves, in order to cope with the payment obligations to policyholders. These reserves may only be covered on account of certain assets, admitted by law. In Romania, Orders No. 8 and 9/2011, issued by the Insurance Supervisory Commission, contain Rules regarding the assets admitted to cover gross technical reserves, the dispersion of assets admitted to cover gross technical reserves and the liquidity coefficient. Order No. 9/2011, relating to general insurance, has been amended by Rule No. 22/2014. In this paper, we have analyzed the main elements of Astra’s assets, their share in total assets and we have calculated the coverage of gross technical reserves by total assets and liquid assets. In 2013 and 2014, the value of total assets was below the value of gross tehnical reserves, which demonstrated Astra’s financial instability, through negative capital and the inability to meet the obligations to policyholders. Failure to comply with the prudential indicators has been one of the main causes of Astra`s bankruptcy.

  15. A prototype surgical manipulator for robotic intraocular micro surgery.

    Science.gov (United States)

    Mulgaonkar, Amit P; Hubschman, Jean-Pierre; Bourges, Jean-Louis; Jordan, Brett L; Cham, Christopher; Wilson, Jason T; Tsao, Tsu-Chin; Culjat, Martin O

    2009-01-01

    A prototype manipulator system was developed for ophthalmologic microsurgery. The system, consisting of two parallel X-Y stages, can mechanically maintain a fixed-point of rotation at the surface of the eye, potentially reducing trauma during surgical procedures. The initial prototype was designed to function in concert with the da Vinci Surgical System for gross positioning. Robotic tests demonstrated the mechanical fitness of the prototype while an in vitro surgical sclerectomy was performed to demonstrate functionality of the approach.

  16. Gross changes in reconstructions of historic land cover/use for Europe between 1900 and 2010.

    Science.gov (United States)

    Fuchs, Richard; Herold, Martin; Verburg, Peter H; Clevers, Jan G P W; Eberle, Jonas

    2015-01-01

    Historic land-cover/use change is important for studies on climate change, soil carbon, and biodiversity assessments. Available reconstructions focus on the net area difference between two time steps (net changes) instead of accounting for all area gains and losses (gross changes). This leads to a serious underestimation of land-cover/use dynamics with impacts on the biogeochemical and environmental assessments based on these reconstructions. In this study, we quantified to what extent land-cover/use reconstructions underestimate land-cover/use changes in Europe for the 1900-2010 period by accounting for net changes only. We empirically analyzed available historic land-change data, quantified their uncertainty, corrected for spatial-temporal effects and identified underlying processes causing differences between gross and net changes. Gross changes varied for different land classes (largest for forest and grassland) and led to two to four times the amount of net changes. We applied the empirical results of gross change quantities in a spatially explicit reconstruction of historic land change to reconstruct gross changes for the EU27 plus Switzerland at 1 km spatial resolution between 1950 and 2010. In addition, the reconstruction was extended back to 1900 to explore the effects of accounting for gross changes on longer time scales. We created a land-change reconstruction that only accounted for net changes for comparison. Our two model outputs were compared with five commonly used global reconstructions for the same period and area. In our reconstruction, gross changes led in total to a 56% area change (ca. 0.5% yr(-1)) between 1900 and 2010 and cover twice the area of net changes. All global reconstructions used for comparison estimated fewer changes than our gross change reconstruction. Main land-change processes were cropland/grassland dynamics and afforestation, and also deforestation and urbanization. © 2014 John Wiley & Sons Ltd.

  17. A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up

    Directory of Open Access Journals (Sweden)

    Mermerkaya MU

    2016-12-01

    Full Text Available Musa Ugur Mermerkaya,1 Houman Adli2 1Department of Orthopaedics and Traumatology, Medical School, Bozok University, 2Department of Orthopaedics and Traumatology, Yozgat State Hospital, Yozgat, Turkey Purpose: We evaluated the short- to midterm outcomes of metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty (total joint replacement [TJR] as surgical treatments for advanced-stage hallux rigidus (HR.Patients and methods: From 2012 to 2014, all data from patients who underwent surgery for the treatment of grades 2–3 HR were retrospectively reviewed, and 45 patients were included in this study. Of these patients, 26 underwent metatarsal head-resurfacing hemiarthroplasty (Group I and 19 underwent TJR (Group II. All patients were clinically graded prior to surgery and at their final follow-up visits using the American Orthopedic Foot and Ankle Society’s (AOFAS hallux metatarsophalangeal–interphalangeal scale, a visual analog scale (VAS, and the “first metatarsophalangeal joint range of motion” (MTPJ ROM score.Results: Metatarsal head resurfacing was performed on 26 patients. Two patients underwent bilateral procedures, yielding a total of 28 cases in Group I. TJR was performed on 19 patients in Group II. Of the 26 Group I patients, 12 (46.2% were male and 14 (53.8% were female, with a mean age of 56.3±4.5 years (range: 47–63 years; the mean follow-up duration was 29.9±5.2 months. Of the 19 Group II patients, eight (42.1% were male and eleven (57.9% were female, with a mean age of 57.1±5.8 years (range: 45–66 years; the mean follow-up duration was 27.1±7.5 months. Significant improvements were evident in the AOFAS scores, and the VAS scores decreased, in both groups. No significant difference was evident between groups I and II.Conclusion: After failure of conservative treatment in patients with moderate-to-severe HR, both MTPJ hemiarthroplasty and TJR were associated with effective

  18. The Gross Motor Skills of Children with Mild Learning Disabilities

    Science.gov (United States)

    Nonis, Karen P.; Jernice, Tan Sing Yee

    2014-01-01

    Many international studies have examined the gross motor skills of children studying in special schools while local studies of such nature are limited. This study investigated the gross motor skills of children with Mild Learning Disabilities (MLD; n = 14, M age = 8.93 years, SD = 0.33) with the Test of Gross Motor Development-2 (TGMD-2, Ulrich,…

  19. 7 CFR 1410.44 - Average adjusted gross income.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Average adjusted gross income. 1410.44 Section 1410... Average adjusted gross income. (a) Benefits under this part will not be available to persons or legal entities whose average adjusted gross income exceeds $1,000,000 or as further specified in part...

  20. 7 CFR 701.17 - Average adjusted gross income limitation.

    Science.gov (United States)

    2010-01-01

    ... 9003), each applicant must meet the provisions of the Adjusted Gross Income Limitations at 7 CFR part... 7 Agriculture 7 2010-01-01 2010-01-01 false Average adjusted gross income limitation. 701.17... RELATED PROGRAMS PREVIOUSLY ADMINISTERED UNDER THIS PART § 701.17 Average adjusted gross income...

  1. GENDER DIFFERENCES IN FINE AND GROSS MOTOR SKILLS OF NORMALLY DEVELOPING OVERWEIGHT AND OBESE ADOLESCENTS

    Directory of Open Access Journals (Sweden)

    Şehmus ASLAN

    2016-12-01

    Full Text Available The purpose of this research is to compare girls’ and boys’ fine and gross motor skills in normally developing overweight and obese adolescents. 18 girls and 28 boys with 12-18 age range, in totally 46 overweight and obese adolecents participated in the study. Body mass index of participants were calculated. Fine and gross motor skills of adolescents were assessed by Short Form Bruininks-Oseretsky Test of Motor Proficiency (BOT-2 SF. There was no differences between girls and boys for BOT-2 SF total scores (p>0.05, but it was found differences in several items of BOT-2 SF. Scores of test items for fine motor scores in the girls were higher than the boys (p0.05. Gross motor skill tests including jumping in place, dribling a ball, sit-ups, one- legged stationary hop test scores were higher in the boys, while tapping feet and fingers test score was higher in the girls (p<0.05. Our results suggested that there is differences between girls’ and boys’ fine and gross motor skills in normally developing overweight and obese adolescents. Girls have better fine motor skill performance while boys have better gross motor skill performance in overweight and obese adolescents.

  2. Surgical Management of Intracranial Neuroenteric Cysts: The UCSF Experience.

    Science.gov (United States)

    Breshears, Jonathan D; Rutkowski, Martin J; McDermott, Michael W; Cha, Soonmee; Tihan, Tarik; Theodosopoulos, Philip V

    2015-12-01

    Objective Modern surgical experience with intracranial neuroenteric cysts is limited in the literature. We review our 15-year institutional experience with these rare lesions. Design Single-institution retrospective study. Setting Large North American tertiary care center. Participants Histologically confirmed cases of intracranial neuroenteric cyst from January 2000 to September 2014. Main Outcome Measures Pre- and postoperative modified Rankin Scale (mRS) scores, extent of resection, and postoperative complications are reported. Clinical presentation, imaging features, pathology, and operative approach are discussed. Results Five spinal and six intracranial neuroenteric cysts were surgically treated over a 15-year period. Median age at presentation for the intracranial cysts was 38.5 years. Mean cyst diameter was 3.8 cm. Five cysts were located in the pre-pontomedullary cistern, and one was located in the third ventricle. Gross total resection was achieved in four of the five posterior fossa cysts through a far lateral transcondylar approach. Postoperative complications included aseptic meningitis (one), transient abducens palsy (one), and pseudomeningocele requiring reoperation (three). Postoperative mRS scores improved to ≤1 by 6.5 months median follow-up. Conclusions Intracranial neuroenteric cysts are rare lesions with a variable imaging appearance. Complete surgical resection through a far lateral transcondylar approach is possible and usually results in symptom improvement or resolution.

  3. Clinical anatomy of the subserous layer: An amalgamation of gross and clinical anatomy.

    Science.gov (United States)

    Yabuki, Yoshihiko

    2016-05-01

    The 1998 edition of Terminologia Anatomica introduced some currently used clinical anatomical terms for the pelvic connective tissue or subserous layer. These innovations persuaded the present author to consider a format in which the clinical anatomical terms could be reconciled with those of gross anatomy and incorporated into a single anatomical glossary without contradiction or ambiguity. Specific studies on the subserous layer were undertaken on 79 Japanese women who had undergone surgery for uterine cervical cancer, and on 26 female cadavers that were dissected, 17 being formalin-fixed and 9 fresh. The results were as follows: (a) the subserous layer could be segmentalized by surgical dissection in the perpendicular, horizontal and sagittal planes; (b) the segmentalized subserous layer corresponded to 12 cubes, or ligaments, of minimal dimension that enabled the pelvic organs to be extirpated; (c) each ligament had a three-dimensional (3D) structure comprising craniocaudal, mediolateral, and dorsoventral directions vis-á-vis the pelvic axis; (d) these 3D-structured ligaments were encoded morphologically in order of decreasing length; and (e) using these codes, all the surgical procedures for 19th century to present-day radical hysterectomy could be expressed symbolically. The establishment of clinical anatomical terms, represented symbolically through coding as demonstrated in this article, could provide common ground for amalgamating clinical anatomy with gross anatomy. Consequently, terms in clinical anatomy and gross anatomy could be reconciled and compiled into a single anatomical glossary.

  4. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  5. Total Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Lopez Moris E

    2016-06-01

    Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.

  6. Baryons in Massive Gross-Neveu Models

    CERN Document Server

    Thies, M; Thies, Michael; Urlichs, Konrad

    2005-01-01

    Baryons in the large N limit of (1+1)-dimensional Gross-Neveu models with either discrete or continuous chiral symmetry have long been known. We generalize their construction to the case where the symmetry is explicitly broken by a bare mass term in the Lagrangian. In the discrete symmetry case, the exact solution is found for arbitrary bare fermion mass, using the Hartree-Fock approach. In the continuous symmetry case, a derivative expansion allows us to rederive a formerly proposed Skyrme-type model and to compute systematically corrections to the leading order description based on an effective sine-Gordon theory.

  7. Surgical treatment for male prolactinoma: A retrospective study of 184 cases.

    Science.gov (United States)

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi

    2017-01-01

    A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index.Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases.

  8. Tratamento cirúrgico das lesões da aorta torácica utilizando parada circulatória total hipotérmica com perfusão cerebral retrógrada Surgical treatment of the pathologies involving thoracic aorta using deep hypothermic total circulatory arrest with retrograde cerebral perfusion

    Directory of Open Access Journals (Sweden)

    Domingo M Braile

    1992-06-01

    ectasia associated with type B dissection. A cava-cava-femoral cardiopulmonary bypass was established with deep hypothermia and total circulatory arrest. Retrograde blood cardioplegia was used for myocardial preservation. During total circulatory arrest retrograde cerebral perfusion was made using arterial line cannulated to the superior vena cava with a flow of 250 to 300 ml/min the central venous pressure monitored at the arm ranged between 30 and 40 cmH2O. Surgical repair was achieved using bovine pericardial tube and patch associated to the biological glue. Duration of cardiopulmonary bypass ranged from 75 to 169 min, total circulatory arrest from 32 to 79 min and retrograde cerebral perfusion from 32 to 79 min. There was no mortality associated to surgery or to immediate postoperative period. There was only one late death, due to septcemia. All other patients are on follow-up. The results show that total circulatory arrest with retrograde cerebral perfusion protects the brain more effectively than conventional total circulatory arrest during surgical treatment of thoracic aorta pathologies that require total circulatory arrest.

  9. Financial Variables Effect on the U.S. Gross Private Domestic Investment (GPDI) 1959-2001

    CERN Document Server

    Bell, Byron E

    2007-01-01

    I studied what role the US stock markets and money markets have possibly played in the Gross Private Domestic Investment (GPDI) of the United States from the year 1959 to the year 2001, Gross Private Domestic Investment refers to the total amount of investment spending by businesses and firms located within the borders of a nation. It includes both the values of the purchases of non-residential fixed investment, which include capital goods used for production, and the values of the purchases of residential fixed investment, which include construction spending for factories or offices. And I created a Multiple Linear Regression Model of the GDPI. To see if companies and private citizens use the stock market and money markets as a way of financing capital projects (business ventures, buying commercial and noncommercial property, etc). Keywords: Gross Private Domestic Investment, Pearson Correlation, SP 500, TB3

  10. Is it All About the Money? Not All Surgical Subspecialization Leads to Higher Lifetime Revenue when Compared to General Surgery.

    Science.gov (United States)

    Baimas-George, Maria; Fleischer, Brian; Slakey, Douglas; Kandil, Emad; Korndorffer, James R; DuCoin, Christopher

    2017-07-10

    It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered. Data were collected from the Medical Group Management Association's 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars. The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined. With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-$1,561,441, -$1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to $5,301,985 and $3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by $325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon. Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional

  11. [Gross anatomy dissection and the legal control].

    Science.gov (United States)

    Yamashina, Shohei; Shibata, Yosaburo

    2010-12-01

    In Japan, dissection of human body is generally prohibited by the Penal Code, i.e. the criminal law. However, the Postmortem Examination and Corpse Preservation Act allows for the dissection of the body in very limited situations, that include gross anatomy dissection and pathological and forensic autopsy in medical and dental schools. Growing numbers of co-medical schools have been founded more recently in Japan, and not a small number of co-medical schools try to adopt human body dissection in the course of anatomy education. The present short communication reminds us of the ways of thinking of the Postmortem Examination and Corpse Preservation Act and the Act on Body Donation for Medical and Dental Education in order that anatomy education in medical as well as co-medical schools takes place under the regulation by these two laws.

  12. A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up

    Science.gov (United States)

    Mermerkaya, Musa Ugur; Adli, Houman

    2016-01-01

    Purpose We evaluated the short- to midterm outcomes of metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty (total joint replacement [TJR]) as surgical treatments for advanced-stage hallux rigidus (HR). Patients and methods From 2012 to 2014, all data from patients who underwent surgery for the treatment of grades 2–3 HR were retrospectively reviewed, and 45 patients were included in this study. Of these patients, 26 underwent metatarsal head-resurfacing hemiarthroplasty (Group I) and 19 underwent TJR (Group II). All patients were clinically graded prior to surgery and at their final follow-up visits using the American Orthopedic Foot and Ankle Society’s (AOFAS) hallux metatarsophalangeal–interphalangeal scale, a visual analog scale (VAS), and the “first metatarsophalangeal joint range of motion” (MTPJ ROM) score. Results Metatarsal head resurfacing was performed on 26 patients. Two patients underwent bilateral procedures, yielding a total of 28 cases in Group I. TJR was performed on 19 patients in Group II. Of the 26 Group I patients, 12 (46.2%) were male and 14 (53.8%) were female, with a mean age of 56.3±4.5 years (range: 47–63 years); the mean follow-up duration was 29.9±5.2 months. Of the 19 Group II patients, eight (42.1%) were male and eleven (57.9%) were female, with a mean age of 57.1±5.8 years (range: 45–66 years); the mean follow-up duration was 27.1±7.5 months. Significant improvements were evident in the AOFAS scores, and the VAS scores decreased, in both groups. No significant difference was evident between groups I and II. Conclusion After failure of conservative treatment in patients with moderate-to-severe HR, both MTPJ hemiarthroplasty and TJR were associated with effective recovery of toe function and MTPJ ROM, as well as good short- to midterm functional outcomes. PMID:28008240

  13. Robust Principal Component Test in Gross Error Detection and Identification

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Principle component analysis (PCA) based chi-square test is more sensitive to subtle gross errors and has greater power to correctly detect gross errors than classical chi-square test. However, classical principal component test (PCT) is non-robust and can be very sensitive to one or more outliers. In this paper, a Huber function liked robust weight factor was added in the collective chi-square test to eliminate the influence of gross errors on the PCT. Meanwhile, robust chi-square test was applied to modified simultaneous estimation of gross error (MSEGE) strategy to detect and identify multiple gross errors. Simulation results show that the proposed robust test can reduce the possibility of type Ⅱ errors effectively. Adding robust chi-square test into MSEGE does not obviously improve the power of multiple gross error identification, the proposed approach considers the influence of outliers on hypothesis statistic test and is more reasonable.

  14. The influence of total nodes examined, number of positive nodes, and lymph node ratio on survival after surgical resection and adjuvant chemoradiation for pancreatic cancer: A secondary analysis of RTOG 9704

    Science.gov (United States)

    Showalter, Timothy N.; Winter, Kathryn A.; Berger, Adam C.; Regine, William F.; Abrams, Ross A.; Safran, Howard; Hoffman, John P.; Benson, Al B.; MacDonald, John S.; Willett, Christopher G.

    2010-01-01

    Purpose Lymph node status is an important predictor of survival in pancreatic cancer. We performed a secondary analysis of RTOG 9704, an adjuvant chemotherapy and chemoradiation trial, to determine the influence of lymph node factors-number of positive nodes (NPN), total nodes examined (TNE), and lymph node ratio (LNR-ratio of NPN to TNE)-on OS and disease-free survival (DFS). Patient and Methods Eligible patients from RTOG 9704 form the basis of this secondary analysis of lymph node parameters. Actuarial estimates for OS and DFS were calculated using Kaplan-Meier methods. Cox proportional hazards models were performed to evaluate associations of NPN, TNE, and LNR with OS and DFS. Multivariate Cox proportional hazards models were also performed. Results There were 538 patients enrolled in the RTOG 9704 trial. Of these, 445 patients were eligible with lymph nodes removed. Overall median NPN was 1 (min-max, 0-18). Increased NPN was associated with worse OS (HR=1.06, p=0.001) and DFS (HR=1.05, p=0.01). In multivariate analyses, both NPN and TNE were associated with OS and DFS. TNE > 12, and >15, were associated with increased OS for all patients, but not for node-negative patients (n =142). Increased LNR was associated with worse OS (HR=1.01, p<0.0001) and DFS (HR=1.006, p=0.002). Conclusion In patients who undergo surgical resection followed by adjuvant chemoradiation, TNE, NPN, and LNR are associated with OS and DFS. This secondary analysis of a prospective, cooperative group trial supports the influence of these lymph node parameters on outcomes after surgery and adjuvant therapy using contemporary techniques. PMID:20934270

  15. The Influence of Total Nodes Examined, Number of Positive Nodes, and Lymph Node Ratio on Survival After Surgical Resection and Adjuvant Chemoradiation for Pancreatic Cancer: A Secondary Analysis of RTOG 9704

    Energy Technology Data Exchange (ETDEWEB)

    Showalter, Timothy N. [Department of Radiation Oncology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA (United States); Winter, Kathryn A. [Radiation Therapy Oncology Group, RTOG Statistical Center, Philadelphia, PA (United States); Berger, Adam C., E-mail: adam.berger@jefferson.edu [Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA (United States); Regine, William F. [Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States); Safran, Howard [Department of Medicine, Miriam Hospital, Brown University Oncology Group, Providence, RI (United States); Hoffman, John P. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Benson, Al B. [Division of Hematology-Oncology, Northwestern University, Chicago, IL (United States); MacDonald, John S. [St. Vincent' s Cancer Care Center, New York, NY (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2011-12-01

    Purpose: Lymph node status is an important predictor of survival in pancreatic cancer. We performed a secondary analysis of Radiation Therapy Oncology Group (RTOG) 9704, an adjuvant chemotherapy and chemoradiation trial, to determine the influence of lymph node factors-number of positive nodes (NPN), total nodes examined (TNE), and lymph node ratio (LNR ratio of NPN to TNE)-on OS and disease-free survival (DFS). Patient and Methods: Eligible patients from RTOG 9704 form the basis of this secondary analysis of lymph node parameters. Actuarial estimates for OS and DFS were calculated using Kaplan-Meier methods. Cox proportional hazards models were performed to evaluate associations of NPN, TNE, and LNR with OS and DFS. Multivariate Cox proportional hazards models were also performed. Results: There were 538 patients enrolled in the RTOG 9704 trial. Of these, 445 patients were eligible with lymph nodes removed. Overall median NPN was 1 (min-max, 0-18). Increased NPN was associated with worse OS (HR = 1.06, p = 0.001) and DFS (HR = 1.05, p = 0.01). In multivariate analyses, both NPN and TNE were associated with OS and DFS. TNE > 12, and >15 were associated with increased OS for all patients, but not for node-negative patients (n = 142). Increased LNR was associated with worse OS (HR = 1.01, p < 0.0001) and DFS (HR = 1.006, p = 0.002). Conclusion: In patients who undergo surgical resection followed by adjuvant chemoradiation, TNE, NPN, and LNR are associated with OS and DFS. This secondary analysis of a prospective, cooperative group trial supports the influence of these lymph node parameters on outcomes after surgery and adjuvant therapy using contemporary techniques.

  16. Risk factors of early surgical site infection after total hip arthroplasty%人工全髋关节置换术后早期手术部位感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    谢章家; 庞安琪; 谢壮

    2011-01-01

    目的 探讨人工全髋关节置换术(THA)后早期手术部位感染的危险因素.方法 回顾分析2000年1月至2010年10月本组所行153例单侧THA的患者,其中男46例,女107例,年龄29~79岁,平均(61.0±8.9)岁.回顾性分析多项临床因素与手术部位感染的相关性.连续变量包括:年龄、手术时间、手术出血量、术前白蛋白血清浓度、伤口引流管停留时间;分类变量包括:性别、有无长期使用激素病史、是否合并糖尿病、有无前次手术史、是否使用骨水泥、预防性抗生素使用方案.153例患者按照是否发生手术部位感染分成两组,对连续变量采用t检验、分类变量采用X2检验进行比较.结果 153例患者中8例出现手术部位感染,发生率为5.23%.单因素分析发现术前白蛋白血清浓度因素差异有统计学意义(t=2.752,P35 g/L比较差异有统计学意义(X2= 7.23,P<0.05).有无长期口服激素、有无前次手术比较差异有统计学意义(其X2值分别为3.93与12.38,P<0.05).年龄、性别、手术时间、术中出血量、抗生素使用时间、引流管停留时间、是否合并糖尿病、是否使用骨水泥等因素对手术部位感染发生无影响,均无统计学差异.结论 THA术前低蛋白血症、前次手术史、长期口服激素史是手术部位感染的高危因素.%Objective To analyse risk factors of infection at surgical site after total hip arthroplasty ( THA ). Methods From January, 2000 to October, 2010, 153 patients. including 46 men and 107 women. received THA in our hospital. The average age was ( 61. 0 ±8. 9 ) years ( range , 29 to 79 years ). Eleven clinical factors were analyzed retrospectively to determine their association with surgical site infection. Five continous variables were analyzed by t test while six categorical variables were analyzed by X2 test. Results The incidence of surgical site infection in this series was 5. 23% ( 8/153 ). Single factor analysis indicated

  17. TERATOGENIC EFFECTS OF SILVER NANOPARTICLES: GROSS ANOMALIES

    Directory of Open Access Journals (Sweden)

    Jyoti Prakash

    2015-07-01

    Full Text Available BACK GROUND: Prenatal exposure of AgNPs can induces devastative and detrimental effect in the organogenesis period of the developing embryos and foetuses. Organogenesis period is highly condemnatory and persuadable. Any injury to embryo during this period leads to dysmorphogenesis or even death AIM: The present study means to evaluate the gross anomalies on developing f o etus subsequent to silver nanoparticle ingestion during the gestational period. MATERIAL & METHOD: Random selections of pregnant Swiss albino mice were selected. AgNPs, of 20 - 100 nm size ra nge, were administered to pregnant mice by repeated oral gavages at concentra tions of 0.5, 1, 5, 10, 15 & 20 mg/kg/day during 4 - 17 gestational day. All dams were subjected to exteriorization on GD 18. The fetuses were evaluated for body malformation effects . RESULTS: Repeated oral gavages treatment with AgNPs at a concentration of 0.5mg/kg/day caused resorption (4.61% and intra uterine growth retardation (7.69% with no gross morphology alteration. 1 mg/kg/day caused resorption (9.23% and intra uterine growth retardation (10.76% with a rare case of haemorrhagic conception (1.53%, 5mg/kg/day caused limb malformation (7.01% resorption (17.54% and intra uterine growth retardation (17.54%, closed type Neural tube deformity (5.26%, 10mg/kg/day caused 20 % of limb malformation including Amelia, foot and tail vein hemorrhages and simple tail vein haemorrhage (3.50% each, resorption (22.80%, intra uterine growth retardation (29.82%, 15mg/kg/day caused severe hemorrhage within the entire body (22.80%, lim b anomaly including syndactyly and oligodactyly (8.77%, resorption (42.10%, intra uterine growth retardation (45.61%, 20mg/kg/day caused Omphalocele (3.27%, Bidiscoidal placental anomaly (9.83%, resorption (29.50% and intra uterine growth retardation (62.29%. CONCLUSION: The results show that a repeated oral dose of AgNPs during pregnancy caused fetal body dysmorphogenesis which is dose

  18. Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed.OBJECTIVE: To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy.DESIGN: A case-controlled analysis.SETTING: Qilu Children's Hospital of Shandong University.PARTICIPANTS: Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0 - 2 years old,47 cases of 2 - 4 years and 36 cases of 4 - 6 years. Informed contents were obtained from relatives of all the children.METHODS: ① Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub,pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was

  19. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

    Directory of Open Access Journals (Sweden)

    Suresh K Sankhla

    2015-01-01

    Full Text Available Objective: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas. Methods: Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors. Results: A gross total or near total excision was achieved in 10 (66.7% patients, subtotal resection in 4 (26.7%, and partial removal in 1 (6.7% patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20% developed postoperative CSF leaks which were managed conservatively. Three (20% patients with diabetes insipidus and 2 (13.3% with panhypopituitarism required long-term hormonal replacement therapy. Conclusions: Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks.

  20. Gross revenue risk in Swiss dairy farming.

    Science.gov (United States)

    El Benni, N; Finger, R

    2013-02-01

    This study investigated how agricultural policy reforms, including market liberalization and market deregulation, have influenced gross revenue risk of Swiss dairy producers using farm-level panel data between 1990 and 2009. Based on detrended data, variance decomposition was applied to assess how output prices and yields contributed to revenue risk over 3 different periods: the whole period (1990-2009), the first decade (1990-1999), and the second decade (1999-2009). In addition, the effect of expected changes in animal-based support for roughage-consuming cattle and price volatility on revenue risk was evaluated using a simulation model. Prices were the main contributor to revenue risk, even if the importance of yield risk increased over time. Swiss dairy producers can profit from natural hedge but market deregulation and market liberalization have reduced the natural hedge at the farm level. An increase in price volatility would substantially increase revenue risk and would, together with the abandonment of direct payments, reduce the comparative advantage of dairy production for risk-averse decision makers. Depending on other available risk management strategies, price risk management instruments might be a valuable solution for Swiss dairy producers in the future.

  1. Guidelines for Standard Photography in Gross and Clinical Anatomy

    Science.gov (United States)

    Barut, Cagatay; Ertilav, Hakan

    2011-01-01

    Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers…

  2. 26 CFR 1.61-4 - Gross income of farmers.

    Science.gov (United States)

    2010-04-01

    ... Gross income of farmers. (a) Farmers using the cash method of accounting. A farmer using the cash receipts and disbursements method of accounting shall include in his gross income for the taxable year— (1) The amount of cash and the value of merchandise or other property received during the taxable...

  3. Guidelines for Standard Photography in Gross and Clinical Anatomy

    Science.gov (United States)

    Barut, Cagatay; Ertilav, Hakan

    2011-01-01

    Photography has a widespread usage in medicine and anatomy. In this review, authors focused on the usage of photography in gross and clinical anatomy. Photography in gross and clinical anatomy is not only essential for accurate documentation of morphological findings but also important in sharing knowledge and experience. Photographs of cadavers…

  4. Psychiatric Symptoms in Children with Gross Motor Problems

    Science.gov (United States)

    Emck, Claudia; Bosscher, Ruud J.; van Wieringen, Piet C. W.; Doreleijers, Theo; Beek, Peter J.

    2012-01-01

    Children with psychiatric disorders often demonstrate gross motor problems. This study investigates if the reverse also holds true by assessing psychiatric symptoms present in children with gross motor problems. Emotional, behavioral, and autism spectrum disorders (ASD), as well as psychosocial problems, were assessed in a sample of 40 children…

  5. The Gross Anatomy Course: An Analysis of Its Importance

    Science.gov (United States)

    Bockers, Anja; Jerg-Bretzke, Lucia; Lamp, Christoph; Brinkmann, Anke; Traue, Harald C.; Bockers, Tobias M.

    2010-01-01

    The gross anatomy dissection course is a cost-intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an "important" course and so developed a quantitative…

  6. 5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

    Directory of Open Access Journals (Sweden)

    Alessandro Della Puppa

    2014-01-01

    Full Text Available Background. 5-Aminolevulinic acid (5-ALA fluorescence is a validated technique for resection of high grade gliomas (HGG; the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR>98% and GTR>90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO. Results. 94 patients were finally enrolled. Overall GTR>98% and GTR>90% was achieved in 93% and 100% of patients. Extent of resection (GTR>98% was dependent on tumor location, tumor grade (P<0.05, and tumor size (P<0.05. In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57% (P<0.01 and recurrent (60% tumors. Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

  7. 婴幼儿完全性肺静脉异位引流的外科治疗%Surgical Treatment of Total Anomalous Pulmonary Venous Connection in Infants

    Institute of Scientific and Technical Information of China (English)

    乔芳珍; 刘鑫伟

    2015-01-01

    Objective:To summarize the experience of the surgical treatment for infants and children with total a-nomalous pulmonary venous connection( TAPVC). Methods:21 patients with TAPVC were conducted surgical thera-py,including 13 boys and 8girls with main age at 4. 3 ± 1. 2month from 54 days to 12 months,with weight at 5. 42 ± 1. 41Kg from3. 6kg to 9. 3 kg ,in which 12 cases were in supracardiac type,7 cases in cardic type,1 case in mixed type and 1 case in intracardiac type . The correction of TAPVC was performed under moderate hypothermic cardiopulmonary bypass with all patients. Results:The aortic clamping time was(42. 6 ± 21. 3)min,cardiopulmonary bypass time (84. 6 ± 28. 4)min,and postoperative respirator use time(3. 42 ± 2. 01). All children were performed successfully without early death. In the early postoperation,8 cases occurred with pneumonia,2 cases of low cardiac output syn-drome,1cases with pulmonary hypertension crisis,1 case of renal insufficiency,in 3 cases of premature beat,section sex rhythm of the heart in 2 cases,and delay closed chest in 1 case. All recovered after treatment. Follow -up was completed in 21 patients from 3 months to 2 years. The children were in good condition. The cyanosis disappeared. With multiple reexamination,the echocardiographic was no obstruction;anastomotic atrioventricular cavity was reduced or basic close to normal earlier. Conclusions:The infants and children who are once diagnosed TAPVC should be taken early surgical treatment with the postoperative care,and enough intraoperative anastomotic stoma is the key to successful operation. Meanwhile,it is important to prevent the occurrence of postoperative low cardiac and pulmonary hypertension crisis and strengthen postoperative follow-up.%目的:对婴幼儿完全性肺静脉异位引流的外科治疗进行分析总结。方法:选取山西省儿童医院心胸外科2009年10月˜2014年4月收治的TAPVC患儿21例,其中心上型12例、心内型7

  8. Surgical approach to total anomalous pulmonary venous connection in 34 cases of neonate%新生儿完全性肺静脉异位引流的手术治疗

    Institute of Scientific and Technical Information of China (English)

    翟波; 陈振良; 陈忠建; 王鹏高; 杨房; 董向阳; 崔亚洲

    2014-01-01

    Objective To summarize the experience of surgical treatment of total anomalous pulmonary venous connection ( TAPVC).Methods From March 2011 to May 2014,34 neonates less than 28 days old underwent surgical correction of TAPVC,23 males and 11 females,aged from 6 days to 28 days with a mean of (15.00 ±4.60)days,body weight from 2.6 to 4.5 kg with a mean of(3.70 ±0.96)kg.There were 21 cases of supracardiac type(vertical vein was located on the right side in 2 cases and left side in 19 cases),1 case of mixed type,9 cases of cardiac type and 3 cases of infracardiac type.Median sternotomy was used;the pulmonary veins confluence was anastomosed to the left atrium ( side-to-side anastomosis ) for the supracardiac and infracardiac TAPVC.In cardiac TAPVC repair procedure,the tissue between the foramen ovale and coronary sinus was incised and extended in the roof of the coronary sinus to the posterior wall of the heart ,so the blood from pulmonary vein flow through the left atrium without obstruction .Cardiopulmonary bypass time was 39-143 min, the average (78.76 ±27.17)min;aortic clamp time was 21-73 min,the average(37.71 ±10.51)min.Results Early mortality was 8.82%(3 /34),low cardiac output syndrome occured in 7 cases,arrhythmia in 4 cases,pneumonia in 7 cases and temporary pacing were used in 9 cases.Thirty-one cases were followed up from one month to three years ,no death and re-operation for correction of anastomotic stenosis in children .Echocardiography suggested that blood flow velocity in the anastomotic orifice was less than 1.4 m/s.Conclusions Surgical operation should be undertaken early in neonate with TAPVC.%目的总结新生儿期完全性肺静脉异位引流(TAPVC)的手术治疗经验及疗效。方法回顾2011年3月至2014年5月,在我科手术治疗的新生儿 TAPVC 34例的病历资料,男23例,女11例。手术年龄6~28 d,平均(15.00±4.60)d,体重2.6~4.5 kg,平均(3.70±0.96)kg。其中心上型21

  9. Surgical treatment of infra-cardiac total anomalous pulmonary venous connection in 13 neonates%新生儿心下型完全性肺静脉异位引流的外科治疗

    Institute of Scientific and Technical Information of China (English)

    刘宇航; 衣慧; 温志杰; 洪小杨; 王辉; 王刚; 于文文; 封志纯; 周更须

    2015-01-01

    Objective To evaluate the effectiveness of urgent surgical correction for infra-cardiac total anomalous pulmonary venous connection(TAPVC)in neonates.Methods From October 2009 to Janu-ary 2015,13 patients with infra-cardiac TAPVC received surgical correction.The age of patients ranged from 6 to 28 days[(15.08 ±7.42)days],the body weight ranged from 2.5 to 4.8 kg [(3.34 ±0.67)kg].A median sternotomy was performed.Continuous cardiopulmonary bypass using bicaval cannulation with aortic cross-clamping and mild systemic hypothermia were used in all patients.Bi-atrial incision technique making anastomosis between the posterior left atrial wall and the vertical vein were employed in 3 cases.In the other 10 cases,the heart was elevated upward and to the right to expose the anomalous descending vertical vein to facilitate the anastomosis between the posterolateral left atrial wall and vertical vein.Results Emergent or subemergent operations were performed in all patients without surgical death.In the early stage after opera-tion,delayed sternal closure was employed in 1 1 patients,pulmonary hypertension crisis occurred in 3 pa-tients,small atrial septal defect was kept open for hemodynamic stabilization in 6 patients,temporary cardiac pacemaker for proper heart rate in 3 patients.All patients were uneventfully discharged except 2 patients died of severe low cardiac output syndrome.During the period of follow up,2 patients presented with recurrent pulmonary infection and signs of pulmonary venous obstruction including the increased flow speed at the site of anastomosis.One of 2 patients was lost of follow up and the other patient was uneventfully discharged after the second operation.The rest 9 patients received postoperative follow up for 1 month to 5 years,echocardio-graphy,X ray chest radiography,and electrocardiogram were performed during this period.As a result,all children had good cardiac function and with sinus rhythm on electrocardiogram and apparently reduced pul

  10. [The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital].

    Science.gov (United States)

    Lamy, J; Yassine, A-H; Gourari, A; Forme, N; Zakine, G

    2015-04-01

    Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important. This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented. Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy. By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites

  11. Assessing the influence of historic net and gross land changes on the carbon fluxes of Europe.

    Science.gov (United States)

    Fuchs, Richard; Schulp, Catharina J E; Hengeveld, Geerten M; Verburg, Peter H; Clevers, Jan G P W; Schelhaas, Mart-Jan; Herold, Martin

    2016-07-01

    Legacy effects of land cover/use on carbon fluxes require considering both present and past land cover/use change dynamics. To assess past land use dynamics, model-based reconstructions of historic land cover/use are needed. Most historic reconstructions consider only the net area difference between two time steps (net changes) instead of accounting for all area gains and losses (gross changes). Studies about the impact of gross and net land change accounting methods on the carbon balance are still lacking. In this study, we assessed historic changes in carbon in soils for five land cover/use types and of carbon in above-ground biomass of forests. The assessment focused on Europe for the period 1950 to 2010 with decadal time steps at 1-km spatial resolution using a bookkeeping approach. To assess the implications of gross land change data, we also used net land changes for comparison. Main contributors to carbon sequestration between 1950 and 2010 were afforestation and cropland abandonment leading to 14.6 PgC sequestered carbon (of which 7.6 PgC was in forest biomass). Sequestration was highest for old-growth forest areas. A sequestration dip was reached during the 1970s due to changes in forest management practices. Main contributors to carbon emissions were deforestation (1.7 PgC) and stable cropland areas on peaty soils (0.8 PgC). In total, net fluxes summed up to 203 TgC yr(-1) (98 TgC yr(-1) in forest biomass and 105 TgC yr(-1) in soils). For areas that were subject to land changes in both reconstructions (35% of total area), the differences in carbon fluxes were about 68%. Overall for Europe the difference between accounting for either gross or net land changes led to 7% difference (up to 11% per decade) in carbon fluxes with systematically higher fluxes for gross land change data.

  12. The gross motor function measure is a valid and sensitive outcome measure for spinal muscular atrophy.

    Science.gov (United States)

    Nelson, Leslie; Owens, Hollis; Hynan, Linda S; Iannaccone, Susan T

    2006-06-01

    Spinal muscular atrophy is a genetic disease of the anterior horn cell with high morbidity rate in childhood. Certain drugs may be of benefit and are in or under consideration for Phase II trials. Outcome measures that are age appropriate and representative of disease activity remain under study. Several have not yet been validated for spinal muscular atrophy. The Gross Motor Function Measure is a measure of motor function. We showed previously that the Gross Motor Function Measure is a reliable outcome measure to assess motor function in children with spinal muscular atrophy. By collating our data from 40 spinal muscular atrophy patients, ages 5 through 17 years, we now show the validity of the Gross Motor Function Measure when compared to Quantitative Muscle Testing and ambulatory status in children with spinal muscular atrophy. The median for Gross Motor Function Measure total scores for walkers was 237 (range: 197-261) and for non-walkers, 64 (range: 4-177; PGross Motor Function Measure is valid and sensitive as an outcome measure for clinical trials in pediatric spinal muscular atrophy.

  13. Clinical, radiological, surgical, and pathological determinants of olfactory groove schwannoma

    Directory of Open Access Journals (Sweden)

    Andi Sadayandi Ramesh

    2014-01-01

    Full Text Available Background: Olfactory groove schwannomas (OGS are rare anterior cranial fossa base tumors with only 41 cases reported in literature. Olfactory ensheathing cell schwannoma (OECS has similar clinico-radiological features as OGS, but a different cell of origin. In recent years, there is growing interest in OECS as more cases are being reported. Aims: The objective was to study the clinico-radiological features of OGS and define the histological differentiation from OECS. Materials and Methods: We retrospectively analyzed clinical, radiological, surgical and histopathological picture of all cases of OGS managed in our institute. Immuno histochemical studies were performed in these tumors for differentiating from OECS. A comprehensive review of articles published until date describing the operative treatment was done. Results: All three cases had presented with seizures, two had anosmia and papilledema. Gross-total resection was achieved in all our patients. One patient expired in the postoperative period due to septicemia. Positive expression to newer immuno histochemical biomarker CD57 (Leu7, with negative staining to smooth muscle α-actin (SMA was helpful in confirming the diagnosis of OGS and differentiating it from OECS in all our cases. Conclusions: OECS, though rare has to be differentiated from OGS using immuno histochemistry. Gross-total resection of OGS with preservation of olfactory function is often possible and curative. Although these tumors are commonly treated with microsurgical skull base approaches, an endoscopic endonasal approach can be considered in some cases, with repair using mucoperiosteal pedicled flap to prevent cerebrospinal fluid leak.

  14. Middle ear and mastoid glomus tumors (glomus tympanicum): an algorithm for the surgical management.

    Science.gov (United States)

    Sanna, Mario; Fois, Paolo; Pasanisi, Enrico; Russo, Alessandra; Bacciu, Andrea

    2010-12-01

    Glomus tumors are slow-growing benign lesions and represent the most common primary neoplasms of the middle ear. The objective of the present study is to report our surgical strategy in the management of glomus tympanicum tumors. Between December 1988 and July 2008, 68 patients with histologically confirmed glomus tympanicum tumor underwent surgical treatment. The follow-up of the series ranged from 6 to 194 months (mean, 33.4 months). Distribution of tumors according to Fisch and Mattox classification was as follows: type A, 44 cases (64.7%); type B, 24 cases (35.3%). All of the 44 Class A tumors were safely removed via either a stapedectomy-type transcanal approach or a retroauricolar-transcanal approach. Five patients with Class B tumors were operated on through a transmastoid approach. Nineteen patients with larger Class B tumors underwent a subtotal petrosectomy with blind sac closure of the external auditory canal and middle ear obliteration. Gross total tumor removal was achieved in all 68 cases. In one case (1.4%) there was recurrence after 9 years, for which the patient was re-operated. No residual/recurrence has been detected on computed tomography in the rest of the patients. Surgical excision of glomus tympanicum tumors is a safe procedure, allowing total tumor removal with minimal morbidity, a low recurrence rate, and a low complication rate. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Gross Nitrogen Mineralization in Surface Sediments of the Yangtze Estuary.

    Science.gov (United States)

    Lin, Xianbiao; Hou, Lijun; Liu, Min; Li, Xiaofei; Yin, Guoyu; Zheng, Yanling; Deng, Fengyu

    2016-01-01

    Nitrogen mineralization is a key biogeochemical process transforming organic nitrogen to inorganic nitrogen in estuarine and coastal sediments. Although sedimentary nitrogen mineralization is an important internal driver for aquatic eutrophication, few studies have investigated sedimentary nitrogen mineralization in these environments. Sediment-slurry incubation experiments combined with 15N isotope dilution technique were conducted to quantify the potential rates of nitrogen mineralization in surface sediments of the Yangtze Estuary. The gross nitrogen mineralization (GNM) rates ranged from 0.02 to 5.13 mg N kg(-1) d(-1) in surface sediments of the study area. The GNM rates were generally higher in summer than in winter, and the relative high rates were detected mainly at sites near the north branch and frontal edge of this estuary. The spatial and temporal distributions of GNM rates were observed to depend largely on temperature, salinity, sedimentary organic carbon and nitrogen contents, and extracellular enzyme (urease and L-glutaminase) activities. The total mineralized nitrogen in the sediments of the Yangtze Estuary was estimated to be about 6.17 × 10(5) t N yr(-1), and approximately 37% of it was retained in the estuary. Assuming the retained mineralized nitrogen is totally released from the sediments into the water column, which contributed 12-15% of total dissolved inorganic nitrogen (DIN) sources in this study area. This result indicated that the mineralization process is a significant internal nitrogen source for the overlying water of the Yangtze Estuary, and thus may contribute to the estuarine and coastal eutrophication.

  16. Gross Nitrogen Mineralization in Surface Sediments of the Yangtze Estuary.

    Directory of Open Access Journals (Sweden)

    Xianbiao Lin

    Full Text Available Nitrogen mineralization is a key biogeochemical process transforming organic nitrogen to inorganic nitrogen in estuarine and coastal sediments. Although sedimentary nitrogen mineralization is an important internal driver for aquatic eutrophication, few studies have investigated sedimentary nitrogen mineralization in these environments. Sediment-slurry incubation experiments combined with 15N isotope dilution technique were conducted to quantify the potential rates of nitrogen mineralization in surface sediments of the Yangtze Estuary. The gross nitrogen mineralization (GNM rates ranged from 0.02 to 5.13 mg N kg(-1 d(-1 in surface sediments of the study area. The GNM rates were generally higher in summer than in winter, and the relative high rates were detected mainly at sites near the north branch and frontal edge of this estuary. The spatial and temporal distributions of GNM rates were observed to depend largely on temperature, salinity, sedimentary organic carbon and nitrogen contents, and extracellular enzyme (urease and L-glutaminase activities. The total mineralized nitrogen in the sediments of the Yangtze Estuary was estimated to be about 6.17 × 10(5 t N yr(-1, and approximately 37% of it was retained in the estuary. Assuming the retained mineralized nitrogen is totally released from the sediments into the water column, which contributed 12-15% of total dissolved inorganic nitrogen (DIN sources in this study area. This result indicated that the mineralization process is a significant internal nitrogen source for the overlying water of the Yangtze Estuary, and thus may contribute to the estuarine and coastal eutrophication.

  17. Estimating the gross moist stability in shallow and deep convection

    Science.gov (United States)

    Chen, C. A.; Jong, B. T.; Chou, C.

    2015-12-01

    Gross moist stability has been used to study the link between tropical deep convection and large scale circulation in a moist static energy (MSE) budget. Here we aim to calculate the gross moist stability from more realistic profiles of vertical velocity and extend it beyond deep convection, adding shallow convection. Based on a principal component analysis, we were able to decompose the vertical velocity into two leading modes, which are dominated by deep and shallow convection, respectively. According to the deep and shallow modes, we calculate the gross moist stability for these two modes and discuss the roles of deep and shallow convection in the MSE budget. The gross moist stability of deep convection tends to be positive in the tropics, while that of shallow convection is negative over most areas of the tropics. This implies that deep convection exports MSE to stabilize the atmosphere and shallow convection imports MSE to enhance deep convection and destabilize the atmosphere. Based on the spatial distribution, moisture tends to reduce the gross moist stability of deep convection, while dry static energy has little impact. Deeper deep convection tends to have greater gross moist stability. For shallow convection, on the other hand, the gross moist stability is affected not only by low-level moisture but also mid-level moisture. Both moister low-level and drier mid-level moisture reduce the gross moist stability of shallow convection. Greater low-level dry static energy, which is associated with warmer sea surface temperature, also tends to reduce gross moist stability.

  18. Tomografia computadorizada na avaliação tardia do tratamento cirúrgico da conexão anômala total de veias pulmonares Computed tomography in late evaluation of surgical treatment of pulmonary veins total anomalous connection

    Directory of Open Access Journals (Sweden)

    Ulisses Alexandre Croti

    2011-12-01

    findings of multislice computed tomography (MSCT are associated with clinical and laboratory tests routinely used in the late follow-up of children undergoing surgical treatment of total anomalous pulmonary venous connection (TAPVC. METHODS: From January 2002 to December 2007, 12 patients operated due to CATVP were evaluated with history, physical examination, chest X-ray, electrocardiogram, echocardiography and MSCT. Specific changes observed in each one of these tests were identified and compared with MSCT qualitative findings. RESULTS: Eleven patients were in functional class I (NYHA, three had nonspecific murmurs, and three were below the 15th percentile of weight and height. Two had pulmonary field abnormalities and three had a slight increase of the cardiac area in the X-ray examination. In the electrocardiogram, one patient had right ventricular overload and one had junctional rhythm. All echocardiograms were within the normal range, except for one patient with stenosis between the superior vena cava and right atrium. MSCT was completely normal in four patients, three had compression of the pulmonary veins and four had significant caliber reduction, which correlated with the other findings. Thus, MSCT showed a sensitivity of 87.5%, specificity of 0.75%, positive predictive value of 87.5%, negative predictive value of 75% and accuracy of 83.3% to demonstrate anatomic changes compared to changes in the physical examination or other additional tests. CONCLUSION: MSTC may provide valuable information and complement the diagnosis of possible anatomical and functional changes in the late follow-up of patients undergoing surgical repair of TAPVC.

  19. Totally robotic atrial septal defect closure using da vinci S surgical system on beating heart%全机器人心脏不停跳下房间隔缺损修补术

    Institute of Scientific and Technical Information of China (English)

    杨明; 高长青; 肖苍松; 王刚; 王加利

    2011-01-01

    目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5~3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.%Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general

  20. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  1. Teaching surgical exposures to undergraduate medical students: an integration concept for anatomical and surgical education.

    Science.gov (United States)

    Hammer, Niels; Hepp, Pierre; Löffler, Sabine; Schleifenbaum, Stefan; Steinke, Hanno; Klima, Stefan

    2015-06-01

    Decreasing numbers of students are interested in starting a surgical career, posing substantial challenges to patient care in the next years. The anatomy course is one of the key subjects in medical training, especially in surgical disciplines. Innovative teaching concepts that integrate surgically relevant anatomy and manual dexterity might help boost student interest in surgery. A preclinical workshop entitled "Surgical exposures" was developed. A team of anatomists and surgeons introduced the surgical exposures, demonstrating the procedures on Thiel-fixed body donors. Following this introduction, students practiced the exposures in an operating room-like manner. A six-point Likert scale was used to evaluate the workshop and to compare it to the first-year dissection course. The overall evaluation result for the surgical exposures was excellent, proving to be a significantly better result when compared to the first-year dissection course. The students were more satisfied with the teaching time invested by the peers and regarded the workshop as clinically highly relevant. Furthermore, they felt that questions were addressed better and that the overall atmosphere was better than in the gross anatomy course. Subject to criticism was the course size and practicing time in both cases. The surgical exposures workshop provides preclinical students with clinically relevant anatomy and manual dexterity. It may positively influence the decision to follow a surgical career. This course, however, requires extensive teaching resources. The given concept may help implement practical medical skills in the preclinical curriculum, strengthening the professional identity of surgeons and anatomists.

  2. Assessment outcomes: computerized instruction in a human gross anatomy course.

    Science.gov (United States)

    Bukowski, Elaine L

    2002-01-01

    New and traditional educational media were used to study alternative methods of instruction in a human gross anatomy course. Three consecutive entry-level physical therapy (PT) classes (55 students total) participated in this study. No other anatomy course was available to these students during this time. During the first year, all entering PT students (n = 18) completed a traditional cadaver anatomy course. This traditional group attended weekly lectures and dissection laboratories for 15 weeks. During the second year, the next entering class of PT students (n = 17) completed a self-study, computerized noncadaver anatomy course. This self-study group attended an introductory session to receive course objectives and instruction in using the computer package chosen for the study. After the introductory session, this group worked independently for the remainder of their 15-week course. During the third year, the entering class of PT students (n = 20) attended weekly lectures and completed a self-study, computerized non-cadaver laboratory course. This lecture and self-study group attended an introductory session to review course objectives and receive instruction in using the computer package. For the remainder of their 15-week course, this group attended a weekly lecture and worked independently on the computer for the laboratory portion of their course. All groups kept time logs, recording class and study time for each day of the course. The time logs were collected on the last day of each course. Each group's performance in anatomy-based system courses was followed through the remainder of the PT curricula, including clinical rotations, and through the completion of the state board licensure examination. Data were analyzed using a multivariate analysis of variance and a Kruskal-Wallis analysis of variance. There was no significant difference in anatomy course class means, class study times, performance throughout the remainder of the PT curricula, and performance

  3. How the Integration of Pathology in the Gross Anatomy Laboratory Affects Medical Students.

    Science.gov (United States)

    Rae, Guenevere; Cork, John R; Karpinski, Aryn C; McGoey, Robin; Swartz, William

    2017-01-01

    The main objective of this project was to integrate pathologists into the gross anatomy laboratory setting to increase the exposure that early medical students receive to pathologists as clinicians. Pathologists visited the gross anatomy laboratory 3 times throughout the 15-week course to assist medical students in determining the cause of death of the cadaver being dissected. This intervention was implemented with 1st-semester medical students for 2 consecutive years (a total of 100 dissection teams consisting of 4 students in each team). A quantitative content analysis was performed on the students' end of the course assignments to determine whether the students learned a greater percentage of pathologic information by having interactions with pathologists in the gross lab and to identify trends in the way medical students diagnosed their "first patient" (i.e., the cadaver). The students who had interactions with pathologists in the laboratory had significantly more pathology in their narrative than the students who did not receive pathologist interaction. They were also more likely to conclude that the cadaver they dissected actually died from a cause other than the one listed on the death certificate (18.3%; n = 15) compared to the students who had no pathologist interaction (1.8%; n = 2). A postintervention survey indicated that 65% of students felt that interaction with pathologists helped them understand the clinical application of gross anatomy, more than 40% become more interested in pathology, and 74% would have liked to have had more pathologist interaction. This intervention demonstrated a way to increase pathologist interaction within the undergraduate medical curriculum and enhance the educational environment of the gross anatomy laboratory.

  4. Range of Hip Joint Motion in Developmental Dysplasia of the Hip Patients Following Total Hip Arthroplasty With the Surgical Technique Using the Concept of Combined Anteversion: A Study of Crowe I and II Patients.

    Science.gov (United States)

    Zhang, Jingwei; Wei, Jianhe; Mao, Yuanqing; Li, Huiwu; Xie, Youzhuan; Zhu, Zhenan

    2015-12-01

    The combined anteversion surgical technique has been proposed and used in clinical practice. To more objectively evaluate the feasibility of this surgical technique using combined anteversion concept for DDH patients, we studied 34 DDH patients (40 hips) in this research. Every patient underwent pelvic CT scans before and after surgery and the HHSs were recorded. Optimal range of joint motion was measured using a three-dimensional reconstruction technique and a dynamic measurement technique. The results revealed that joint function met the requirements of daily life and the range of motion was not over-limited by impingement between the prosthesis and the skeleton. Moreover, the combined anteversion was found to be the most critical parameter in this study. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Calculation of gross energy consumption[in a building]; Beregning af bruttoenergiforbrug

    Energy Technology Data Exchange (ETDEWEB)

    Engelund Thomsen, Kirsten; Aggerholm, Soeren

    2000-07-01

    This bulletin presents a method for calculating the gross energy consumption of a building. The net heat demand for space heating, ventilation and domestic hot water should be calculated. Next converted to gross energy consumption, i.e. the amount of energy that is required to supply, for instance, a gas furnace in order that it produces the calculated amount of heat. First the electricity consumption required for ventilation, appliances and lighting is calculated, taking into consideration the daylight utilisation in commercial buildings. The point of departure is the existing method for calculating the net heat demand of buildings. The method includes heat supply from persons, lighting and appliances. This calculating method was later extended to include a method for calculating the energy demand for domestic hot water and addition of non-utilised heat loss from pipes and heat producing installations. This loss is calculated on the basis of loss in hot water tanks, heat and hot water pipes. Heat supply from solar collectors is calculated and deducted from the heat demand. The calculated end result is called gross heat requirement. Next the gross energy consumption for heating, ventilation and domestic hot water is determined by means of annual efficiency for heating installations. An inventory of the environmental impact is calculated based on the energy consumption measured by the total CO{sub 2} production per m{sup 2} floor area. The CO{sub 2} emission is calculated on the basis of the calculated gross energy consumption of heating and electricity, and on standard values for CO{sub 2} contents in the fuels used and emissions from electricity production issued by the Danish Energy Agency. The gross energy consumption is calculated for three examples of buildings: a single-family house, an administration building and a multi-storey building. The examples show that it is feasible to do calculations for typical buildings. Heat consumption for space heating and

  6. Surgical strategies for petroclival meningioma in 57 patients

    Institute of Scientific and Technical Information of China (English)

    LI Pei-liang; MAO Ying; ZHU Wei; ZHAO Nai-qing; ZHAO Yao; CHEN Liang

    2010-01-01

    Background Resection of petroclival meningioma (PCM) is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.Methods We recruited 57 patients (14 male, 43 female, mean age, 50.5 years) who underwent surgical resection of PCM in Huashan Hospital during 2002-2006. The primary outcomes including postoperative neurological deficits,modified Rankin scale (mRS) score and recurrence rate were evaluated, and all potential risk factors were assessed by the X2 test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.Results Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients.Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months.Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no furtherprogression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score (P=0.0002; P=0.0051; P=0.0009). Tumor adherence to adjacent structures clearly affected the extent of resection (P=0.0029). The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures (P=0.0004).Conclusions Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help

  7. Sectoral contributions to Nigerian gross domestic product using a ...

    African Journals Online (AJOL)

    Global Journal of Pure and Applied Sciences ... This study analyzed sectoral contributions to Gross Domestic Product by Agriculture, Industry and services ... KEYWORDS: Granger causality, Unit root, VAR model and sectoral contribution ...

  8. Surgical management of vestibular schwannomas after failed radiation treatment.

    Science.gov (United States)

    Nonaka, Yoichi; Fukushima, Takanori; Watanabe, Kentaro; Friedman, Allan H; Cunningham, Calhoun D; Zomorodi, Ali R

    2016-04-01

    Increasing numbers of patients with vestibular schwannoma (VS) have been treated with focused-beam stereotactic radiation treatment (SRT) including Gamma knife, CyberKnife, X-knife, Novalis, or proton beam therapy. The purpose of this study was to document the incidence of tumor regrowth or symptoms that worsened or first developed following SRT and to discuss surgical strategies for patients who have failed SRT for VS. A consecutive series of 39 patients with SRT failed VS were surgically treated. Clinical symptoms, tumor regrowth at follow-up, intraoperative findings, and surgical outcome were evaluated. There were 15 males and 24 females with a mean age of 51.8 years. Thirty-six patients (92.3%) demonstrated steady tumor growth after SRT. Two (5.1%) patients with slight increase of the mass underwent surgical resection because of development of unbearable facial pain. Symptoms that worsened or newly developed following SRT in this series were deafness (41%), dizziness (35.9%), facial numbness (25.6%), tinnitus (20.5%), facial nerve palsy (7.7%), and facial pain (7.7%). Intraoperative findings demonstrated fibrous changes of the tumor mass, cyst formation, and brownish-yellow or purple discoloration of the tumor capsule. Severe adhesions between the tumor capsule and cranial nerves, vessels, and the brainstem were observed in 69.2%. Additionally, the facial nerve was more fragile and irritable in all cases. Gross total resection (GTR) was achieved in 33.3% of patients, near-total resection (NTR) in 35.9%, and subtotal resection (STR) in 30.8% of patients. New facial nerve palsy was seen in seven patients (19.4%) postoperatively. Our findings suggest that patients with VS who fail SRT with either tumor progression or worsening of clinical symptoms will have an increased rate of adhesions to the neurovascular structures and may have radiation-influenced neuromalacia. Salvage surgery of radiation-failed tumors is more difficult and will have a higher risk of

  9. Premedical anatomy experience and student performance in medical gross anatomy.

    Science.gov (United States)

    Kondrashov, Peter; McDaniel, Dalton J; Jordan, Rebecca M

    2017-04-01

    Gross anatomy is considered one of the most important basic science courses in medical education, yet few medical schools require its completion prior to matriculation. The effect of taking anatomy courses before entering medical school on performance in medical gross anatomy has been previously studied with inconsistent results. The effect of premedical anatomy coursework on performance in medical gross anatomy, overall medical school grade point average (GPA), and Comprehensive Osteopathic Medical Licensing Examination Level 1 (COMLEX 1) score was evaluated in 456 first-year osteopathic medical students along with a survey on its perceived benefits on success in medical gross anatomy course. No significant differences were found in gross anatomy grade, GPA, or COMLEX 1 score between students with premedical anatomy coursework and those without. However, significant differences and higher scores were observed in students who had taken three or more undergraduate anatomy courses including at least one with cadaveric laboratory. There was significantly lower perceived benefit for academic success in the medical gross anatomy course (P<.001) from those students who had taken premedical anatomy courses (5.9 of 10) compared with those who had not (8.2 of 10). Results suggest that requiring any anatomy course as a prerequisite for medical school would not have significant effect on student performance in the medical gross anatomy course. However, requiring more specific anatomy coursework including taking three or more undergraduate anatomy courses, one with cadaveric laboratory component, may result in higher medical gross anatomy grades, medical school GPA, and COMLEX 1 scores. Clin. Anat. 30:303-311, 2017. © 2017 Wiley Periodicals, Inc.

  10. Gross Motor Profile and Its Association with Socialization Skills in Children with Autism Spectrum Disorders

    Directory of Open Access Journals (Sweden)

    Hardiono D. Pusponegoro

    2016-12-01

    Conclusion: Children with ASD had lower gross motor skills compared to typically developing children. Gross motor impairments were found in 20% of the ASD children, and these children also had lower socialization skills than those without gross motor impairments.

  11. Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

    Directory of Open Access Journals (Sweden)

    T. Grau

    2003-06-01

    Full Text Available Objetivo: Las infusiones lipídicas de una mezcla física de triglicéridos de cadena media/triglicéridos de cadena larga (MCT/LCT, utilizadas en la nutrición parenteral total (NPT peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente triglicéridos de cadena larga (LCT. El objetivo de este estudio fue comparar la incidencia de infecciones nosocomiales y la mortalidad hospitalaria de los pacientes quirúrgicos severamente desnutridos, tratados con NPT con una emulsión lipídica de MCT/LCT, o con una mezcla LCT, administradas de forma aleatoria y a doble ciego. Pacientes y métodos: Se reclutaron de forma prospectiva 72 pacientes severamente desnutridos sometidos a una laparotomía programada o urgente, estratificados por la presencia o ausencia de cáncer, e ingresados en los Servicios de Cirugía General y Medicina Intensiva de un hospital universitario. El desenlace principal fue la incidencia de infección nosocomial intrahospitalaria y el desenlace secundario fue la mortalidad. Resultados: Los pacientes del grupo de estudio (MCT/LCT y el grupo control (LCT tenían características similares. Los pacientes del grupo de MCT/LCT tuvieron una menor incidencia de abscesos intraabdominales (2/26 que el grupo LCT (10/31 de forma significativa (p Goal: Lipid infusions of a physical mixture of medium- chain triglycerides and long-chain triglycerides (MCT/LCT used in peri-operative total parenteral nutrition (TPN have a lower immunosuppressive effect in laboratory studies than emulsions containing only longchain triglycerides (LCT. The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. Patients and methods: A total of 72 severely undernourished

  12. Surgical electronic logbook: A step forward.

    Science.gov (United States)

    Gómez Díaz, Carlos Javier; Luna Aufroy, Alexis; Rebasa Cladera, Pere; Serra Pla, Sheila; Jurado Ruiz, Cristina; Mora López, Laura; Serra Aracil, Xavier; Navarro Soto, Salvador

    2015-12-01

    The surgical electronic logbook (surgical e-logbook) aims to: simplify registration of the training activities of surgical residents, and to obtain reliable and detailed reports about these activities for resident evaluation. The surgical e-logbook is a unique and shared database. Residents prospectively record their activities in 3 areas: surgical, scientific and teaching. We can access activity reports that are constantly updated. Study period using the surgical e-logbook: Between June 2011 and May 2013. Number of surgeries reported: 4,255. Number of surgical procedures reported: 11,907. Number of surgeries per resident per year reported: 250. Number of surgical procedures per resident per year reported: 700. Surgical activity as a primary surgeon during the first year of residency is primarily in emergency surgery (68,01%) and by laparotomy (97,73%), while during the fifth year of residency 51,27% is performed in elective surgery and laparoscopy is used in 23,10% of cases. During this period, residents participated in a total of 11 scientific publications, 75 conference presentations and 69 continuing education activities. The surgical e-logbook is a useful tool that simplifies the recording and analysis of data about surgical and scientific activities of the residents. It is a step forward in the evaluation of the training of surgical residents, however, is only an intermediate step towards the development of a larger Spanish registry. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. 改良一期后路全脊椎整块切除术治疗胸腰椎肿瘤%Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach

    Institute of Scientific and Technical Information of China (English)

    沈慧勇; 黄霖; 杨睿; 叶记超; 陈铿; 唐勇; 王鹏

    2011-01-01

    Objective To investigate the operation key points, instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors. Methods A series of modified instruments have been designed for the TES, including threadwire saw (T-saw) with a diameter of 0.81 mm, director and clamping for the saw, L shape and furcation osteotomes.The corpectomy of original TES which was defined as "one step dissection" from anteriorly to posteriorly, was modified into "two step dissection" which means that corpectomy was performed with saw cutting anteriorposteriorly and the L shape cutting posterior-anteriorly. In the cases with difficulty in pediculotomy using a T-saw, furcation osteotome was used for pediculotomy. Ten patients with thoracic or lumbar tumors were treated with the modified TES. There were 1 case of bone giant cell tumor, 1 case of bone neurilemmoma and 8 cases of metastatic tumors. All patients suffered moderate-severe pain and neurological deficit. Results The average follow-up period was 8.1(3.3-18.1) months. The average operating time was 7.8 h(6.0-10.3 h),and average blood loss was 2100 ml (1200-3500 ml). No disruption of dural mater, the leakage of cerebrospinal fluid, iatrogenic spinal cord injury and major vessel damage occurred. Two patients who underwent pleura disruption happened during the operation were treated with intrathoracic drain remedy. Among 7 cases with thoracic tumors, significant improvement in neurological function were achieved in 5 patients with the improvement of one grade in ASIA classification, while no change was found in 2 cases. In 3 cases with lumbar tumor, lumbar nerve root pain relieved and the muscle strength had recovered to grade 4 at least postoperatively. Conclusion Significant improvement has been achieved in the maneuverability and safety of the modified surgical techniques in TES with a single posterior approach for thoracic and lumbar tumors.%目的 探

  14. The influence of the calibration standard and the chemical composition of the water samples residue in the counting efficiency of proportional detectors for gross alpha and beta counting. Application on the radiologic control of the IPEN-CNEN/SP; A influencia do padrao de calibracao e da composicao do residuo de amostras de agua na eficiencia de contadores proporcionais para contagem alfa e beta total. Aplicacao no controle radiologico do IPEN-CNEN/SP

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Cecilia Martins

    2003-07-01

    In this work the efficiency calibration curves of thin-window and low background gas-flow proportional counters were determined for calibration standards with different energies and different absorber thicknesses. For the gross alpha counting we have used {sup 241}Am and natural uranium standards and for the gross beta counting we have used {sup 90}Sr/{sup 90}Y and {sup 137}Cs standards in residue thicknesses ranging from 0 to approximately 18 mg/cm{sup 2}. These sample thicknesses were increased with a previously determined salted solution prepared simulating the chemical composition of the underground water of IPEN The counting efficiency for alpha emitters ranged from 0,273 +- 0,038 for a weightless residue to only 0,015 +- 0,002 in a planchet containing 15 mg/cm{sup 2} of residue for {sup 241}Am standard. For natural uranium standard the efficiency ranged from 0,322 +- 0,030 for a weightless residue to 0,023 +- 0,003 in a planchet containing 14,5 mg/cm{sup 2} of residue. The counting efficiency for beta emitters ranged from 0,430 +- 0,036 for a weightless residue to 0,247 +- 0,020 in a planchet containing 17 mg/cm{sup 2} of residue for {sup 137}Cs standard. For {sup 90}Sr/{sup 90}Y standard the efficiency ranged from 0,489 +- 0,041 for a weightless residue to 0,323 +- 0,026 in a planchet containing 18 mg/cm{sup 2} of residue. Results make evident the counting efficiency variation with the alpha or beta emitters energies and the thickness of the water samples residue. So, the calibration standard, the thickness and the chemical composition of the residue must always be considered in the gross alpha and beta radioactivity determination in water samples. (author)

  15. Total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2012-01-01

    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  16. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  17. Surgical outcomes of lateral approach for jugular foramen schwannoma: postoperative facial nerve and lower cranial nerve functions.

    Science.gov (United States)

    Cho, Yang-Sun; So, Yoon Kyoung; Park, Kwan; Baek, Chung-Hwan; Jeong, Han-Sin; Hong, Sung Hwa; Chung, Won-Ho

    2009-01-01

    The lateral surgical approach to jugular foramen schwannomas (JFS) may result in complications such as temporary facial nerve palsy (FNP) and hearing loss due to the complicated anatomical location. Ten patients with JFS surgically treated by variable methods of lateral approach were retrospectively reviewed with emphasis on surgical methods, postoperative FNP, and lower cranial nerve status. Gross total removal of the tumors was achieved in eight patients. Facial nerves were rerouted at the first genu (1G) in six patients and at the second genu in four patients. FNP of House-Brackmann (HB) grade III or worse developed immediately postoperatively in six patients regardless of the extent of rerouting. The FNP of HB grade III persisted for more than a year in one patient managed with rerouting at 1G. Among the lower cranial nerves, the vagus nerve was most frequently paralyzed preoperatively and lower cranial nerve palsies were newly developed in two patients. The methods of the surgical approach to JFS can be modified depending on the size and location of tumors to reduce injury of the facial nerve and loss of hearing. Careful manipulation and caution are also required for short facial nerve rerouting as well as for long rerouting to avoid immediately postoperative FNP.

  18. THE ANALYSIS OF THE MAIN CHARACTERISTICS CONSIDERED FOR THE GROUPING EU MEMBER STATES ACCORDING TO GROSS INLAND ENERGY CONSUMPTION

    Directory of Open Access Journals (Sweden)

    POPESCU Catalin

    2016-09-01

    Full Text Available Gross inland energy consumption represents the quantity of energy necessary to satisfy inland consumption of the geographical entity under consideration. It describes the total energy needs of a country. According to some Eurostat reports from 2013 and 2014, over the last two decades, gross inland energy consumption in the EU28, as can be noted, has changed pretty much: in 1990 cumulated 1670 million tonnes of oil equivalent (Mtoe, rose to a peak of 1830 Mtoe in 2006 and then decreased to 1680 Mtoe in 2012. These contradictory values required a comprehensive analysis and therefore, present paper describes the main characteristics related to the grouping EU Member States according to gross inland energy consumption in order to discover some common patterns among EU member states.

  19. 外来手术器械全程质量管理在消毒供应中心医院感染控制中的应用%Application of total quality management of foreign surgical instruments in nosocomial infection control in the sterilization and supply center

    Institute of Scientific and Technical Information of China (English)

    焦丽玲; 耿汇涓; 刘根生

    2012-01-01

    Objective To investigate the effect of total quality management of foreign surgical instruments in nosocomial infection control in the sterilization and supply center. Methods The effect before and after the application of total quality management for foreign surgical instruments in the control of nosocomial infection in the sterilization and supply center was comparatively analyzed. Results The results showed that after the application of total quality management for foreign surgical instruments,the onetime passing rate of sterilization and limits of microbial detection of surgical instruments increased significantly compared with that before application.The passing rate after application was significantly higher than before.The difference was significant.The implementation rate of planed surgery depending on foreign surgical instruments was 98.3%,the rate was 92.4% before application.There was a significant difference before and after application,the nosocomial infection rate after surgery depending on foreign surgical instruments was 0.88%,before the application was 6.50%,there was a significant difference before and after application. Conclusions Application of total quality management of foreign surgical instruments can significantly improve the efficiency of the use of foreign equipment and working efficiency of the operation room,reduce costs and the incidence of nosocomial infection significantly.It should be applied in the management of foreign surgical instruments in the sterilization and supply center.%目的 探讨全程质量管理用于消毒供应中心外来手术器械管理控制医院感染(简称院感)中的效果.方法 对比分析消毒供应中心将全程质量管理理念引入对外来手术器械管理以控制院感前后的效果,综合评价全程质量管理在控制外来手术器械引发院感方面的作用.结果 结果显示,对外来手术器械实施全程质量管理后,外来手术器械无菌或微生物限度

  20. Gross Pollutant Traps: Wet Load Assessment at Sungai Kerayong, Malaysia

    Science.gov (United States)

    Mohd Shah, M. R.; Zahari, N. M.; Said, N. F. Md; Sidek, L. M.; Basri, H.; Noor, M. S. F. Md; Husni, M. M. Mohammad; Jajarmizadeh, Milad; Roseli, ZA; Mohd. Dom, N.

    2016-03-01

    The purpose of this project is to carry out assessment on the effectiveness and performance of Gross Pollutant Traps (GPTs) stormwater quality control in the urban areas. The study aims to provide a management and planning tool for effective management of the gross pollutants in the urban areas specifically in River of Life (ROL) project. ROL project is a Malaysian Government initiative under the Economic Transformation Program. One of the program in the greater Klang Valley is to transform Klang River into a vibrant and livable waterfront by the year 2020. The main river in ROL catchment is Sungai Klang (upper catchment), with main tributaries Sungai Gombak, Sungai Batu, Sungai Jinjang, Sungai Keroh, Sungai Bunus, Sungai Ampang and Sungai Kerayong. This paper objective is to study the gross pollutant wet load at Sungai Kerayong 1 and Sungai Kerayong 2 which is located at the downstream location of the ROL project. The result shows that Sungai Kerayong 2 produced higher gross pollutant wet load (8025.33 kg/ha/yr) than Sungai Kerayong 1 (4695.12 kg/ha/yr). This could be due to high contributions amounts of gross pollutant traps from residential area, the degree of develop area, and also the location of the river itself related to climate and rainfall.

  1. Gross efficiency during rowing is not affected by stroke rate.

    Science.gov (United States)

    Hofmijster, Mathijs J; Van Soest, Arthur J; De Koning, Jos J

    2009-05-01

    It has been suggested that the optimal stroke rate in rowing is partly determined by the stroke-rate dependence of internal power losses. This should be reflected in a stroke-rate dependency of gross efficiency (e(gross)). The purpose of this study was to investigate if e(gross) is affected by stroke rate. A second aim was to determine whether internal power losses can be estimated by the negative power output during the stroke cycle (P(negative)). Seventeen well-trained female rowers participated in this study. They rowed three trials on a modified rowing ergometer on slides at a submaximal intensity, with a respiratory exchange ratio of 1 or close to 1. Stroke rates were 28, 34, and 40 strokes per minute. The trials were fully randomized. Power transfer to the flywheel was kept constant whereas e(gross) was determined during each trial. No significant differences in e(gross) were found between conditions. This finding suggests that in rowing internal power losses are not influenced by stroke rate. Furthermore, although P(negative) increased at increasing stroke rate (P measure to estimate internal power losses. This study shows that within the range of stroke rates applied in competitive rowing, internal power losses are unrelated to rowing cycle frequency.

  2. Gross, Histologic, and Computed Tomographic Anatomy of the Lacrimal System of Snakes

    Science.gov (United States)

    Souza, Nicole M.; Maggs, David J.; Park, Shin Ae; Puchalski, Sarah; Reilly, Christopher M.; Paul-Murphy, Joanne; Murphy, Christopher J.

    2014-01-01

    Objective To describe the lacrimal system of snakes using contrast micro-computed tomography (micro-CT) with 3-dimensional reconstruction, fluorescein passage (“Jones”) testing, histology, and gross dissection. Animals studied One Royal Python and 19 snake cadavers representing 10 species. Procedures Direct observation following injection of fluorescein into the subspectacular space, micro-CT following injection of 3 contrast agents into the subspectacular space, gross dissection following injection of latex into the subspectacular space, and histopathology. Results Injection of fluorescein confirmed patency but not course of the lacrimal duct. Barium enabled clear visualization of the lacrimal duct whereas two iodinated contrast agents proved inadequate. Collectively, micro-CT, anatomic dissections, and histology suggest tears are produced by a single, large, serous, retrobulbar gland, released into the subspectacular space via several ductules, and drained through a single punctum originating in the ventronasal subspectacular space and the lacrimal duct taking one of 3 routes of variable tortuosity before opening into the oral cavity in close association with the opening of the duct of the vomeronasal organ. Conclusions The ophidian lacrimal duct has a generally tortuous course and the details of its anatomy is species variable. The tortuous course of the duct likely predisposes snakes to duct occlusion and must be considered when planning medical and surgical interventions in snakes with pseudobuphthalmos and subspectacular abscessation. PMID:24862081

  3. Gross, histologic, and micro-computed tomographic anatomy of the lacrimal system of snakes.

    Science.gov (United States)

    Souza, Nicole M; Maggs, David J; Park, Shin Ae; Puchalski, Sarah M; Reilly, Christopher M; Paul-Murphy, Joanne; Murphy, Christopher J

    2015-01-01

    To describe the lacrimal system of snakes using contrast micro-computed tomography (micro-CT) with 3-dimensional reconstruction, fluorescein passage ('Jones') testing, histology, and gross dissection. One royal python and 19 snake cadavers representing 10 species. Direct observation following injection of fluorescein into the subspectacular space, micro-CT following injection of three contrast agents into the subspectacular space, gross dissection following injection of latex into the subspectacular space, and histopathology. Injection of fluorescein confirmed patency, but not course of the lacrimal duct. Barium enabled clear visualization of the lacrimal duct, whereas two iodinated contrast agents proved inadequate. Collectively, micro-CT, anatomic dissections, and histology suggest tears are produced by a single, large, serous, retrobulbar gland, released into the subspectacular space via several ductules, and drained through a single punctum originating in the ventronasal subspectacular space, and the lacrimal duct, which takes one of three routes of variable tortuosity before opening into the oral cavity in close association with the opening of the duct of the vomeronasal organ. The ophidian lacrimal duct has a generally tortuous course, and the details of its anatomy are species-variable. The tortuous course of the duct likely predisposes snakes to duct occlusion and must be considered when planning medical and surgical interventions in snakes with pseudobuphthalmos and subspectacular abscessation. © 2014 American College of Veterinary Ophthalmologists.

  4. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  5. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M

    1994-01-01

    One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one was cu......--including bilateral neck exploration and attempted biopsies of all parathyroid glands--is safe with a high cure rate....

  6. Gross municipal product: the design procedure and application

    Directory of Open Access Journals (Sweden)

    Dmitry Vasilevich Kolechkov

    2012-12-01

    Full Text Available The article is devoted to the actual problem to find the adequate methods to assess the economic performance of municipalities conditioned by their growing independence and role in the development of regional economy. Nowadays many researchers are working on the practical application and testing of various approaches to assessing theterritory economicresults based on thecalculation of gross municipal product (GМP. However, the development of methodological reasonable calculation tools is still at an early stage. In this article presents a simplified method of calculating the gross municipal product, an analysis of the dynamics and territorialindustrial structure GМP, implemented in terms of grouping areas GМP methods hierarchical cluster analysis of the economic characteristics of the obtained clustersbased on systematic occurring in the economic literature, methodological developments in the calculation of gross municipal product, determination of strengths and weaknesses of different methodological approaches

  7. Anatomy of the Gross Intestine of the Capybara (Hydrochoerus Hydrochaeris

    Directory of Open Access Journals (Sweden)

    Noelia Vazquez

    2012-01-01

    Full Text Available Problem statement: The anatomy of the gross intestine and its mesentery of the capybara (Hydrochoerus hydrochaeris have not been described completely. Approach: In the present study, eight adult capybaras were studied using gross dissection. Results: The cecum was the largest part of the intestine and was divided into base, body and apex. The cecocolic fold joined the cecum to the full extent of the proximal loop of ascending colon. The ascending colon was divided into two ansae, one proximal and one distal or spiral. The distal ansa had a spiral arrangement and was placed cranially to the right, covered ventrally by the apex of the cecum. This ansa had a centripetal gyrus to the left, a central flexure and a centrifugal gyrus turning to the right that was continuous with the transverse colon in the right colic flexure. Conclusion: The gross intestine of the capybara was different to other previously studied rodents.

  8. Potato production in Europe - a gross margin analysis

    DEFF Research Database (Denmark)

    Pedersen, Søren Marcus; Bizik, Jan; Costa, Luisa Dalla;

    The purpose of this paper is to examine different cropping practices, cost structures and gross margins for producing conventional table potatoes in 6 different regions within the European Union: Czech Republic, Denmark, Italy, Poland, Portugal and Slovakia. Findings from this study show that pot......The purpose of this paper is to examine different cropping practices, cost structures and gross margins for producing conventional table potatoes in 6 different regions within the European Union: Czech Republic, Denmark, Italy, Poland, Portugal and Slovakia. Findings from this study show...... that potato cropping practices varies signifi-cantly between these countries with major differences in yields and costs. Italy and Denmark are the two regions with highest gross margins due to high yields and reve-nues. Poland is by far the largest potato producing country among the 6 countries ex...

  9. Ludwik Gross, Sarah Stewart, and the 1950s discoveries of Gross murine leukemia virus and polyoma virus.

    Science.gov (United States)

    Morgan, Gregory J

    2014-12-01

    The Polish-American scientist Ludwik Gross made two important discoveries in the early 1950s. He showed that two viruses - murine leukemia virus and parotid tumor virus - could cause cancer when they were injected into susceptible animals. At first, Gross's discoveries were greeted with skepticism: it seemed implausible that viruses could cause a disease as complex as cancer. Inspired by Gross's initial experiments, similar results were obtained by Sarah Stewart and Bernice Eddy who later renamed the parotid tumor virus SE polyoma virus after finding it could cause many different types of tumors in mice, hamsters, and rats. Eventually the "SE" was dropped and virologists adopted the name "polyoma virus." After Gross's work was published, additional viruses capable of causing solid tumors or blood-borne tumors in mice were described by Arnold Graffi, Charlotte Friend, John Moloney and others. By 1961, sufficient data had been accumulated for Gross to confidently publish an extensive monograph--Oncogenic Viruses--the first history of tumor virology, which became a standard reference work and marked the emergence of tumor virology as a distinct, legitimate field of study. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. 2010年北京地区全髋关节置换术手术部位感染目标性监测分析%Targeted monitoring of surgical site infections after total hip arthroplasty in Beijing in 2010

    Institute of Scientific and Technical Information of China (English)

    钟群杰; 林剑浩; 武迎宏

    2012-01-01

    目的 通过分析2010年北京地区全髋关节置换术手术部位感染目标性监测数据,探讨全髋关节置换术手术部位感染率及危险因素,并间接评价手术部位感染导致的经济损失.方法 该研究数据来自北京医院感染监控管理系统,2010年1-12月对北京地区的39所医院的714例全髋关节置换术进行前瞻性研究,采用SPSS 12.0软件对与手术部位感染相关的危险因素进行单因素以及多因素logistic回归分析,并且采用MannWhitney检验比较感染组与未感染组住院日的差异.结果 714例初次全髋关节置换术患者术后SSI发生率为2.24%;多因素logistic回归分析显示,手术医院级别、手术后进入ICU、糖尿病以及手术前住院日是全髋关节置换术手术部位感染发生的危险因素;感染组(中位数31.0 d)与未感染组(中位数16.9 d)的住院日比较,差异有统计学意义(P<0.05).结论 北京地区全髋关节置换术手术部位感染发生率与欧美国家的类似;手术部位感染所造成的经济损失将越来越受到重视,对SSI进行目标性监测有助于降低医疗体制所承受的巨大经济损失;全髋关节置换术手术部位感染的发生是多因素的综合,必须采取综合性的预防措施才能有效降低其发生率.%OBJECTIVE To explore the surgical site infection rate and the risk factors and estimate the economic loss due to surgical site infections indirectly by analyzing data from targeted monitoring of surgical site infections after total hip arthroplasty in 2010. METHODS A total of 714 patients who underwent total hip replacements from 39 hospitals in Beijing were monitored prospectively by Beijing Nosocomial Infection Surveillance System from Jan 2010 to Dec 2010. Univariate and multivariate logistic analysis of all related risk factors for surgical site infections were analyzed with statistical software SPSS 12. 0. At the same time, the total hospital stay between

  11. Numerical simulation for the Gross-Pitaevskii equation based on the lattice Boltzmann method

    Science.gov (United States)

    Wang, Huimin

    2017-09-01

    A lattice Boltzmann model for the Gross-Pitaevskii equation is proposed in this paper. Some numerical tests for one- and two-dimensional Gross-Pitaevskii equation have been conducted. The waves of the Gross-Pitaevskii equation are simulated. Numerical results show that the lattice Boltzmann method is an effective method for the wave of the Gross-Pitaevskii equation.

  12. 29 CFR 779.259 - What is included in annual gross volume.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false What is included in annual gross volume. 779.259 Section... Coverage Annual Gross Volume of Sales Made Or Business Done § 779.259 What is included in annual gross volume. (a) The annual gross volume of sales made or business done of an enterprise consists of its...

  13. 29 CFR 794.122 - Ascertainment of “annual” gross sales volume.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Ascertainment of âannualâ gross sales volume. 794.122... Annual Gross Volume of Sales § 794.122 Ascertainment of “annual” gross sales volume. The annual gross volume of sales of an enterprise engaged in the wholesale or bulk distribution of petroleum...

  14. Happy Life Years: a measure of Gross National Happiness

    OpenAIRE

    Veenhoven, Ruut

    2004-01-01

    textabstractHappiness is defined as the degree to which a person enjoys his or her life-as-a-whole. Accordingly ‘Gross National Happiness’ is defined as the degree to which citizens in a country enjoy the life they live. Individual happiness can be measured by self-report on a single standard question. Hence Gross National Happiness can be measured by the average response to such questions in general populations surveys. Survey data on average self-report of happiness can be combined with est...

  15. The Impact of Investments and Gross Value Added upon Earnings

    Directory of Open Access Journals (Sweden)

    Larisa APARASCHIVEI

    2011-02-01

    Full Text Available In this paper we tried to capture the impact of investments and gross value added, but also the impact of the employment on the average wage. The analysis refers to the period 1998- 2008 and we are using data on the activities of the Romanian economy. The results of this study confirm the negative influence of the employment, being consistent with the theory. Also, the impact of investments and that of gross value added came out to be positive and significant.

  16. Revised Phase Diagram of the Gross-Neveu Model

    CERN Document Server

    Thies, M; Thies, Michael; Urlichs, Konrad

    2003-01-01

    We confirm earlier hints that the conventional phase diagram of the discrete chiral Gross-Neveu model in the large N limit is deficient at non-zero chemical potential. We present the corrected phase diagram constructed in mean field theory. It has three different phases, including a kink-antikink crystal phase. All transitions are second order. The driving mechanism for the new structure of baryonic matter in the Gross-Neveu model is an Overhauser type instability with gap formation at the Fermi surface.

  17. COST OF PRODUCTION, GROSS RETURN AND NET PROFIT IN COMMERCIAL EGG PRODUCTION

    Directory of Open Access Journals (Sweden)

    M. Farooq, Zahoor-ul-Haq1, M.A. Mian, F.R. Durrani and M. Syed

    2003-01-01

    Full Text Available The present study was carried out in Chakwal, Pakistan by collecting data from randomly selected 109 flocks to investigate cost of production, gross return and net profit per layer. Majority of the buildings in the study area were rented therefore, rent per layer was added to the total cost of production instead of depreciation on building and equipments. Overall total cost of production, gross return and net profit per layer was Rs. 393.88 ± 5.36, 432.14 ± 8.01 and 38.26 ± 6.66, respectively. Rate of return over the invested capital was 27%. Mean feed cost per layer was Rs. 302.23 ± 5.01, including Rs. 10.27 ± 0.24, 29.19 ± 0.42 and 262.77 ± 5.08 for starter, grower and layer ration, respectively. Feed cost was the major component contributing 76.73% to the total cost of production. Average cost of labor, day-old chick, building rent, vaccination, therapy, miscellaneous item, electricity, bedding material and transportation was Rs. 19.90 ± 0.45, 19.75 ± 0.05, 16.25 ± 0.26, 12.80 ± 0.10, 10.90 ± 2.32, 4.35 ± 0.09, 3.15 ± 0.07, 2.65 ± 0.09 and 1.90 ± 0.08, respectively, contributing 5.05, 5.01, 4.13, 3.25, 2.77, 1.10, 0.80, 0.67 and 0.48 % to the total cost of production. Gross return from the sale of marketable eggs, culled eggs, spent/culled bird, empty bags and manure was Rs. 388.84 ± 7.91, 3.85 ± 0.01, 35.80 ± 0.23, 2.20 ± 0.04 and 1.45 ± 0.01, respectively, contributing 89.98, 0.89, 8.28, 0.51 and 0.34% to the total return. Determining the effect of different parameters on the cost of production and net profit, large flocks, Hisex strain, brood-grow and lay system of rearing, good hygienic conditions of the farm, normal stocking rate and cage system of housing wee found to give maximum gross return as well as net profit.

  18. [Total temporomandibular joint prostheses].

    Science.gov (United States)

    Zwetyenga, N; Amroun, S; Wajszczak, B-L; Moris, V

    2016-09-01

    The temporomandibular joint (TMJ) is probably the most complex human joint. As in all joints, its prosthetic replacement may be indicated in selected cases. Significant advances have been made in the design of TMJ prostheses during the last three decades and the indications have been clarified. The aim of our work was to make an update on the current total TMJ total joint replacement. Indications, contraindications, prosthetic components, advantages, disadvantages, reasons for failure or reoperation, virtual planning and surgical protocol have been exposed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  20. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  1. Novel Totally Laparoscopic Endolumenal Rectal Resection With Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening: A Modification of Our Recently Published Clean Surgical Technique in a Porcine Model.

    Science.gov (United States)

    Kvasha, Anton; Hadary, Amram; Biswas, Seema; Szvalb, Sergio; Willenz, Udi; Waksman, Igor

    2015-06-01

    Our group has recently described a novel technique for clean endolumenal bowel resection, in which abdominal and transanal approaches were used. In the current study, 2 modifications of this procedure were tested for feasibility in a porcine model. A laparoscopic approach to the peritoneal cavity was employed in rectal mobilization; this was followed by a transanal rectorectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. Once IPT was established, a second ligature was placed around the rectum approximating the proximal and distal resection margins. This was followed by a purse string suture through 2 bowel walls, encircling the shaft of the anvil just proximal to the ligatures. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls distal to the previously placed purse string suture and ligatures. The anastomosis was achieved by applying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although, this is a novel and evolving procedure, its minimally invasive nature, as well as aseptic bowel manipulation during endolumenal rectal resection, has the potential to limit the complications associated with abdominal wall incision and surgical site infection.

  2. Monitoring of gross alpha, gross beta and actinides activities in exhaust air released from the waste isolation pilot plant

    Energy Technology Data Exchange (ETDEWEB)

    Thakur, P., E-mail: pthakur@cemrc.org [Carlsbad Environmental Monitoring and Research Center, 1400 University Drive, Carlsbad, New Mexico 88220 (United States); Mulholland, G.P. [Carlsbad Environmental Monitoring and Research Center, 1400 University Drive, Carlsbad, New Mexico 88220 (United States)

    2011-09-15

    The simultaneous measurements of gross alpha and beta activities is one of the simplest radioanalytical technique used as a method for screening samples of both high and low activities of alpha and beta emitting radionuclides in environmental and bioassay samples. Such measurements are of great interest from both a radiological, waste disposal viewpoint, and to establish a trend of radioactivity based on long term monitoring. At the WIPP (Waste Isolation Pilot Plant) site, unfiltered exhaust air from the underground repository is the most important effluent. As part of its monitoring program, the particulates from WIPP exhaust air are collected everyday at a location typically called the Fixed Air Sampler (FAS) site or Station A, this site is located at the release point for aerosol effluents from the underground to the environment. The measurements of gross alpha and beta activity on air filter samples were performed using an ultra low level counter, PIC-MPC 9604-{alpha}/{beta}, from Protean Instrument Corporation. The high sensitivity of the gross alpha and beta instrument enables detection of low value activity from the air filters. In 2009, the values of gross alpha and beta activity concentrations ranged from Simultaneous measurements of gross alpha and gross beta activities in the particulates from WIPP exhaust air were performed. > Ultra low level counter, PIC-MPC 9604-{alpha}/{beta} counter was used for the measurements. > Values of gross alpha activity concentrations ranged from Values of gross beta activity concentrations ranged from

  3. Total algorithms

    NARCIS (Netherlands)

    Tel, G.

    1993-01-01

    We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of distri

  4. Gross morphometry of young Geochelone sulcata (Testudines: Testudinidae) in Costa Rica

    OpenAIRE

    Merchán, Manuel; Coll, Marta; Fournier, Raúl

    2014-01-01

    The African Spur tortoise, Geochelone sulcata, has been introduced to Costa Rica. A total of 31 tortoises were measured for 26 gross morphometry parameters. All individuals measured were inmature, aged from 5 to 34 months, and were born in captivity in La Garita de Alajuela, Costa Rica. Mean straight carapace length was 83.1 mm, mean straight plastron length was 68.3 mm and mean maximum height was 46.2 mm. All the measurements were correlated, except tail length and cloacal distance. Weight h...

  5. Gross morphometry of young Geochelone sulcata (Testudines: Testudinidae) in Costa Rica

    OpenAIRE

    Merchán, Manuel; Coll, Marta; Fournier, Raúl

    2014-01-01

    The African Spur tortoise, Geochelone sulcata, has been introduced to Costa Rica. A total of 31 tortoises weremeasured for 26 gross morphometry parameters. All individuals measured were inmature, aged from 5 to 34months, and were born in captivity in La Garita de Alajuela, Costa Rica. Mean straight carapace length was 83.1mm, mean straight plastron length was 68.3 mm and mean maximum height was 46.2 mm. All the measurementswere correlated, except tail length and cloacal distance. Weight had t...

  6. 26 CFR 1.555-2 - Additions to gross income.

    Science.gov (United States)

    2010-04-01

    ... Corporation sells 90percent of its stock in the Y Corporation and thus is a minority shareholder in the Y... on which the required United States group exists, and (2) Such foreign corporation is a shareholder... the gross income of its shareholders, whether United States shareholders or other foreign...

  7. Comments on the research article by Gross et al. (2012)

    DEFF Research Database (Denmark)

    Guntur, Srinivas; Sørensen, Niels N.

    2014-01-01

    The purpose of this Letter to the Editor is to present a discussion on the physics of rotational augmentation based on existing work. One of the latest works by Gross et al. (2012) is highlighted here, and its conclusions are discussed. Based on the existing understanding of rotational augmentati...

  8. Effective Collaboration among the Gross Motor Assessment Team Members

    Science.gov (United States)

    Menear, Kristi S.; Davis, Timothy D.

    2015-01-01

    This article describes the gross motor assessment team (GMAT) members' roles and collaborative approach to making appropriate decisions and modifications when addressing the needs of individuals with disabilities in physical education. Case studies of students are used to demonstrate effective uses of the GMAT. The primary outcome of the GMAT's…

  9. 40 CFR 403.15 - Net/Gross calculation.

    Science.gov (United States)

    2010-07-01

    ... STANDARDS GENERAL PRE-TREAT-MENT REGULATIONS FOR EXIST-ING AND NEW SOURCES OF POLLUTION § 403.15 Net/Gross... pollutants in the Industrial User's intake water in accordance with this section. Any Industrial User wishing... of the Industrial User, the applicable Standard will be calculated on a “net” basis (i.e., adjusted...

  10. Rubriek 'Meten in de praktijk': Gross Motor Function Measure.

    NARCIS (Netherlands)

    Veenhof, C.; Ketelaar, M.

    2004-01-01

    De Gross Motor Function Measure (GMFM) is een instrument dat de grof-motorische vaardigheden meet van kinderen met cerebrale parese. De GMFM is expliciet ontwikkeld als evaluatief meetinstrument, wat betekent dat het bedoeld is om veranderingen over de tijd of verandering en die optreden na behandel

  11. Development of the Gross Motor Function Classification System (1997)

    Science.gov (United States)

    Morris, Christopher

    2008-01-01

    To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the…

  12. Effective Collaboration among the Gross Motor Assessment Team Members

    Science.gov (United States)

    Menear, Kristi S.; Davis, Timothy D.

    2015-01-01

    This article describes the gross motor assessment team (GMAT) members' roles and collaborative approach to making appropriate decisions and modifications when addressing the needs of individuals with disabilities in physical education. Case studies of students are used to demonstrate effective uses of the GMAT. The primary outcome of the GMAT's…

  13. Assessing Gross Motor Skills of Kosovar Preschool Children

    Science.gov (United States)

    Shala, Merita

    2009-01-01

    In the light of the new developments in preschool education in Kosovo, this study attempts to carry out an assessment of the development of gross motor skills of preschool children attending institutional education. The emphasis is on creating a set of tests to measure the motor attainments of these children by conducting assessments of the…

  14. 78 FR 26575 - Gross Combination Weight Rating; Definition

    Science.gov (United States)

    2013-05-07

    ... Weight Rating; Definition AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION... definition of ``gross combination weight rating'' (or GCWR) to clarify that a GCWR is the greater of: the....regulations.gov . Fax: 1-202-493-2251. Mail: Docket Management Facility (M-30), U.S. Department of...

  15. Happy Life Years: a measure of Gross National Happiness

    NARCIS (Netherlands)

    R. Veenhoven (Ruut)

    2004-01-01

    textabstractHappiness is defined as the degree to which a person enjoys his or her life-as-a-whole. Accordingly ‘Gross National Happiness’ is defined as the degree to which citizens in a country enjoy the life they live. Individual happiness can be measured by self-report on a single standard

  16. 77 FR 51706 - Gross Combination Weight Rating (GCWR); Definition

    Science.gov (United States)

    2012-08-27

    ... Federal Motor Carrier Safety Administration 49 CFR Parts 383 and 390 RIN 2126-AB53 Gross Combination Weight Rating (GCWR); Definition AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Direct final rule; request for comments. SUMMARY: The Federal Motor Carrier Safety Administration...

  17. Strategic improvements for gross anatomy web-based teaching.

    Science.gov (United States)

    Marker, David R; Juluru, Krishna; Long, Chris; Magid, Donna

    2012-01-01

    Current generations of graduate students have been immersed in technology from their early school years and have high expectations regarding digital resources. To better meet the expectations of Gross Anatomy students at our institution, electronic radiology teaching files for first-year coursework were organized into a web site. The web site was custom designed to provide material that directly correlated to the Gross Anatomy dissection and lectures. Quick links provided sets of images grouped by anatomic location. Additionally, Lab and Study Companions provided specific material for the students to review prior to and after lectures and gross dissections. Student opinions of this education resource were compared to student opinions of the prior year's digital teaching files. The new content was ranked as more user friendly (3.1 points versus 2.3 points) and more useful for learning anatomy (3.3 points versus 2.6 points). Many students reported that using the web portal was critical in helping them to better understand relationships of anatomical structures. These findings suggest that a well-organized web portal can provide a user-friendly, valuable educational resource for medical students who are studying Gross Anatomy.

  18. Fine and Gross Motor Ability in Males with ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2003-09-01

    Full Text Available Both fine and gross motor abilities were evaluated in 10-year-old males with attention deficit hyperactivity disorder (ADHD and compared to a group of control children at the School of Psychology, Curtin University of Technology, Perth, Australia.

  19. Construction of 2-dimensional Grosse-Wulkenhaar Model

    CERN Document Server

    Wang, Zhituo

    2011-01-01

    In this paper we construct the noncommutative Grosse-Wulkenhaar model on 2-dimensional Moyal plane with the method of loop vertex expansion. We treat renormalization with this new tool, adapt Nelson's argument and prove Borel summability of the perturbation series. This is the first non-commutative quantum field theory model to be built in a non-perturbative sense.

  20. Monopol suretab kohaliku loomakasvataja / Oleg Gross ; interv . Illar Mõttus

    Index Scriptorium Estoniae

    Gross, Oleg, 1952-

    2005-01-01

    Väike-Maarja jäätmetehase monopoolse seisundi vastu sõna võtnud OG Elektra omanik Oleg Gross on kindel, et jäätmetehasega suretatakse kohalikud väiksemad lihatootjad välja. Kommenteerivad talupidaja Jüri Järvet ja Rakvere Lihakombinaadi direktor Olle Horm

  1. ɛ-expansion in the Gross-Neveu

    Science.gov (United States)

    Raju, Avinash

    2016-10-01

    We use the recently developed CFT techniques of Rychkov and Tan to compute anomalous dimensions in the O( N ) Gross-Neveu model in d = 2 + ɛ dimensions. To do this, we extend the "cowpie contraction" algorithm of arXiv:1506.06616 to theories with fermions. Our results match perfectly with Feynman diagram computations.

  2. Barn music at St Donat's castle / Philip Gross

    Index Scriptorium Estoniae

    Gross, Philip, 1952-

    2011-01-01

    Muusikafestivalist "Vale of Glamorgan", mis oli 2010. a. pühendatud Arvo Pärdile. Eesti kammermuusikaansambli Resonabilis kavas oli ka festivali tellimusel valminud uelsi helilooja Gareth Peredur Churchilli "Vocable", mille teksti kirjutas Philip Gross. Festivalikontsertide muljeid leiab Grossi luuletsüklis "Barn music" (avaldatud samas ajakirjanumbris, lk. 42-43)

  3. Attitudes of Healthcare Students on Gross Anatomy Laboratory Sessions

    Science.gov (United States)

    Kawashiro, Yukiko; Anahara, Reiko; Kohno, Toshihiko; Mori, Chisato; Matsuno, Yoshiharu

    2009-01-01

    At Chiba University, gross anatomy laboratory sessions ("laboratories") are required for physical therapy students. Though most physical therapy schools require their students to participate in laboratories so that they will better understand the structure of the human body, few data exist on the value of these laboratories specifically…

  4. Uniqueness of Meromorphic Functions and Question of Gross

    Institute of Scientific and Technical Information of China (English)

    仪洪勋

    1994-01-01

    In this paper, we deal with the problem of uniqueness of meromorphic functions. It is shown that there exist two finite sets Sj (j=1, 2) such that any two nonconstant meromorphic functions f and g satisfying Ef(Sj)=Eg(Sj) for j = 1,2 must be identical, which answers a question posed by Gross.

  5. Interlimb Coordination: An Important Facet of Gross-Motor Ability

    Science.gov (United States)

    Bobbio, Tatiana; Gabbard, Carl; Cacola, Priscila

    2009-01-01

    Motor development attains landmark significance during early childhood. Although early childhood educators may be familiar with the gross-motor skill category, the subcategory of interlimb coordination needs greater attention than it typically receives from teachers of young children. Interlimb coordination primarily involves movements requiring…

  6. Barn music at St Donat's castle / Philip Gross

    Index Scriptorium Estoniae

    Gross, Philip, 1952-

    2011-01-01

    Muusikafestivalist "Vale of Glamorgan", mis oli 2010. a. pühendatud Arvo Pärdile. Eesti kammermuusikaansambli Resonabilis kavas oli ka festivali tellimusel valminud uelsi helilooja Gareth Peredur Churchilli "Vocable", mille teksti kirjutas Philip Gross. Festivalikontsertide muljeid leiab Grossi luuletsüklis "Barn music" (avaldatud samas ajakirjanumbris, lk. 42-43)

  7. 75 FR 15610 - Exclusions From Gross Income of Foreign Corporations

    Science.gov (United States)

    2010-03-30

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 Exclusions From Gross Income of Foreign Corporations CFR Correction In Title 26 of the Code of Federal Regulations, Part 1 (Sec. Sec. 1.851 to 1.907), revised as...

  8. Gross Motor Development, Movement Abnormalities, and Early Identification of Autism

    Science.gov (United States)

    Ozonoff, Sally; Young, Gregory S.; Goldring, Stacy; Greiss-Hess, Laura; Herrera, Adriana M.; Steele, Joel; Macari, Suzanne; Hepburn, Susan; Rogers, Sally J.

    2008-01-01

    Gross motor development (supine, prone, rolling, sitting, crawling, walking) and movement abnormalities were examined in the home videos of infants later diagnosed with autism (regression and no regression subgroups), developmental delays (DD), or typical development. Group differences in maturity were found for walking, prone, and supine, with…

  9. Outcomes of a Rotational Dissection System in Gross Anatomy

    Science.gov (United States)

    Marshak, David W.; Oakes, Joanne; Hsieh, Pei-Hsuan; Chuang, Alice Z.; Cleary, Leonard J.

    2015-01-01

    At the University of Texas Houston Medical School, a rotational dissection system was introduced to improve coordination between the Gross Anatomy and the Introduction to Clinical Medicine (ICM) courses. Six students were assigned to each cadaver and divided into two teams. For each laboratory, one team was assigned to dissect and the other to…

  10. Strategic Improvements for Gross Anatomy Web-Based Teaching

    Directory of Open Access Journals (Sweden)

    David R. Marker

    2012-01-01

    Full Text Available Current generations of graduate students have been immersed in technology from their early school years and have high expectations regarding digital resources. To better meet the expectations of Gross Anatomy students at our institution, electronic radiology teaching files for first-year coursework were organized into a web site. The web site was custom designed to provide material that directly correlated to the Gross Anatomy dissection and lectures. Quick links provided sets of images grouped by anatomic location. Additionally, Lab and Study Companions provided specific material for the students to review prior to and after lectures and gross dissections. Student opinions of this education resource were compared to student opinions of the prior year’s digital teaching files. The new content was ranked as more user friendly (3.1 points versus 2.3 points and more useful for learning anatomy (3.3 points versus 2.6 points. Many students reported that using the web portal was critical in helping them to better understand relationships of anatomical structures. These findings suggest that a well-organized web portal can provide a user-friendly, valuable educational resource for medical students who are studying Gross Anatomy.

  11. Surgical Complications of Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Basir Hashemi

    2010-03-01

    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  12. Participation in asynchronous online discussion forums does improve student learning of gross anatomy.

    Science.gov (United States)

    Green, Rodney A; Farchione, Davide; Hughes, Diane L; Chan, Siew-Pang

    2014-01-01

    Asynchronous online discussion forums are common in blended learning models and are popular with students. A previous report has suggested that participation in these forums may assist student learning in a gross anatomy subject but it was unclear as to whether more academically able students post more often or whether participation led to improved learning outcomes. This study used a path model to analyze the contribution of forum participation, previous academic ability, and student campus of enrolment to final marks in a multicampus gross anatomy course for physiotherapy students. The course has a substantial online learning management system (LMS) that incorporates asynchronous forums as a learning tool, particularly to answer learning objectives. Students were encouraged to post new threads and answer queries in threads started by others. The forums were moderated weekly by staff. Discussion forums were the most used feature of the LMS site with 31,920 hits. Forty-eight percent of the students posted at least once with 186 threads initiated by students and a total of 608 posts. The total number of posts made a significant direct contribution to final mark (P = 0.008) as did previous academic ability (P = 0.002). Although campus did not contribute to final mark, there was a trend for students at the campus where the course coordinator was situated to post more often than those at the other campus (P = 0.073). These results indicate that asynchronous online discussion forums can be an effective tool for improving student learning outcomes as evidenced by final marks in gross anatomy teaching.

  13. An advanced digital image-capture computer system for gross specimens: a substitute for gross description.

    Science.gov (United States)

    Leong, A S; Visinoni, F; Visinoni, C; Milios, J

    2000-05-01

    The description of macroscopic appearances of surgically excised specimens together with the sites of specimen sampling form an important component in the documentation of a histopathology specimen. Unfortunately, accuracy of description depends on the vocabulary and descriptive prowess of the pathologist which means that the result can be variable. Transcription of the dictated word also takes time and involves typists. We developed a user-friendly, high-resolution image capture system that will supplement word description of macroscopic specimens and has the potential to replace it completely. It also provides the opportunity of revisiting traditional methods of documenting specimens with words, allowing the production of more relevant and user-friendly reports containing information relevant to clinical management and supplemented by high-resolution digital images. The accompanying Windows-based software has capabilities of generating the entire histopathology report and allows rapid retrospective searches through any one of several common search parameters. The stored images form a powerful database for teaching and research. Connection to remote transmission facilities allows teleconferencing and telepathology consultations.

  14. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  15. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  16. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  17. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin

    2016-07-01

    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  18. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  19. VOICE REHABILITATION FOLLOWING TOTAL LARYNGECTOMY

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thiagarajan

    2015-03-01

    Full Text Available Despite continuing advances in surgical management of laryngeal malignancy, total laryngectomy is still the treatment of choice in advanced laryngeal malignancies. Considering the longevity of the patient following total laryngectomy, various measures have been adopted in order to provide voice function to the patient. Significant advancements have taken place in voice rehabilitation of post laryngectomy patients. Advancements in oncological surgical techniques and irradiation techniques have literally cured laryngeal malignancies. Among the various voice rehabilitation techniques available TEP (Tracheo oesophageal puncture is considered to be the gold standard. This article attempts to explore the various voice rehabilitation technique available with primary focus on TEP.

  20. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations.

    Science.gov (United States)

    Englot, Dario J; Han, Seunggu J; Lawton, Michael T; Chang, Edward F

    2011-12-01

    Seizures are the most common presenting symptom of supratentorial cerebral cavernous malformations (CCMs) and progress to medically refractory epilepsy in 40% of patients. Predictors of seizure freedom in the resection of CCMs are incompletely understood. The authors systematically reviewed the published literature on seizure freedom following the resection of supratentorial CCMs in patients presenting with seizures. Seizure outcomes were stratified across 12 potential prognostic variables. A total of 1226 patients with supratentorial CCMs causing seizures were identified across 31 predominantly retrospective studies; 361 patients had medically refractory epilepsy. Seventy-five percent of the patients were seizure free after microsurgical lesion removal, whereas 25% continued to have seizures. All patients had had preoperative seizures and > 6 months of postoperative follow-up. Modifiable predictors of postoperative seizure freedom included gross-total resection (OR 36.6, 95% CI 8.5-157.5) and surgery within 1 year of symptom onset (OR 1.83, 95% CI 1.30-2.58). Additional prognostic indicators of a favorable outcome were a CCM size seizures (OR 2.38, 95% CI 1.29-4.39), and the lack of secondarily generalized seizures (OR 3.33, 95% CI 2.09-5.30). Other factors, including extended resection of the hemosiderin ring, were not significantly predictive. In the surgical treatment of supratentorial CCMs, gross-total resection and early operative intervention may improve seizure outcome. While surgery should not be considered the first-line treatment for CCM-related epilepsy, it is important to understand the variables associated with seizure freedom in CCM resection given the considerable morbidity and diminished quality of life associated with epilepsy.

  1. The relationship between spasticity in young children (18 months of age with cerebral palsy and their gross motor function development

    Directory of Open Access Journals (Sweden)

    Verschuren Olaf

    2009-09-01

    Full Text Available Abstract Background It is thought that spasticity has an influence on the development of functional motor abilities among children with cerebral palsy (CP. The extent to which spasticity is associated with the change in motor abilities in young children with CP has not been established. The objective of this study is to evaluate the relationship of initial spasticity in young children with CP and their gross motor function development over one year. Methods Fifty children with CP aged 18 months, GMFCS-levels I-V participated in a longitudinal observational study. Change in gross motor functioning (GMFM-66 was measured over one year. The level of spasticity measured at the first assessment was determined with the Modified Tardieu Scale in three muscle groups of the lower extremity (adductor muscles, the hamstrings and the m. gastrocnemius. The Spasticity Total Score per child was calculated with a maximum score of 12 points. Results Spearman's Rho Correlation (-0.28 revealed a statistically significant relationship (p Conclusion Our findings indicate that when measured over one year, spasticity is marginally related to gross motor function development in infants with CP. The initial level of spasticity is only one of the many child, environmental and family factors that determines gross motor development of a young child with CP.

  2. P13.10SURGICAL TREATMENT FOR GLIOBLASTOMA MULTIFORME: OUTCOME AND ANALYSIS OF PROGNOSTIC FACTORS ESPECIALLY ORIENTED TO THE EXTENT OF SURGICAL RESECTION

    Science.gov (United States)

    Di Somma, L.; Iacoangeli, M.; Alvaro, L.; Di Rienzo, A.; Liverotti, V.; Della Costanza, M.; Brunozzi, D.; Polonara, G.; Scarpelli, M.; Scerrati, M.

    2014-01-01

    INTRODUCTION: The prognosis of Glioblastoma Multiforme (GBM) remains poor despite recent therapeutic advances. The surgical treatment of GBM (supported by functional imaging, neuronavigation and electrophysiological monitoring) remains a fundamental step. The methylation of the enzyme O6-methylguanine-DNA methyltransefrase (MGMT) seems to improve the effectiveness of alkylating agents on this tumour, but other factors can influence the survival. An evaluation of all prognostic factors is essential to individuate subgroups of patients for a better selection of different treatment modalities. Our study confirms the prognostic values of both new recognized factors (MGMT presence, IDH1, news schedule of TM2 etc.) and the well-recognized prognostic factors particularly to the extent of surgical removal with the help of new technologies and in the era where people is asking more and more a better quality of life. METHODS: We retrospectively analysed 172 operated patients (115 males and 57 females), 55 of which located in eloquent areas, between March 2008 and December 2012. For each patient age, sex, preoperative clinical evaluation (Karnofsky score, KPS), tumour location, extent of surgical removal, genetic and epigenetic profile (MGMT, IDH1,etc) and postoperative treatments were recorded. We used Kaplan Meier method for the univariate analysis and the Cox regression for the multivariate one. Surgical strategy was always planned for a total tumour resection, when allowed by the intrinsic characteristics of the tumour using the so called “extracapsular “ technique. RESULTS: Overall median survival time after surgery was 10 months. At univariate analysis the gross total removal (p70 (p<0,0001) and radiotherapy (p<0,0001) improve survivals. Deep structures involved or multifocal lesions (p<0,0001) resulted as negative factors in term of the quod vitam prognosis, whereas lesions arising in insula, deep structures or in primary motor cortex worse the quod valitudinem

  3. Vast Portfolio Selection with Gross-exposure Constraints*

    Science.gov (United States)

    Fan, Jianqing; Zhang, Jingjin; Yu, Ke

    2012-01-01

    We introduce the large portfolio selection using gross-exposure constraints. We show that with gross-exposure constraint the empirically selected optimal portfolios based on estimated covariance matrices have similar performance to the theoretical optimal ones and there is no error accumulation effect from estimation of vast covariance matrices. This gives theoretical justification to the empirical results in Jagannathan and Ma (2003). We also show that the no-short-sale portfolio can be improved by allowing some short positions. The applications to portfolio selection, tracking, and improvements are also addressed. The utility of our new approach is illustrated by simulation and empirical studies on the 100 Fama-French industrial portfolios and the 600 stocks randomly selected from Russell 3000. PMID:23293404

  4. Vast Portfolio Selection with Gross-exposure Constraints().

    Science.gov (United States)

    Fan, Jianqing; Zhang, Jingjin; Yu, Ke

    2012-01-01

    We introduce the large portfolio selection using gross-exposure constraints. We show that with gross-exposure constraint the empirically selected optimal portfolios based on estimated covariance matrices have similar performance to the theoretical optimal ones and there is no error accumulation effect from estimation of vast covariance matrices. This gives theoretical justification to the empirical results in Jagannathan and Ma (2003). We also show that the no-short-sale portfolio can be improved by allowing some short positions. The applications to portfolio selection, tracking, and improvements are also addressed. The utility of our new approach is illustrated by simulation and empirical studies on the 100 Fama-French industrial portfolios and the 600 stocks randomly selected from Russell 3000.

  5. Gross-Pitaevski map as a chaotic dynamical system

    Science.gov (United States)

    Guarneri, Italo

    2017-03-01

    The Gross-Pitaevski map is a discrete time, split-operator version of the Gross-Pitaevski dynamics in the circle, for which exponential instability has been recently reported. Here it is studied as a classical dynamical system in its own right. A systematic analysis of Lyapunov exponents exposes strongly chaotic behavior. Exponential growth of energy is then shown to be a direct consequence of rotational invariance and for stationary solutions the full spectrum of Lyapunov exponents is analytically computed. The present analysis includes the "resonant" case, when the free rotation period is commensurate to 2 π , and the map has countably many constants of the motion. Except for lowest-order resonances, this case exhibits an integrable-chaotic transition.

  6. GLOBALIZATION AND GROSS DOMESTIC PRODUCT CONSTRUCTION IN ASEAN

    Directory of Open Access Journals (Sweden)

    Muhammad Sri Wahyudi Suliswanto

    2011-09-01

    Full Text Available There is no more doubt about the importance of economic growth, which can be calculated fromGross Domestic Product (GDP. This research analyzes the role of globalization on GDP inASEAN-5 by estimating panel data. It uses a fixed effect approach to accommodate various characteristicsin the countries. To accommodate such variation, it assumes that the intercepts variesacross these countries, while the slopes remain similar. Based on the estimation result, it suggeststhat net export and foreign direct investment represent the globalization process. Both have positiveand significant influences on GDP in the corresponding countries.Keywords: Globalization, international trade, foreign direct investment, gross domestic productJEL classification numbers: E01, F51, F43

  7. Gross efficiency and energy expenditure in kayak ergometer exercise.

    Science.gov (United States)

    Gomes, B B; Mourão, L; Massart, A; Figueiredo, P; Vilas-Boas, J P; Santos, A M C; Fernandes, R J

    2012-08-01

    We purposed to study energy expenditure, power output and gross efficiency during kayak ergometer exercise in 12 elite sprint kayakers. 6 males (age 24.2±4.8 years, height 180.4±4.8 cm, body mass 79.7±8.5 kg) and 6 females (age 24.3±4.5 years, height 164.5±3.9 cm, body mass 65.4±3.5 kg), performed an incremental intermittent protocol on kayak ergometer with VO2 and blood lactate concentration assessment, a non-linear increase between power output and energy expenditure being observed. Paddling power output, energy expenditure and gross efficiency corresponding to VO2max averaged 199.92±50.41 W, 75.27±6.30 ml.kg - 1.min - 1, and 10.10±1.08%. Male kayakers presented higher VO2max, power output and gross efficiency at the VO2max, and lower heart rate and maximal lactate concentration than females, but no differences were found between genders regarding energy expenditure at VO2max. Aerobic and anaerobic components of energy expenditure evidenced a significant contribution of anaerobic energy sources in sprint kayak performance. Results also suggested the dependence of the gross efficiency on the changes in the amount of the aerobic and anaerobic contributions, at heavy and severe intensities. The inter-individual variance of the relationship between energy expenditure and the corresponding paddling power output revealed a relevant tracking for females (FDγ=0.73±0.06), conversely to the male group (FDγ=0.27±0.08), supporting that some male kayakers are more skilled in some paddling intensities than others.

  8. Constructive Renormalization of 2-dimensional Grosse-Wulkenhaar Model

    CERN Document Server

    Wang, Zhituo

    2012-01-01

    In this talk we briefly report the recent work on the construction of the 2-dimensional Grosse-Wulkenhaar model with the method of loop vertex expansion. We treat renormalization with this new tool, adapt Nelson's argument and prove Borel summability of the perturbation series. This is the first non-commutative quantum field theory model to be built in a non-perturbative sense.

  9. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  10. Understanding the planes of total mesorectal excision through surgical anatomy of pelvic fascia%从盆腔筋膜的外科解剖来理解直肠全系膜切除术的层次

    Institute of Scientific and Technical Information of China (English)

    林谋斌; 金志明; 尹路; 丁文龙; 陈伟国; 倪俊声; 朱正纲

    2008-01-01

    目的 探讨直肠系膜与盆腔筋膜和神经的关系,以明确直肠全系膜切除术合理的切除平面.方法 对24具尸体的盆腔进行解剖.结果 直肠周围的层次是连续的,可以分为2段3层,2段指耻骨联合至坐骨棘和坐骨棘至骶岬;3层分别为脏筋膜、膀胱腹下筋膜和壁筋膜.在膀胱腹下筋膜与脏筋膜之间存在盆丛及其膀胱、子宫神经分支,而在脏、壁筋膜之间存在腹下神经和盆内脏神经.结论 直肠全系膜切除术的层次在直肠后方为脏、壁筋膜之间,而在直肠侧方实际上位于脏筋膜和膀胱腹下筋膜之间.侧后方的腹下神经、侧前方的盆丛及其分支是正确层次的标记.%Objective To study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision. Methods Twenty- four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection. Results There were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia. Conclusions The posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

  11. Differences of Respiratory Function According to Level of the Gross Motor Function Classification System in Children with Cerebral Palsy

    OpenAIRE

    Kwon, Yong Hyun; Lee, Hye Young

    2014-01-01

    [Purpose] The current study was designed to investigate the difference in lung capacity and muscle strengthening related to respiration depending on the level of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) through tests of respiratory function and respiratory pressure. [Subjects and Methods] A total of 49 children with CP who were classified as below level III of the GMFCS were recruited for this study. They were divided into three groups (i.e.,...

  12. Individualized surgical strategies for Rathke cleft cyst based on cyst location.

    Science.gov (United States)

    Fan, Jun; Peng, Yuping; Qi, Songtao; Zhang, Xi-an; Qiu, Binghui; Pan, Jun

    2013-12-01

    An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra- and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15). Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p strategies for RCCs based on cyst location. Gross-total resection does not appear to reduce the recurrence rate but increase the risk of postoperative complications. The endonasal approach seems more appropriate for primarily intrasellar RCCs, while the craniotomy is recommended for purely or mainly suprasellar cysts. The supraorbital route appears to be preferred over traditional craniotomy for its minimal invasiveness

  13. Fusion following failed total ankle replacement.

    Science.gov (United States)

    Wünschel, Markus; Leichtle, Ulf G; Leichtle, Carmen I; Walter, Christian; Mittag, Falk; Arlt, Eva; Suckel, Andreas

    2013-04-01

    Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.

  14. Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

    National Research Council Canada - National Science Library

    T. Grau; J. Carlos Ruiz de Adana; S. Zubillaga; S. Fuerte; C. Girón

    2003-01-01

    .../triglicéridos de cadena larga (MCT/LCT), utilizadas en la nutrición parenteral total (NPT) peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente...

  15. Landscape History of Grosses Moos, NW Swiss Alpine Foreland.

    Science.gov (United States)

    Joanna Heer, Aleksandra; Adamiec, Grzegorz; Veit, Heinz; May, Jan-Hendrik; Novenko, Elena; Hajdas, Irka

    2017-04-01

    The western Swiss Plateau with Lake Neuchâtel is part of the alpine foreland and among the key areas for the reconstruction of environmental changes since the last postglacial. This study was carried out in a landscape located NE of the lake and called Grosses Moos (The Large Fen) - currently designated the Swiss largest, continuous farming area, after the fen was drained in course of landscape engineering projects performed in Switzerland at the end of the 19th century. The study contributes new results from nine excavations of littoral ridges identified in Grosses Moos, and integrates sedimentology, paleo-environmental analysis and three independent chronological methods. Radiocarbon dating, pollen analysis and optically stimulated luminescence (OSL) were applied to the sediments. While pollen and radiocarbon follow the standard procedures, the evaluation of the luminescence age estimates demanded adjustment according to the physical and microdosimetric properties of the alpine quartz, and consideration of the peculiarities of the changing littoral environments of Grosses Moos. The Grosses Moos landscape developed on the temporary surface of the post-Last Glacial sedimentary infill of the over-deepened glacial Aare valley. In this study the landscape history has been fitted into the existing supraregional time scales of NGRIP, the Swiss bio-zones system and the human history based on archaeological and historic records and covers a time span of up to 15'000 yr b2k. The wide-ranging suite of geomorphic features and sedimentary sequences, including littoral lake sediments, beach ridges, dunes, palaeo-channels, peat and colluvial deposits, enable the extensive reconstruction of spatially and temporally variable natural shaping processes. In addition, our results indicate remobilization of soil, colluvium, and sediment due to human settlement activities since the Neolithic - with an important increase in sediment load and spatial variability since the Bronze Age

  16. Methodology for full comparative assessment of direct gross glycerin combustion in a flame tube furnace

    Energy Technology Data Exchange (ETDEWEB)

    Maturana, Aymer Yeferson; Pagliuso, Josmar D. [Dept. of Mechanical Engineering. Sao Carlos School of Engineering. University of Sao Paulo, Sao Carlos, SP (Brazil)], e-mails: aymermat@sc.usp.br, josmar@sc.usp.br

    2010-07-01

    This study is to develop a methodology to identify and evaluate the emissions and heat transfer associated to combustion of gross glycerin a by-product of the Brazilian biodiesel manufacture process as alternative energy source. It aims to increase the present knowledge on the matter and to contribute to the improvement of the economic and environmental perspective of biodiesel industry. This methodology was considered to be used for assessment of gross glycerin combustion from three different types of biodiesel (bovine tallow, palm and soy). The procedures for evaluation and quantification of emissions of sulphur and nitrogen oxides, total hydrocarbons, carbon monoxide, carbon dioxide, and acrolein were analyzed, described and standardized. Experimental techniques for mutagenic and toxic effects assessment of gases similarly were analyzed and standardized, as well as the calorific power, the associate heat transfer and fundamentals operational parameters. The methodology was developed, using a full-instrumented flame tube furnace, continuous gas analyzers, a chromatograph, automatic data acquisition systems and other auxiliary equipment. The mutagenic and toxic effects of the study was based on Tradescantia clone KU-20, using chambers of intoxication and biological analytical techniques previously developed and others were specially adapted. The benchmark for the initial set up was based on the performance evaluation of the previous equipment tested with diesel considering its behavior during direct combustion. Finally, the following factors were defined for the combustion of crude glycerin, configurations of equipment types, operational parameters such as air fuel ratio adiabatic temperature and other necessary aspect for successful application of the methodology. The developed and integrated methodology was made available to the concern industry, environmental authorities and researchers as procedures to access the viability of gross glycerin or similar fuels as

  17. Surgical Lasers In Gynecology

    Science.gov (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  18. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    SHEN Hui-liang; LI Zheng; FENG Ming-li; CAO Guang-le

    2011-01-01

    Background Total knee arthroplasty (TKA) is an important therapy for the treatment of various late-stage knee diseases. However, it has been observed that patients have lower hemoglobin (HB) counts postoperatively, which are significantly inconsistent with the measured blood loss. Although the concept of hidden blood loss has been presented in 2000, very little clinical attention has been paid since then. In this study, we investigated the characteristics and influential factor of hidden blood loss after TKA in treating knee osteoarthritis.Methods One hundred and eight patients, with 42 males and 66 females, were retrospectively analyzed. The perioperative blood loss and the hidden blood loss following TKA were calculated by Gross formula. Potential factors affecting perioperative and hidden blood loss included gender, surgical time, tourniquet time, hemostasis (during operation with deflating tourniquet), and reinfusion of salvaged blood.Results The average perioperative blood loss was found to be (1553±356) ml and the average hidden blood loss was (793±223) ml. The hidden blood loss of the male was significantly higher than that of the female, and was reduced by hemostasis during the operation with a deflating tourniquet. Hidden blood loss was not affected by postoperative blood salvage and reinfusion, surgical time, or tourniquet time.Conclusions When calculating the value of hidden blood loss by Gross formula, the lowest value of hematocrit should be chosen as the parameter so that hidden blood loss would not be underestimated. No significant differences could be found in hidden blood loss for males compared to females. Hidden blood loss can be reduced by hemostasis during operation with a deflating tourniquet. Although reinfusion of salvaged blood could not reduce the perioperative blood loss or hidden blood loss, it was still an effective method to reduce transfusion rate.

  19. Relationship Between Gross Motor Function and Daily Functional Skill in Children With Cerebral Palsy

    OpenAIRE

    Kwon, Tae Gun; Yi, Sook-Hee; Kim, Tae Won; Chang, Hyun Jung; Kwon, Jeong-Yi

    2013-01-01

    Objective To investigate the relationship between gross motor function and daily functional skill in children with cerebral palsy (CP) and to explore how this relationship is moderated by the Gross Motor Function Classification System, Bimanual Fine Motor Function (BFMF), neuromotor types, and limb distribution of CP. Methods A cross-sectional survey of 112 children with CP (range, 4 years to 7 years and 7 months) was performed. Gross motor function was assessed with the Gross Motor Function ...

  20. Surgical management of tumors producing the thalamopeduncular syndrome of childhood.

    Science.gov (United States)

    Broadway, S Jared; Ogg, Robert J; Scoggins, Matthew A; Sanford, Robert; Patay, Zoltan; Boop, Frederick A

    2011-06-01

    another had lateral deviation, facilitating a transtemporal and a transfrontal approach, respectively. The thalamopeduncular syndrome of progressive spastic hemiparesis presenting in children with or without symptoms of headache should alert the examiner to the possibility of a tumoral involvement of CSTs. Preoperative tractography is a useful adjunct to surgical planning in tumors that displace motor pathways. Gross-total resection of pilocytic astrocytomas usually results in cure, and therefore should be entertained when developing a treatment strategy for thalamopeduncular tumors of childhood.

  1. 26 CFR 1.927(b)-1T - Temporary regulations; Definition of gross receipts.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Temporary regulations; Definition of gross...(b)-1T Temporary regulations; Definition of gross receipts. (a) General rule. Under section 927(b.... The FSC's gross receipts for purposes of computing its profit under the administrative pricing...

  2. The relationship between gross motor skills and academic achievement in children with learning disabilities

    NARCIS (Netherlands)

    Westendorp, Marieke; Hartman, Esther; Houwen, Suzanne; Smith, Joanne; Visscher, Chris

    2011-01-01

    The present study compared the gross motor skills of 7- to 12-year-old children with learning disabilities (n = 104) with those of age-matched typically developing children (n = 104) using the Test of Gross Motor Development-2. Additionally, the specific relationships between subsets of gross motor

  3. 46 CFR 130.110 - Internal communications on OSVs of less than 100 gross tons.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Internal communications on OSVs of less than 100 gross... Internal communications on OSVs of less than 100 gross tons. Each vessel of less than 100 gross tons... have a fixed means of communication between the pilothouse and the place where the auxiliary means...

  4. The relationship between gross motor skills and academic achievement in children with learning disabilities

    NARCIS (Netherlands)

    Westendorp, Marieke; Hartman, Esther; Houwen, Suzanne; Smith, Joanne; Visscher, Chris

    2011-01-01

    The present study compared the gross motor skills of 7- to 12-year-old children with learning disabilities (n = 104) with those of age-matched typically developing children (n = 104) using the Test of Gross Motor Development-2. Additionally, the specific relationships between subsets of gross motor

  5. 26 CFR 1.872-1 - Gross income of nonresident alien individuals.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Gross income of nonresident alien individuals. 1...) INCOME TAX (CONTINUED) INCOME TAXES Nonresident Aliens and Foreign Corporations § 1.872-1 Gross income of nonresident alien individuals. (a) In general—(1) Inclusions. The gross income of a nonresident...

  6. 26 CFR 20.2031-1 - Definition of gross estate; valuation of property.

    Science.gov (United States)

    2010-04-01

    ..., except that if the executor elects the alternate valuation method under section 2032, it is the fair... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Definition of gross estate; valuation of... § 20.2031-1 Definition of gross estate; valuation of property. (a) Definition of gross estate. Except...

  7. 26 CFR 1.924(a)-1T - Temporary regulations; definition of foreign trading gross receipts.

    Science.gov (United States)

    2010-04-01

    ... trading gross receipts. 1.924(a)-1T Section 1.924(a)-1T Internal Revenue INTERNAL REVENUE SERVICE... United States § 1.924(a)-1T Temporary regulations; definition of foreign trading gross receipts. (a) In general. The term “foreign trading gross receipts” means any of the five amounts described in...

  8. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors.

    Science.gov (United States)

    Englot, Dario J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-01-01

    Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low-grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor-related epilepsy significantly affects patients' quality-of-life. We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables. Overall, 80% of patients were seizure-free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II-IV). We observed significantly higher rates of seizure-freedom in patients with ≤1 year duration of epilepsy compared to those with >1 year of seizures [odds ratio (OR) 9.48; 95% confidence interval (CI) 2.26-39.66], and with gross-total resection over subtotal lesionectomy (OR 5.34; 95% CI 3.61-7.89). In addition, the presence of secondarily generalized seizures preoperatively predicted a lower rate of seizure-freedom after surgery (OR 0.40; 95% CI 0.24-0.66). Outcomes did not differ significantly between adults and children, patients with temporal lobe versus extratemporal tumors, pathologic diagnosis of GG versus DNET, medically controlled versus refractory seizures, or with the use of electrocorticography (ECoG). Extended resection of temporal lobe tumors, with hippocampectomy and/or corticectomy, conferred additional benefit. These results suggest that early operative intervention and gross-total resection are critically important factors in achieving seizure-freedom, and thus improving quality-of-life, in patients with glioneuronal tumors causing epilepsy. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  9. Determinants of gross motor skill performance in children with visual impairments.

    Science.gov (United States)

    Haibach, Pamela S; Wagner, Matthias O; Lieberman, Lauren J

    2014-10-01

    Children with visual impairments (CWVI) generally perform poorer in gross motor skills when compared with their sighted peers. This study examined the influence of age, sex, and severity of visual impairment upon locomotor and object control skills in CWVI. Participants included 100 CWVI from across the United States who completed the Test of Gross Motor Development II (TGMD-II). The TGMD-II consists of 12 gross motor skills including 6 object control skills (catching, kicking, striking, dribbling, throwing, and rolling) and 6 locomotor skills (running, sliding, galloping, leaping, jumping, and hopping). The full range of visual impairments according to United States Association for Blind Athletes (USABA; B3=20/200-20/599, legally blind; B2=20/600 and up, travel vision; B1=totally blind) were assessed. The B1 group performed significantly worse than the B2 (0.000 ≤ p ≤ 0.049) or B3 groups (0.000 ≤ p ≤ 0.005); however, there were no significant differences between B2 and B3 except for the run (p=0.006), catch (p=0.000), and throw (p=0.012). Age and sex did not play an important role in most of the skills, with the exception of boys outperforming girls striking (p=0.009), dribbling (p=0.013), and throwing (p=0.000), and older children outperforming younger children in dribbling (p=0.002). The significant impact of the severity of visual impairment is likely due to decreased experiences and opportunities for children with more severe visual impairments. In addition, it is likely that these reduced experiences explain the lack of age-related differences in the CWVI. The large disparities in performance between children who are blind and their partially sighted peers give direction for instruction and future research. In addition, there is a critical need for intentional and specific instruction on motor skills at a younger age to enable CWVI to develop their gross motor skills.

  10. Improved gross efficiency during long duration submaximal cycling following a short-term high carbohydrate diet.

    Science.gov (United States)

    Cole, M; Coleman, D; Hopker, J; Wiles, J

    2014-03-01

    To assess the effect of dietary manipulation on gross efficiency (GE), 15 trained male cyclists completed 3×2 h tests at submaximal exercise intensity (60% Maximal Minute Power). Using a randomized, crossover design participants consumed an isoenergetic diet (~4 000 kcal.day-1) in the 3 days preceding each test, that was either high in carbohydrate (HighCHO, [70% of the total energy derived from carbohydrate, 20% fat, 10% protein]), low in carbohydrate (LowCHO, [70% fat, 20% carbohydrate, 10% protein]) or contained a moderate amount of carbohydrate (ModCHO, [45% carbohydrate, 45% fat, 10% protein]). GE along with blood lactate and glucose were assessed every 30 min, and heart rate was measured at 5 s intervals throughout. Mean GE was significantly greater following the HighCHO than the ModCHO diet (HighCHO=20.4%±0.1%, ModCHO=19.6±0.2%; PDiet had no effect on blood glucose or lactate (P>0.05). This study suggests that before the measurement of gross efficiency, participants' diet should be controlled and monitored to ensure the validity of the results obtained.

  11. Gross and fine motor function in fibromyalgia and chronic fatigue syndrome

    Science.gov (United States)

    Rasouli, Omid; Fors, Egil A; Borchgrevink, Petter Chr; Öhberg, Fredrik; Stensdotter, Ann-Katrin

    2017-01-01

    Purpose This paper aimed to investigate motor proficiency in fine and gross motor function, with a focus on reaction time (RT) and movement skill, in patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS) compared to healthy controls (HC). Methods A total of 60 individuals (20 CFS, 20 FM, and 20 HC), age 19–49 years, participated in this study. Gross motor function in the lower extremity was assessed using a RT task during gait initiation in response to an auditory trigger. Fine motor function in the upper extremity was measured during a precision task (the Purdue Pegboard test) where the number of pins inserted within 30 s was counted. Results No significant differences were found between FM and CFS in any parameters. FM and CFS groups had significantly longer RT than HC in the gait initiation (p=0.001, and p=0.004 respectively). In the Purdue Pegboard test, 20% in the FM group, 15% in the CFS groups, and 0% of HC group, scored below the threshold of the accepted performance. However, there were no significant differences between FM, CFS, and HC in this task (p=0.12). Conclusion Compared to controls, both CFS and FM groups displayed significantly longer RT in the gait initiation task. Generally, FM patients showed the worst results in both tests, although no group differences were found in fine motor control, according to the Purdue Pegboard test. PMID:28223840

  12. [Surgical tactics by various ameloblastic tumors].

    Science.gov (United States)

    Semkin, V A; Grigor'ian, A S; Babichenko, I I; Usachev, E S; Zaretskaia, A S

    2012-01-01

    Ameloblastoma and ameloblastic fibroma are benign odontogenous tumors of the jaws with local destructive growth, prone to recurrence. They have various typical radiological and histological features. Surgical tactic generally includes partial resection of the affected jaw. Immunohistochemical study of the tumor tissues allows assessing the expression of tumor progression markers and forecasting tumor growth thus providing individual choice of surgical tactics. Our experience in treatment of ameloblastic tumors showed total biopsy with osseous surgical margins resection to be sufficient for normal bone structure remodeling in some patients.

  13. The response of gross nitrogen mineralization to labile carbon inputs

    Science.gov (United States)

    Bengtson, Per

    2014-05-01

    Input of labile carbon sources to forest soils commonly result in priming, i.e. an increase in the microbial decomposition of soil organic matter. Efforts aimed at quantifying the extent of priming have, to date, largely focused on soil organic matter decomposition manifested as soil respiration. Less is known about how gross nitrogen mineralization responds to input of labile carbon. It is often assumed that increased priming results in decreased soil carbon stocks. However, microbial mineralization of organic nitrogen into plant available forms is a major factor limiting primary production in forests. If increased decomposition of soil organic matter in response to labile carbon is accompanied by a concurrent increased nitrogen mineralization, this could result in elevated primary production and higher rates of plant derived organic matter input to soils. Therefore, in order to fully understand the effect of priming on net ecosystem exchange and soil carbon stocks, it is vital to consider if increased decomposition of soil organic matter caused by priming also results in increased nitrogen mineralization. Here I present the results from a series of experiments aimed at determining if, and to which extent, gross nitrogen mineralization is stimulated by input of labile carbon. The results suggest that it is by no means uncommon to find an increase in gross N mineralization rates in response to labile carbon inputs. The magnitude of the increase seems dependent on the nitrogen status of the soil, as well as the concentration and rate of labile carbon inputs. However, continuous input of labile carbon sources that also contains nitrogen, e.g. amino acids, seems to inhibit rather than increase the mineralization of organic nitrogen. These findings suggest that there is a potential for a positive feedback between priming and primary production that needs to be considered in order to fully understand the influence of priming on net ecosystem exchange and soil carbon

  14. The Schroedinger functional for Gross-Neveu models

    Energy Technology Data Exchange (ETDEWEB)

    Leder, B.

    2007-04-18

    Gross-Neveu type models with a finite number of fermion flavours are studied on a two-dimensional Euclidean space-time lattice. The models are asymptotically free and are invariant under a chiral symmetry. These similarities to QCD make them perfect benchmark systems for fermion actions used in large scale lattice QCD computations. The Schroedinger functional for the Gross-Neveu models is defined for both, Wilson and Ginsparg-Wilson fermions, and shown to be renormalisable in 1-loop lattice perturbation theory. In two dimensions four fermion interactions of the Gross-Neveu models have dimensionless coupling constants. The symmetry properties of the four fermion interaction terms and the relations among them are discussed. For Wilson fermions chiral symmetry is explicitly broken and additional terms must be included in the action. Chiral symmetry is restored up to cut-off effects by tuning the bare mass and one of the couplings. The critical mass and the symmetry restoring coupling are computed to second order in lattice perturbation theory. This result is used in the 1-loop computation of the renormalised couplings and the associated beta-functions. The renormalised couplings are defined in terms of suitable boundary-to-boundary correlation functions. In the computation the known first order coefficients of the beta-functions are reproduced. One of the couplings is found to have a vanishing betafunction. The calculation is repeated for the recently proposed Schroedinger functional with exact chiral symmetry, i.e. Ginsparg-Wilson fermions. The renormalisation pattern is found to be the same as in the Wilson case. Using the regularisation dependent finite part of the renormalised couplings, the ratio of the Lambda-parameters is computed. (orig.)

  15. Verbal priming and taste sensitivity make moral transgressions gross.

    Science.gov (United States)

    Herz, Rachel S

    2014-02-01

    The aims of the present study were to assess whether: (a) visceral and moral disgust share a common oral origin (taste); (b) moral transgressions that are also viscerally involving are evaluated accordingly as a function of individual differences in taste sensitivity; (c) verbal priming interacts with taste sensitivity to alter how disgust is experienced in moral transgressions; and (d) whether gender moderates these effects. Standard tests of disgust sensitivity, a questionnaire developed for this research assessing different types of moral transgressions (nonvisceral, implied-visceral, visceral) with the terms "angry" and "grossed-out," and a taste sensitivity test of 6-n-propylthiouracil (PROP) were administered to 102 participants. Results confirmed past findings that the more sensitive to PROP a participant was the more disgusted they were by visceral, but not moral, disgust elicitors. Importantly, the findings newly revealed that taste sensitivity had no bearing on evaluations of moral transgressions, regardless of their visceral nature, when "angry" was the emotion primed. However, when "grossed-out" was primed for evaluating moral violations, the more intense PROP tasted to a participant the more "grossed-out" they were by all transgressions. Women were generally more disgust sensitive and morally condemning than men, but disgust test, transgression type, and priming scale modulated these effects. The present findings support the proposition that moral and visceral disgust do not share a common oral origin, but show that linguistic priming can transform a moral transgression into a viscerally repulsive event and that susceptibility to this priming varies as a function of an individual's sensitivity to the origins of visceral disgust-bitter taste.

  16. Four loop renormalization of the Gross-Neveu model

    CERN Document Server

    Gracey, J A; Schroder, Y

    2016-01-01

    We renormalize the SU(N) Gross-Neveu model in the modified minimal subtraction (MSbar) scheme at four loops and determine the beta-function at this order. The theory ceases to be multiplicatively renormalizable when dimensionally regularized due to the generation of evanescent 4-fermi operators. The first of these appears at three loops and we correctly take their effect into account in deriving the renormalization group functions. We use the results to provide estimates of critical exponents relevant to phase transitions in graphene.

  17. Gross shell structure at high spin in heavy nuclei

    CERN Document Server

    Deleplanque, M A; Pashkevich, V V; Chu, S Y; Unzhakova, A

    2004-01-01

    Experimental nuclear moments of inertia at high spins along the yrast line have been determined systematically and found to differ from the rigid-body values. The difference is attributed to shell effects and these have been calculated microscopically. The data and quantal calculations are interpreted by means of the semiclassical Periodic Orbit Theory. From this new perspective, features in the moments of inertia as a function of neutron number and spin, as well as their relation to the shell energies can be understood. Gross shell effects persist up to the highest angular momenta observed.

  18. Labor Absorption and Its Impact on Gross Regional Domestic Product

    OpenAIRE

    Made Ika Prastyadewi; Agus Suman; Devanto Shasta Pratomo

    2013-01-01

    The objective of this study is to examine the determinants of labor absorption in the trade, hotel and restaurant sector and its impact on Gross Regional Domestic Product/GRDP at Bali Province. This study is important due to the fact that the GRDP in this sector is the highest compared to other sector but the labor absorption is lower than the agriculture sector. This study used panel data comprising 9 regencies/cities at Bali Province in the period 2003-2009 including fixed effect model and ...

  19. Characterizing the development of sectoral gross domestic product composition.

    Science.gov (United States)

    Lutz, Raphael; Spies, Michael; Reusser, Dominik E; Kropp, Jürgen P; Rybski, Diego

    2013-07-01

    We consider the sectoral composition of a country's gross domestic product (GDP), i.e., the partitioning into agrarian, industrial, and service sectors. Exploring a simple system of differential equations, we characterize the transfer of GDP shares between the sectors in the course of economic development. The model fits for the majority of countries providing four country-specific parameters. Relating the agrarian with the industrial sector, a data collapse over all countries and all years supports the applicability of our approach. Depending on the parameter ranges, country development exhibits different transfer properties. Most countries follow three of eight characteristic paths. The types are not random but show distinct geographic and development patterns.

  20. Gross shell structure at high spin in heavy nuclei

    Energy Technology Data Exchange (ETDEWEB)

    Deleplanque, Marie-Agnes; Frauendorf, Stefan; Pashkevich, Vitaly V.; Chu, S.Y.; Unzhakova, Anja

    2003-10-07

    Experimental nuclear moments of inertia at high spins along the yrast line have been determined systematically and found to differ from the rigid-body values. The difference is attributed to shell effect and these have been calculated microscopically. The data and quantal calculations are interpreted by means of the semiclassical Periodic Orbit Theory. From this new perspective, features in the moments of inertia as a function of neutron number and spin, as well as their relation to the shell energies can be understood. Gross shell effects persist up to the highest angular momenta observed.

  1. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría

    2014-10-01

    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  2. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  3. Surgical travellers: tapestry to Bayeux.

    Science.gov (United States)

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  4. Surgical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Stavros Gourgiotis; Stylianos Germanos; Marco Pericoli Ridolifni

    2007-01-01

    BACKGROUND:Treatment of chronic pancreatitis (CP) is a challenging condition for surgeons. During the last decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and integration of sophisticated diagnostic methods in clinical practice have resulted in signiifcant changes in surgery for CP. DATA SOURCES:To detail the indications for CP surgery, the surgical procedures, and outcome, a Pubmed database search was performed. The abstracts of searched articles about surgical management of CP were reviewed. The articles could be identiifed and further scrutinized. Further references were extracted by cross-referencing. RESULTS: Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Non-pancreatic and endoscopic management of pain has also been advocated. CONCLUSIONS:Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. In addition to available results from randomized controlled trials, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

  5. Surgical considerations about amyloid goiter.

    Science.gov (United States)

    García Villanueva, Augusto; García Villanueva, María Jesús; García Villanueva, Mercedes; Rojo Blanco, Roberto; Collado Guirao, María Vicenta; Cabañas Montero, Jacobo; Beni Pérez, Rafael; Moreno Montes, Irene

    2013-05-01

    Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.

  6. The implications of particle energy and acidic media on gross alpha and gross beta determination using liquid scintillation

    Energy Technology Data Exchange (ETDEWEB)

    Zapata-Garcia, D. [Laboratori de Radiologia Ambiental (LRA), Departament de Quimica Analitica, Universitat de Barcelona, Marti i Franques, 1-11 Planta 3, E-08028 Barcelona (Spain); Llaurado, M., E-mail: montse.llaurado@ub.edu [Laboratori de Radiologia Ambiental (LRA), Departament de Quimica Analitica, Universitat de Barcelona, Marti i Franques, 1-11 Planta 3, E-08028 Barcelona (Spain); Rauret, G. [Laboratori de Radiologia Ambiental (LRA), Departament de Quimica Analitica, Universitat de Barcelona, Marti i Franques, 1-11 Planta 3, E-08028 Barcelona (Spain)

    2012-04-15

    The interaction of humans with radioactivity present in the environment from natural and artificial sources necessitates an evaluation of its risk on human health. Gross alpha and gross beta activities can provide a rapid evaluation of the radioactive content of a sample and can be simultaneously determined by using liquid scintillation counters. However, calibration of the liquid scintillation counter is required and is affected by many factors, such as particle energy and the acidity of the media. This study investigates what effect the particle energy used for calibration has on misclassification and how to account for this misclassification in routine measurements. The variability in measurement produced by the final pH, as well as any acids used in sample treatment, was also studied. These results showed that the most commonly used acid for these types of analyses, HNO{sub 3}, produced a high amount of misclassifications at very low pH. The results improved when HCl was used to adjust the sample to low pH. - Highlights: Black-Right-Pointing-Pointer We study the effect of alpha and beta energies on PSA optimisation. Black-Right-Pointing-Pointer The optimum PSA shifts to higher values as the alpha energy increases. Beta energies do not affect it. Black-Right-Pointing-Pointer We study the effect of pH on the simultaneous determination of gross alpha/beta activities. Black-Right-Pointing-Pointer HNO{sub 3} produces a high amount of misclassification at very low pH. Black-Right-Pointing-Pointer The results improve when HCl is used to adjust the sample to low pH.

  7. Surgical ethics and the challenge of surgical innovation.

    Science.gov (United States)

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  8. Totally ossified metaplastic spinal meningioma.

    Science.gov (United States)

    Ju, Chang Il; Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

    2013-09-01

    A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma.

  9. Analysis of the Total Surgical Cardiac Denervation by Computer Simulation

    Science.gov (United States)

    2007-11-02

    filtration rate and increase vasopressin, plasma renin activity, angiotensin II and aldosteron” [2][3]. It is claimed that these effects weaken...CE: Chemoreceptor Effect OSR: Autonomous System Resp. CK: Potassium Concent PPC: Plasma Osmotic Pressure CNa: Sodium Concentration RAP: Right...receptors respond to hypervolemia by supressing vasopressin, renin - angiotensin-aldosteron axis, thirst and sympathetic traffic to the kidney

  10. Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

    OpenAIRE

    T. Grau; J. Carlos Ruiz de Adana; S. Zubillaga; S. Fuerte; C. Girón

    2003-01-01

    Objetivo: Las infusiones lipídicas de una mezcla física de triglicéridos de cadena media/triglicéridos de cadena larga (MCT/LCT), utilizadas en la nutrición parenteral total (NPT) peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente triglicéridos de cadena larga (LCT). El objetivo de este estudio fue comparar la incidencia de infecciones nosocomiales y la mortalidad hospitalaria de los pacientes quirúrgicos severamente desnut...

  11. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  12. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  13. Incidence of gross reproductive abnormalities in small east African zebu cattle.

    Science.gov (United States)

    Assey, R J; Kessy, B M; Matovelo, J A; Minga, U

    1998-12-01

    Reproductive organs from mature Small East African zebu (SEAZ) heifers and cows slaughtered at the Morogoro abattoir were collected twice a month and evaluated over a period of 12 months. Out of the 402 animals from which reproductive organs were taken, 54% were pregnant, 24% were actively cycling and 22% were non-cycling. Various gross abnormalities were observed in the reproductive organs of about 16% of the cattle, and the major reproductive abnormality in both total and the non-cycling animals was various degrees of fibrous adhesion between the ovary and the infundibulum and mesosalpinx. It is concluded that, contrary to common belief, a majority of the female SEAZ cattle that are slaughtered are fertile.

  14. [Gross morphometry of young Geochelone sulcata (Testudines: Testudinidae) in Costa Rica].

    Science.gov (United States)

    Merchán, Manuel; Coll, Marta; Fournier, Raúl

    2005-01-01

    The African Spur tortoise, Geochelone sulcata, has been introduced to Costa Rica. A total of 31 tortoises were measured for 26 gross morphometry parameters. All individuals measured were inmature, aged from 5 to 34 months, and were born in captivity in La Garita de Alajuela, Costa Rica. Mean straight carapace length was 83.1 mm, mean straight plastron length was 68.3 mm and mean maximum height was 46.2 mm. All the measurements were correlated, except tail length and cloacal distance. Weight had the highest positive allometry coefficient. All the variables were joined in two Principal Components; tail length and cloacal distance in Factor 2 and the rest of them in Factor 1. Lack of correlation among tail measures and the other variables as well as their inclusion in a different Factor could be related with an incipient development of sexual dimorphism characters.

  15. The natural radioactivity in water by gross alpha and beta measurements

    Energy Technology Data Exchange (ETDEWEB)

    Bonotto, D.M. [Departamento de Petrologia e Metalogenia, Universidade Estadual Paulista (UNESP), Av. 24-A No. 1515, C.P. 178, CEP 13506-900, Rio Claro, SP (Brazil)], E-mail: danielbonotto@yahoo.com.br; Bueno, T.O.; Tessari, B.W.; Silva, A. [Departamento de Petrologia e Metalogenia, Universidade Estadual Paulista (UNESP), Av. 24-A No. 1515, C.P. 178, CEP 13506-900, Rio Claro, SP (Brazil)

    2009-01-15

    An alternative method for evaluating gross alpha and beta radioactivity in water was developed by performing alpha counting using a surface barrier detector and gamma- ray spectrometry using a NaI(Tl) scintillation detector. Several experiments were realized under controlled conditions in the laboratory with the aim of establishing adequate calibration of the systems utilized for performing activity concentration measurements in water samples of variable salinity. Groundwater samples collected at several spas in Sao Paulo and Minas Gerais States in Brazil were submitted to the developed technique in order to assure its applicability in waters characterized by different Total Dissolved Solids content. The values obtained were compatible with the previous knowledge of the radioactivity of the studied water sources, thus indicating the reliability and usefulness of the method for generating information on investigations focusing environmental aspects and/or the evaluation of the drinking water quality in terms of radiological aspects.

  16. Evolution of a superfluid vortex filament tangle driven by the Gross-Pitaevskii equation

    CERN Document Server

    Villois, Alberto; Krstulovic, Giorgio

    2016-01-01

    The development and decay of a turbulent vortex tangle driven by the Gross-Pitaevskii equation is studied. Using a recently-developed accurate and robust tracking algorithm, all quantised vortices are extracted from the fields. The Vinen's decay law for the total vortex length with a coefficient that is in quantitative agreement with the values measured in Helium II is observed. The topology of the tangle is then studied showing that linked rings may appear during the decay. The tracking also allows for determining the statistics of small-scales quantities of vortex lines, exhibiting large fluctuations of curvature and torsion. Finally, the temporal evolution of the Kelvin wave spectrum is obtained providing evidence of the development of a weak-wave turbulence cascade.

  17. Global Dental Research Productivity and Its Association With Human Development, Gross National Income, and Political Stability.

    Science.gov (United States)

    Allareddy, Veerasathpurush; Allareddy, Veeratrishul; Rampa, Sankeerth; Nalliah, Romesh P; Elangovan, Satheesh

    2015-09-01

    The objective of this study is to examine the associations between country level factors (such as human development, economic productivity, and political stability) and their dental research productivity. This study is a cross-sectional analysis of bibliometric data from Scopus search engine. Human Development Index (HDI), Gross National Income per capita (GNI), and Failed State Index measures were the independent variables. Outcomes were "Total number of publications (articles or articles in press) in the field of dentistry" and "Total number of publications in the field of dentistry per million population." Non-parametric tests were used to examine the association between the independent and outcome variables. During the year 2013, a total of 11,952 dental research articles were published across the world. The top 5 publishing countries were United States, Brazil, India, Japan, and United Kingdom. "Very High" HDI countries had significantly higher number of total dental research articles and dental research articles per million population when compared to the "High HDI," "Medium HDI," and "Low HDI" countries (p human development and economic development of a country are linearly correlated with dental research productivity. Dental research productivity also increases with increasing political stability of a country. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Surgical management of medically refractory epilepsy in patients with polymicrogyria

    Science.gov (United States)

    Wang, Doris D.; Knox, Renatta; Rolston, John D.; Englot, Dario J.; Barkovich, A. James; Tihan, Tarik; Auguste, Kurtis I.; Knowlton, Robert C.; Cornes, Susannah B.; Chang, Edward F.

    2017-01-01

    Objective Polymicrogyria (PMG) is a malformation of cortical development characterized by formation of an excessive number of small gyri. Sixty percent to 85% of patients with PMG have epilepsy that is refractory to medication, but surgical options are usually limited. We characterize a cohort of patient with polymicrogyria who underwent epilepsy surgery and document seizure outcomes. Methods A retrospective study of all patients with PMG who underwent epilepsy surgery (focal seizure foci resection and/or hemispherectomy) at our center was performed by review of all clinical data related to their treatment. Results We identified 12 patients (7 males and 5 female) with mean age of 18 (ranging from 3 months to 44 years) at time of surgery. Mean age at seizure onset was 8 years, with the majority (83%) having childhood onset. Six patients had focal, five had multifocal, and one patient had diffuse PMG. Perisylvian PMG was the most common pattern seen on magnetic resonance imaging (MRI). Eight patients had other cortical malformations including hemimegalencephaly and cortical dysplasia. Scalp electroencephalography (EEG) often showed diffuse epileptic discharges that poorly lateralized but were focal on intracranial electrocorticography (ECoG). Eight patients underwent seizure foci resection and four underwent hemispherectomy. Mean follow-up was 7 years (ranging from one to 19 years). Six patients (50%) were seizure-free at last follow-up. One patient had rare seizures (Engel class II). Three patients were Engel class III, having either decreased seizure frequency or severity, and two patients were Engel class IV. Gross total resection of the PMG cortex trended toward good seizure control. Significance Our study shows that even in patients with extensive or bilateral PMG malformations, some may still be good candidates for surgery because the epileptogenic zone may involve only a portion of the malformation. Intracranial ECoG can provide additional localizing

  19. Gross Motor Profile and Its Association with Socialization Skills in Children with Autism Spectrum Disorders.

    Science.gov (United States)

    Pusponegoro, Hardiono D; Efar, Pustika; Soedjatmiko; Soebadi, Amanda; Firmansyah, Agus; Chen, Hui-Ju; Hung, Kun-Long

    2016-12-01

    While social impairment is considered to be the core deficit in children with autism spectrum disorder (ASD), a large proportion of these children have poor gross motor ability, and gross motor deficits may influence socialization skills in children with ASD. The objectives of this study were to compare gross motor skills in children with ASD to typically developing children, to describe gross motor problems in children with ASD, and to investigate associations between gross motor and socialization skills in children with ASD. This was a cross-sectional study including 40 ASD children aged from 18 months to 6 years and 40 age-matched typically developing controls. Gross motor and socialization skills were scored using the Vineland Adaptive Behavior Scales, 2(nd) edition (Vineland-II). Below average gross motor function was found in eight of 40 (20%) ASD children. The mean gross motor v-scale score in the ASD group was 15.1 [standard deviation (SD) 3.12], significantly lower than in the control group [18.7, SD 2.09, p = 0.0001; 95% confidence intervals (CI) from -4.725 to -2.525]. The differences were most prominent in ball throwing and catching, using stairs, jumping, and bicycling. The ASD children with gross motor impairments had a mean socialization domain score of 66.6 (SD 6.50) compared to 85.7 (SD 10.90) in those without gross motor impairments (p = 0.0001, 95% CI from -25.327 to -12.736). Children with ASD had lower gross motor skills compared to typically developing children. Gross motor impairments were found in 20% of the ASD children, and these children also had lower socialization skills than those without gross motor impairments. Copyright © 2016. Published by Elsevier B.V.

  20. Surgical smoke in dermatologic surgery.

    Science.gov (United States)

    Oganesyan, Gagik; Eimpunth, Sasima; Kim, Silvia Soohyun; Jiang, Shang I Brian

    2014-12-01

    Potential dangers associated with smoke generated during electrosurgery have been described. However, the use of smoke management in dermatology is unknown. There is no objective data showing the amount or the composition of the smoke generated in dermatologic surgeries. To assess the use of smoke management in dermatologic surgery and provide data on the amount and chemical composition of surgical smoke. A total of 997 surveys were sent to dermatologic surgeons across the United States to assess the use of smoke management. Amounts and concentrations of particulates and chemical composition were measured during electrosurgery using a particulate meter and the Environmental Protection Agency-standardized gas chromatography-mass spectrometry analysis. Thirty-two percent of the surgeons responded to the survey, and 77% of the respondents indicated no use of smoke management at all. Only approximately 10% of surgeons reported consistent use of smoke management. Active electrosurgery produced significant amounts of particulates. In addition, surgical smoke contained high concentrations of known carcinogens, such as benzene, butadiene, and acetonitrile. Surgical smoke contains toxic compounds and particulates. Most dermatologic surgeons do not use smoke management within their practices. Raising the awareness of the potential risks can help increase the use of smoke management.

  1. Optimal Bilinear Control of Gross--Pitaevskii Equations

    KAUST Repository

    Hintermüller, Michael

    2013-01-01

    A mathematical framework for optimal bilinear control of nonlinear Schrödinger equations of Gross--Pitaevskii type arising in the description of Bose--Einstein condensates is presented. The obtained results generalize earlier efforts found in the literature in several aspects. In particular, the cost induced by the physical workload over the control process is taken into account rather than the often used L^2- or H^1-norms for the cost of the control action. Well-posedness of the problem and existence of an optimal control are proved. In addition, the first order optimality system is rigorously derived. Also a numerical solution method is proposed, which is based on a Newton-type iteration, and used to solve several coherent quantum control problems.

  2. Gross National Happiness: Ideology versus practices in Bhutanese Seconday Schools

    DEFF Research Database (Denmark)

    Kjær-Rasmussen, Lone Krogh; Giri, Krishna Prasad

    2015-01-01

    This paper investigates practices related to the ideology of infusing Gross National Happiness (GNH) into school curriculum, the effectiveness of the meditation and mind training and the implication of GNH for school environment. It also explores how GNH ambience has been managed and practiced......, the influence of the concept of GNH in school life generally and specifically and the effects on teachers and students of mindfull training in the class, how does it work? The investigation is based on empirical data from eight selected secondary schools spread all over Bhutan. Principals, teachers, students...... and parents were interviewed in 2012/2013 individually and in groups. Further more classroom observations took place. Finally the investigation is based on literature review and readings of documents, which describe and analyse policies, principles, strategies and philosophies related to the implementation...

  3. Measurement and Quantification of Gross Human Shoulder Motion

    Directory of Open Access Journals (Sweden)

    Jeremy T. Newkirk

    2013-01-01

    Full Text Available The shoulder girdle plays an important role in the large pointing workspace that humans enjoy. The goal of this work was to characterize the human shoulder girdle motion in relation to the arm. The overall motion of the human shoulder girdle was characterized based on motion studies completed on test subjects during voluntary (natural/unforced motion. The collected data from the experiments were used to develop surface fit equations that represent the position and orientation of the glenohumeral joint for a given humeral pointing direction. These equations completely quantify gross human shoulder girdle motion relative to the humerus. The equations are presented along with goodness-of-fit results that indicate the equations well approximate the motion of the human glenohumeral joint. This is the first time the motion has been quantified for the entire workspace, and the equations provide a reference against which to compare future work.

  4. Labor Absorption and Its Impact on Gross Regional Domestic Product

    Directory of Open Access Journals (Sweden)

    Made Ika Prastyadewi

    2013-12-01

    Full Text Available The objective of this study is to examine the determinants of labor absorption in the trade, hotel and restaurant sector and its impact on Gross Regional Domestic Product/GRDP at Bali Province. This study is important due to the fact that the GRDP in this sector is the highest compared to other sector but the labor absorption is lower than the agriculture sector. This study used panel data comprising 9 regencies/cities at Bali Province in the period 2003-2009 including fixed effect model and simultaneous equation model of Two-Stage Least Square. The results showed that GRDP, working age population, and the minimum wage have positive effect on employment, while the educated unemployment has no significant effect on the employment in the trade, hotel and restaurant sector. In addition, increases in employment and workers productivity have positive and significant effects the GRDP in the trade, hotel and restaurant sector at Bali Province.

  5. Specific features of measuring the ecologically adjusted gross regional product

    Directory of Open Access Journals (Sweden)

    Douginets Ganna V.

    2013-03-01

    Full Text Available The article formulates a necessity of deepening and improvement of ecological and economic indicators and considers the existing indices and indicators of sustainable development. It conducts a comparative analysis of existing norms of calculation of the ecological tax and fees for environmental pollution. It marks main problems of nature management in Ukraine and their consequences, namely, negative impact on health of the population. It offers methods of measurement of the ecologically adjusted gross regional product (EGRP on the basis of improvement of the cost method. It analyses dependence of the regional welfare on the state of environment with the help of measuring the EGRP of Ukrainian regions. It studies the pressure on Ukrainian regions by components: pollution of aquatic environment, atmospheric air, land resources and rates of waste formation. It conducts grouping of regions by EGRP per capita with specification of positive and negative dynamics of the indicator.

  6. Stimulation of gross dimethylsulfide (DMS) production by solar radiation

    Science.gov (United States)

    Galí, Martí; Saló, Violeta; Almeda, Rodrigo; Calbet, Albert; Simó, Rafel

    2011-08-01

    Oceanic gross DMS production (GP) exerts a fundamental control on the concentration and the sea-air flux of this climatically-active trace gas. However, it is a poorly constrained process, owing to the complexity of the microbial food web processes involved and their interplay with physical forcing, particularly with solar radiation. The “inhibitor method”, using dimethyldisulfide (DMDS) or other compounds to inhibit bacterial DMS consumption, has been frequently used to determine GP in dark incubations. In the work presented here, DMDS addition was optimized for its use in light incubations. By comparing simultaneous dark and light measurements of GP in meso- to ultraoligotrophic waters, we found a significant enhancement of GP in natural sunlight in 7 out of 10 experiments. Such stimulation, which was generally between 30 and 80% on a daily basis, occurred throughout contrasting microbial communities and oceanographic settings.

  7. Full Phase Diagram of the Massive Gross-Neveu Model

    CERN Document Server

    Schnetz, O; Urlichs, K; Schnetz, Oliver; Thies, Michael; Urlichs, Konrad

    2006-01-01

    The massive Gross-Neveu model is solved in the large N limit at finite temperature and chemical potential. The scalar potential is given in terms of Jacobi elliptic functions. It contains three parameters which are determined by transcendental equations. Self-consistency of the scalar potential is proved. The phase diagram for non-zero bare quark mass is found to contain a kink-antikink crystal phase as well as a massive fermion gas phase featuring a cross-over from light to heavy effective fermion mass. For zero bare quark mass we recover the three known phases kink-antikink crystal, massless fermion gas, and massive fermion gas. All phase transitions are shown to be of second order. Equations for the phase boundaries are given and solved numerically. Implications on condensed matter physics are indicated where our results generalize the bipolaron lattice in non-degenerate conducting polymers to finite temperature.

  8. Lesson plans in surgical training.

    Science.gov (United States)

    Lester, S E; Robson, A K R

    2007-06-01

    Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments. Lesson plans are individualised to the trainee and encourage ownership of learning. They are based on SMART criteria and therefore have a sound educational footing. Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min. Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees.

  9. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  10. Morphometric Identification, Gross and Histopathological Lesions of Eimeria Species in Japanese Quails (Coturnix coturnix japonica in Zaria, Nigeria

    Directory of Open Access Journals (Sweden)

    H. A. Umar

    2014-01-01

    Full Text Available The objective of the study was to identify the species, gross and histopathological lesions of Eimeria in Japanese quails in Zaria. A total of 400 fresh faecal samples were collected and 10 quail birds were purchased from a quail farm. The faecal samples were processed using simple floatation technique. Oocysts shape indices of sporulated oocysts were determined. The intestines were observed for gross lesions and segments were analyzed using Giemsa stain and Haematoxylin and Eosin stain and then observed microscopically for the developmental stages of the parasite. Four species of Eimeria were identified in the study. Eimeria bateri of shape index of 1.36 conformed to the guidelines used while the other three Eimeria species with shape indices of 1.48, 1.03, and 1.40 were not confirmed. The main gross lesion seen was nonhaemorrhagic ballooning of the caeca. Intestinal scrapping smear revealed a developmental stage of the parasite (merozoites in the jejunum. Histopathology also revealed a developmental stage (schizont of the parasite in the caecum and desquamation of the epithelial lining with areas of necrosis. Further study is required using molecular techniques to properly identify the unknown species of Eimeria that were detected in the study.

  11. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  12. Videolaparoscopic surgical interventions in emergency surgery

    Directory of Open Access Journals (Sweden)

    Сергей Николаевич Завгородний

    2016-03-01

    Full Text Available Aim: To improve the results of treatment of patients with emergency surgical pathology by the analysis of the use of videolaparoscopic surgical interventions.Methods: in the period 2012–2014 year in MI “Zaporozhye municipal clinical hospital of emergency” in the first surgical department on the base of subdepartment “General surgery with care for patients” of Zaporozhye state medical university were carried out 791 videolaparoscopic surgical interventions.508 (64,2 % women, 283 (35,8 % men. The mean age of patients was 48±2,1.The most videolaparoscopic operations were carried out at the acute appendicitis– 359 (45,5 %. Laparoscopic cholecystectomy at the acute cholecystitis was carried out in 157 patients (19,9 %. At the acute commissural intestinal obstruction were carried out 8 videolaparoscopic operations – (1 %. Videolaparoscopic drainage of abdominal cavity at the acute pancreatitis was carried out in 79 patients (10 %. At gynecological pathology were carried out 162 videolaparoscopic surgical interventions (20,6 % and in 26 patients (3,1 % was done diagnostic videolaparoscopy.Result: At the acute appendicitis were carried out 359 (45,5 % videolaparoscopic surgical interventions. There were no complications in postsurgical period. The mean bed-day was 6,8±0,7.Videolaparoscopy at the acute cholecistitis was carried out in 157 patients (19,9 %. In 17 (10,8 % was carried out conversion and surgical intervention was continued from laparotory access.At the commissure intestinal obstruction were carried out 8 surgical interventions (1,0 %. All patients underwent surgery after the short-term pre-surgical preparation. Conversion was carried out in 2 patients (25 %. In 1 (12,5 % was injured the loop of small intestine and in 1 (12,5 % took place the total commissure disease in abdominal cavity.Diagnostic laparoscopy was carried out in 26 patients (3,1 %, in two of them – at the close blunt trauma of the stomach

  13. A STUDY ON GROSS FEATURES AND DIFFERENT POSITIONS OF ADULTS VERMIFORM APPENDIX

    Directory of Open Access Journals (Sweden)

    Kasukurthy Ashalatha

    2016-07-01

    .8%. CONCLUSION The knowledge of anatomy of appendix is very important for thorough understanding of the pathology, signs, and symptoms of acute appendicitis. This study of different positions and gross features of vermiform appendix will be of great help to the surgeons when they do laparotomy and plan for further any surgical procedures.

  14. Single Epoch GPS Deformation Signals Extraction and Gross Error Detection Technique Based on Wavelet Transform

    Institute of Scientific and Technical Information of China (English)

    WANG Jian; GAO Jingxiang; XU Changhui

    2006-01-01

    Wavelet theory is efficient as an adequate tool for analyzing single epoch GPS deformation signal. Wavelet analysis technique on gross error detection and recovery is advanced. Criteria of wavelet function choosing and Mallat decomposition levels decision are discussed. An effective deformation signal extracting method is proposed, that is wavelet noise reduction technique considering gross error recovery, which combines wavelet multi-resolution gross error detection results. Time position recognizing of gross errors and their repairing performance are realized. In the experiment, compactly supported orthogonal wavelet with short support block is more efficient than the longer one when discerning gross errors, which can obtain more finely analyses. And the shape of discerned gross error of short support wavelet is simpler than that of the longer one. Meanwhile, the time scale is easier to identify.

  15. Guide to Surgical Specialists

    Science.gov (United States)

    ... have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of ... and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders ...

  16. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  17. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  18. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  19. Surgical site infections

    African Journals Online (AJOL)

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...

  20. Assessment of leaching loss estimates and gross load of nitrogen from arable land in Sweden

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, Markus (Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Soil Sciences)

    1999-01-01

    The focus of this thesis is on calculating N leaching loss estimates and gross loads of nitrogen. Calculations were done at two different scales, from field resolution in a small catchment to calculations at a large scale for the south and central part of Sweden. The latter study was initiated by Swedish commitments to international agreements concerning a decrease in N emissions to the Baltic Sea. Three of the papers deal with leaching of nitrogen in different periods: as it may have been in the 19[sup th] century, the current situation, and suggestions for a decrease with different countermeasures. The tools used in making these estimations were the SOIL/SOILN models. Calculations indicate that average N leaching was about the same in the 19[sup th] century as it is today at the end of the 20[sup th] century. The main reasons for high losses in the 19[sup th] century were high mineralisation rates in newly ploughed grassland, crop stress due to unfavourable conditions caused poor utilisation of N by crops, and large areas of bare fallow. N leaching was at its lowest in the 1930's due to larger N utilisation, a general termination of enhanced mineralisation and a large acreage of ley. Since then leaching has increased by on average about 60%, and more in the south of Sweden. Results also indicate that the draining of lakes has considerably decreased the retention capacity and is, along with the increase in gross load, one of the main causes of increased net load to the sea. A decrease in N leaching was estimated for the period 1985-1994. The decrease was mostly due to a smaller total area of arable land and an increase in the acreage of ley at the expense of cereals. The increase in the percentage of ley in the ten-year period (1985-1994) was the largest occurring in such a short time in the last 130 years in Sweden. Scenario calculations indicate that there is a potential for a decrease in the gross load of approximately 10 ktonnes from the current level of

  1. HOLISTIC APPROACH OF TEACHING OF GROSS PATHOLOGICAL SPECIMEN FOR 2ND PROFESSIONAL MBBS STUDENTS

    Directory of Open Access Journals (Sweden)

    Anupam

    2016-06-01

    Full Text Available BACKGROUND Study of pathological specimen is necessary for the students towards their practical (including viva as well as theoretical examinations. Past experiences show that most of the students of 2nd Professional MBBS cannot answer properly the questions related to the pathological specimen, especially the histopathological portion when asked by the examiners. This is due to the conventional method of teaching where students are given only didactic lectures on histopathological features, which is not convenient for students to understand the histopathology and related questions. AIMS To assess the impact of new teaching method of gross pathological specimen using visual aids (PowerPoint to show histopathology. MATERIALS AND METHODS Total 41 students present in 2nd Prof. MBBS were divided into 4 groups under the leadership of class assistants or demonstrators. 20 practical classes were arranged for 4 months of study period. In the first one hour, each group was shown power-point presentation of histopathological features, related questions and answers of the gross specimen to be studied. All the aspects were discussed simultaneously. In the next one hour, there was a joint teaching session consisting of all four groups, moderated by the concerned professor with PowerPoint projection. Assessment was done by three mock tests comprising of Viva, Multiple Choice Questions and Short Assay type Questions and a routine internal assessment in the last week of the study period. Then a comparison was made with regards to presence of students and results of successive three mock tests. Result of internal assessment was compared with that of previous two batches in which students were taught with only routine lectures on the same gross pathological specimen. RESULTS The use of new method increased the average attendance of students significantly. The percentage of passing students in the mock tests was very good. There was notable increase of passing

  2. Risk factors for surgical site infection of pilon fractures

    Directory of Open Access Journals (Sweden)

    Tingting Ren

    2015-06-01

    Full Text Available OBJECTIVES: Pilon fracture is a complex injury that is often associated with severe soft tissue damage and high rates of surgical site infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among patients undergoing surgical fixation of a pilon fracture. METHODS: The medical records of all pilon fracture patients who underwent surgical fixation from January 2010 to October 2012 were reviewed to identify those who developed a surgical site infection. Then, we constructed univariate and multivariate logistic regressions to evaluate the independent associations of potential risk factors with surgical site infection in patients undergoing surgical fixation of a pilon fracture. RESULTS: A total of 519 patients were enrolled in the study from January 2010 to October 2012. A total of 12 of the 519 patients developed a surgical site infection, for an incidence of 2.3%. These patients were followed for 12 to 29 months, with an average follow-up period of 19.1 months. In the final regression model, open fracture, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were significant risk factors for surgical site infection following surgical fixation of a pilon fracture. CONCLUSIONS: Open fractures, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were related to an increased risk for surgical site infection following surgical fixation of a pilon fracture. Patients exhibiting the risk factors identified in this study should be counseled regarding the possible surgical site infection that may develop after surgical fixation.

  3. Measuring gross and net calcification of a reef coral under ocean acidification conditions: methodological considerations

    Directory of Open Access Journals (Sweden)

    S. Cohen

    2012-07-01

    Full Text Available Ongoing ocean acidification (OA is rapidly altering carbonate chemistry in the oceans. The projected changes will likely have deleterious consequences for coral reefs by negatively affecting their growth. Nonetheless, diverse responses of reef-building corals calcification to OA hinder our ability to decipher reef susceptibility to elevated pCO2. Some of the inconsistencies between studies originate in measuring net calcification (NC, which does not always consider the proportions of the "real" (gross calcification (GC and gross dissolution in the observed response. Here we show that microcolonies of Stylophora pistillata (entirely covered by tissue, incubated under normal (8.2 and reduced (7.6 pH conditions for 16 months, survived and added new skeletal CaCO3, despite low (1.25 Ωarg conditions. Moreover, corals maintained their NC and GC rates under reduced (7.6 pH conditions and displayed positive NC rates at the low-end (7.3 pH treatment while bare coral skeleton underwent marked dissolution. Our findings suggest that S. pistillata may fall into the "low sensitivity" group with respect to OA and that their overlying tissue may be a key determinant in setting their tolerance to reduced pH by limiting dissolution and allowing them to calcify. This study is the first to measure GC and NC rates for a tropical scleractinian corals under OA conditions. We provide a detailed, realistic assessment of the problematic nature of previously accepted methods for measuring calcification (total alkalinity and 45Ca.

  4. Discriminating Talent Identified Junior Australian Footballers Using a Fundamental Gross Athletic Movement Assessment

    Directory of Open Access Journals (Sweden)

    Carl T. Woods, Harry G. Banyard, Ian McKeown, Job Fransen, Sam Robertson

    2016-09-01

    Full Text Available Talent identification (TID is a pertinent component of the sports sciences, affording practitioners the opportunity to target developmental interventions to a select few; optimising financial investments. However, TID is multi-componential, requiring the recognition of immediate and prospective performance. The measurement of athletic movement skill may afford practitioners insight into the latter component given its augmented relationship with functional sport specific qualities. It is currently unknown whether athletic movement skill is a discriminant quality in junior Australian football (AF. This study aimed to discriminate talent identified junior AF players from their non-talent identified counterparts using a fundamental gross athletic movement assessment. From a total of 50 under 18 (U18 AF players; two groups were classified a priori based on selection level; talent identified (n = 25; state academy representatives and non-talent identified (n = 25; state-based competition representatives. Players performed a fundamental gross athletic movement assessment based on the Athletic Ability Assessment (AAA, consisting of an overhead squat, double lunge (left and right legs, single leg Romanian deadlift (left and right legs, and a push up (six movement criterions. Movements were scored across three assessment points using a three-point scale (resulting in a possible score of nine for each movement. A multivariate analysis of variance revealed significant between group effects on four of the six movement criterions (d = 0.56 – 0.87; p = 0.01 – 0.02. Binary logistic regression models and a receiver operating characteristic curve inspection revealed that the overhead squat score provided the greatest group discrimination (β(SE = -0.89(0.44; p < 0.05, with a score of 4.5 classifying 64% and 88% of the talent identified and non-talent identified groups, respectively. Results support the integration of this assessment into contemporary talent

  5. Suitability of faecal near-infrared reflectance spectroscopy (NIRS) predictions for estimating gross calorific value

    Energy Technology Data Exchange (ETDEWEB)

    De la Roza-Delgado, B.; Modroño, S.; Vicente, F.; Martínez-Fernández, A.; Soldado, A.

    2015-07-01

    A total of 220 faecal pig and poultry samples, collected from different experimental trials were employed with the aim to demonstrate the suitability of Near Infrared Reflectance Spectroscopy (NIRS) technology for estimation of gross calorific value on faeces as output products in energy balances studies. NIR spectra from dried and grounded faeces samples were analyzed using a Foss NIRSystem 6500 instrument, scanning over the wavelength range 400-2500 nm. Validation studies for quantitative analytical models were carried out to estimate the relevance of method performance associated to reference values to obtain an appropriate, accuracy and precision. The results for prediction of gross calorific value (GCV) of NIRS calibrations obtained for individual species showed high correlation coefficients comparing chemical analysis and NIRS predictions, ranged from 0.92 to 0.97 for poultry and pig. For external validation, the ratio between the standard error of cross validation (SECV) and the standard error of prediction (SEP) varied between 0.73 and 0.86 for poultry and pig respectively, indicating a sufficiently precision of calibrations. In addition a global model to estimate GCV in both species was developed and externally validated. It showed correlation coefficients of 0.99 for calibration, 0.98 for cross-validation and 0.97 for external validation. Finally, relative uncertainty was calculated for NIRS developed prediction models with the final value when applying individual NIRS species model of 1.3% and 1.5% for NIRS global prediction. This study suggests that NIRS is a suitable and accurate method for the determination of GCV in faeces, decreasing cost, timeless and for convenient handling of unpleasant samples.. (Author)

  6. Total knee arthroplasty based on the assistance of three-dimensional-printing personalized surgical navigation template%基于3D打印个性化手术导航模板辅助下的人工全膝关节置换

    Institute of Scientific and Technical Information of China (English)

    邱冰; 张明娇; 唐本森; 邓必勇; 李涤尘; 刘非

    2015-01-01

    BACKGROUND:With significantly individual differences in the anatomy of the knee joint, traditional total knee replacement is difficult to accurately predict the position of locating limb alignment, size of the prosthesis and osteotomy amount of patients during operation. OBJECTIVE:To investigate the clinical effect of total knee replacement based on the assistance of medical image reconstruction, computer-aided design technology and 3D-printing personalized surgical navigation template. METHODS:Medical image data of patients were col ected using CT or magnetic resonance scanning equipment. The three-dimensional reconstruction of the bone was conducted by two-dimensional medical image processing technology. The navigation template was designed by computer-aided design technology. The personalized surgical navigation templates were produced by 3D printing technology, and the clinical total knee replacement was conducted. The postoperative results were evaluated using imageology. RESULTS AND CONCLUSION:Arigin 3D Pro (Arigin Medical Co., Ltd.) can accurately reconstruct a three-dimensional model of the lower limb bones. The three-dimensional design software Arigin Surgical Templating by their independent research and development can precisely pinpoint related lower limb axis, including limb alignment, rotation axis of the femur and osteotomy reference point. The personalized navigation template we researched and produced for knee surgery fitted tightly with femoral condyle and tibial plateau bone anatomy during operation, without significant movement. The deviation of patients’ limb alignment was less than 3° after total knee replacement.%背景:膝关节的解剖形态个体差异显著,而传统膝关节置换手术定位力线方法复杂,不能准确预测术中患者的力线位置、假体大小及截骨量。  目的:探讨基于医学图像三维重建、计算机辅助设计技术以及3D打印制造的个性化手术导航模板辅助下全

  7. Dislocation following revision total hip arthroplasty.

    Science.gov (United States)

    Gioe, Terence J

    2002-04-01

    Dislocation is a relatively common complication following revision total hip arthroplasty. Risk factors include surgical approach, gender, underlying diagnosis, comorbidities, surgical experience, and previous surgery; for later dislocations, risk factors include wear/deformation of polyethylene, trauma, and decreased muscle strength. Prevention and precaution are the watchwords for dislocations following revision total hip arthroplasty. For dislocations that do occur, treatment rests first on identifying the source of instability. Most dislocations can be managed by closed reduction. Constrained components may increase success rates, but only for appropriate indications. Prevention and treatment of dislocations following revision total hip arthroplasty are discussed in this article.

  8. Association between gross motor function (GMFCS and manual ability (MACS in children with cerebral palsy. A population-based study of 359 children

    Directory of Open Access Journals (Sweden)

    Arner Marianne

    2007-06-01

    Full Text Available Abstract Background The Gross Motor Function Classification System (GMFCS has become an important tool to describe motor function in children with Cerebral Palsy (CP. The Manual Ability Classification System (MACS was developed recently as a corresponding classification of manual ability. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy. Methods 365 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP for children with CP living in the south of Sweden were included in the study. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four. Results GMFCS levels were available in all 365 children, MACS levels in 359 (98%. There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p Conclusion Gross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. To give a complete clinical picture when evaluating these children, both aspects have to be described. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.

  9. Investigating the Effect of Variations in Irrigation Water Price on Cropping Pattern and Gross Margin under Uncertainty (Case Study: Khorasan Razavi

    Directory of Open Access Journals (Sweden)

    Mostafa Mardani

    2016-03-01

    Full Text Available Water shortage crisis is an issue that has led to drastic changes in different agricultural policies, especially in arid and semi-arid areas. Uncertainty in the amount of resources, e.g. water, used for agricultural production entails risk for farmers' income and cropping pattern changes. In the present study, the robust optimization model was used for optimal allocation of arable lands of Khorasan Razavi Province under uncertainty. During the allocation, the effect of water input price variations on total gross margin and cropping pattern was considered. It was found that under certain data, both parameters of total gross margin and total acreage are more than uncertain data. Given that water price variations resulted in tangible changes in wheat acreage, it is recommended to adopt appropriate policies to reduce its production risk.

  10. 3D Surgical Simulation

    Science.gov (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  11. Disposable surgical face masks for preventing surgical wound infection in clean surgery

    Directory of Open Access Journals (Sweden)

    Allyson Lipp

    Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

  12. World distribution of gross domestic product per-capita

    Science.gov (United States)

    Bustos-Guajardo, R.; Moukarzel, Cristian F.

    2015-05-01

    It is shown that the world distribution of gross domestic products per capita (GDPpc) is well described by a trade-investment model that combines yard-sale (YS) exchange and random multiplicative noise (RMN). We first derive analytically the typical value w(r, t) of the ranked wealths for a system evolving under YS exchange and RMN. The resulting analytical expressions are fitted to data for the GDPpc of up to 200 countries, in the period 1960-2013. Our model fits the data significantly better than previously proposed approaches that consider either Noise or Trade alone. Analysis of the resulting values for the fitting parameters, and of their time dependence, suggests that: (a) International trade conditions have (from 1960 to 2008) a statistical bias towards favoring richer countries. (b) Biased international commerce is the main cause for the observed divergence of GDPpc values from 1960 to 2008. (c) After 2008, the distribution of GDPpc starts to converge, and the world product per capita stops growing.

  13. Gross congenital malformation at birth in a government hospital

    Directory of Open Access Journals (Sweden)

    Sandeep Sachdeva

    2014-01-01

    Full Text Available A hospital-based cross-sectional study was undertaken to determine proportion of gross congenital malformation (GCMF occurring at intramural births. Rate of GCMF was found to be 16.4/1000 consecutive singleton births (>28 weeks with three leading malformation as anencephaly (44.68%, talipes equinovarus (17.02% and meningomyelocele (10.63%. Higher risk of malformed births were noticed amongst un-booked (2.07% in-comparison to booked (1.01% mothers; women with low level of education (up to 8 years [2.14%] vs. at least 9 years of schooling [0.82%]; gravida status of at least 3 (2.69% followed by 1 (1.43% and 2 (1.0% respectively; pre-term (5.13% vs. term (0.66%; cesarean section (4.36% versus vaginal delivery (0.62%. Mortality was significantly higher among congenitally malformed (17.35% than normal (0.34% newborns. With-in study limitation, emergence of neural tube defect as the single largest category of congenital malformation indicates maternal malnutrition (especially folic acid that needs appropriate attention and management.

  14. Progestogen-related gross and microscopic changes in female Beagles.

    Science.gov (United States)

    Nelson, L W; Kelly, W A

    1976-01-01

    Long-term studies of megestrol acetate and chlormadinone acetate in 100 female dogs are in progress. Doses of zero, one, 10 and 25 times the expected human dose of megestrol acetate and 25 times the expected human dose of chlormadinone acetate (on a milligram per kilogram body weight basis) are being given daily. During the first 4 years, eight dogs from each of the five groups were killed. The principal gross findings included enlarged uteri with mucoid material in the lumina, mammary development in dogs given middle and high doses of megestrol acetate and chlormadinone acetate, and thickened gallbladder walls in dogs given high doses of each. Histologic evaluation showed inhibition of ovulation for progestogen-treated dogs and suppression of ovarian follicular development with the high doses. Cystic endometrial hyperplasia was slight in the low-dose dogs and moderate to severe in most of the high-dose dogs; a few also had ulcerative endometritis and pyometra. The mammary glands of dogs given the middle and high doses produced lobules, acini, and secretion exceeding natural metestrus. Slight to marked cystic mucinous hyperplasia occurred in the gallbladders of most dogs given the high doses. Tow high-dose megestrol dogs had clinical signs and microscopic pancreatic, renal, and ocular changes indicative of diabetes mellitus.

  15. Stratospheric sulfate geoengineering enhances terrestrial gross primary productivity

    Science.gov (United States)

    Xia, L.; Robock, A.; Tilmes, S.; Neely, R. R., III

    2015-09-01

    Stratospheric sulfate geoengineering could impact the terrestrial carbon cycle by enhancing the carbon sink. With an 8 Tg yr-1 injection of SO2 to balance a Representative Concentration Pathway 6.0 (RCP6.0) scenario, we conducted climate model simulations with the Community Earth System Model, with the Community Atmospheric Model 4 fully coupled to tropospheric and stratospheric chemistry (CAM4-chem). During the geoengineering period, as compared to RCP6.0, land-averaged downward visible diffuse radiation increased 3.2 W m-2 (11 %). The enhanced diffuse radiation combined with the cooling increased plant photosynthesis by 2.4 %, which could contribute to an additional 3.8 ± 1.1 Gt C yr-1 global gross primary productivity without nutrient limitation. This increase could potentially increase the land carbon sink. Suppressed plant and soil respiration due to the cooling would reduce natural land carbon emission and therefore further enhance the terrestrial carbon sink during the geoengineering period. This beneficial impact of stratospheric sulfate geoengineering would need to be balanced by a large number of potential risks in any future decisions about implementation of geoengineering.

  16. Stratospheric sulfate geoengineering enhances terrestrial gross primary productivity

    Directory of Open Access Journals (Sweden)

    L. Xia

    2015-09-01

    Full Text Available Stratospheric sulfate geoengineering could impact the terrestrial carbon cycle by enhancing the carbon sink. With an 8 Tg yr−1 injection of SO2 to balance a Representative Concentration Pathway 6.0 (RCP6.0 scenario, we conducted climate model simulations with the Community Earth System Model, with the Community Atmospheric Model 4 fully coupled to tropospheric and stratospheric chemistry (CAM4-chem. During the geoengineering period, as compared to RCP6.0, land-averaged downward visible diffuse radiation increased 3.2 W m−2 (11 %. The enhanced diffuse radiation combined with the cooling increased plant photosynthesis by 2.4 %, which could contribute to an additional 3.8 ± 1.1 Gt C yr−1 global gross primary productivity without nutrient limitation. This increase could potentially increase the land carbon sink. Suppressed plant and soil respiration due to the cooling would reduce natural land carbon emission and therefore further enhance the terrestrial carbon sink during the geoengineering period. This beneficial impact of stratospheric sulfate geoengineering would need to be balanced by a large number of potential risks in any future decisions about implementation of geoengineering.

  17. Horava-Lifshitz-like Gross-Neveu model

    Science.gov (United States)

    Lima, A. M.; Mariz, T.; Martinez, R.; Nascimento, J. R.; Petrov, A. Yu.; Ribeiro, R. F.

    2017-03-01

    We describe a Horava-Lifshitz-like reformulated four-fermion Gross-Neveu model describing the dynamics of two-component spinors in (2 +1 )-dimensional space-time. Within our study, we introduce the Lagrange multiplier, study the gap equation (including the finite temperature case) which turns out to display essentially distinct behaviors for even and odd values of the critical exponent z , and show that the dynamical parity breaking occurs only for the odd z . We demonstrate that for any odd z , there exists a critical temperature at which the dynamical parity breaking disappears. Besides of this, we obtain the effective propagator and show that the resulting effective theory is renormalizable within the framework of the 1/N expansion for all values of z . As one more application of the dynamical parity breaking, we consider coupling of the vector field to the fermions in the case of a simplified spinor-vector coupling and discuss the generation of the Chern-Simons term.

  18. Large historical growth in global terrestrial gross primary production

    Science.gov (United States)

    Campbell, J. E.; Berry, J. A.; Seibt, U.; Smith, S. J.; Montzka, S. A.; Launois, T.; Belviso, S.; Bopp, L.; Laine, M.

    2017-04-01

    Growth in terrestrial gross primary production (GPP)—the amount of carbon dioxide that is ‘fixed’ into organic material through the photosynthesis of land plants—may provide a negative feedback for climate change. It remains uncertain, however, to what extent biogeochemical processes can suppress global GPP growth. As a consequence, modelling estimates of terrestrial carbon storage, and of feedbacks between the carbon cycle and climate, remain poorly constrained. Here we present a global, measurement-based estimate of GPP growth during the twentieth century that is based on long-term atmospheric carbonyl sulfide (COS) records, derived from ice-core, firn and ambient air samples. We interpret these records using a model that simulates changes in COS concentration according to changes in its sources and sinks—including a large sink that is related to GPP. We find that the observation-based COS record is most consistent with simulations of climate and the carbon cycle that assume large GPP growth during the twentieth century (31% ± 5% growth; mean ± 95% confidence interval). Although this COS analysis does not directly constrain models of future GPP growth, it does provide a global-scale benchmark for historical carbon-cycle simulations.

  19. Large historical growth in global terrestrial gross primary production

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J. E.; Berry, J. A.; Seibt, U.; Smith, S. J.; Montzka, S. A.; Launois, T.; Belviso, S.; Bopp, L.; Laine, M.

    2017-04-05

    Growth in terrestrial gross primary production (GPP) may provide a feedback for climate change, but there is still strong disagreement on the extent to which biogeochemical processes may suppress this GPP growth at the ecosystem to continental scales. The consequent uncertainty in modeling of future carbon storage by the terrestrial biosphere constitutes one of the largest unknowns in global climate projections for the next century. Here we provide a global, measurement-based estimate of historical GPP growth using long-term atmospheric carbonyl sulfide (COS) records derived from ice core, firn, and ambient air samples. We interpret these records using a model that relates changes in the COS concentration to changes in its sources and sinks, the largest of which is proportional to GPP. The COS history was most consistent with simulations that assume a large historical GPP growth. Carbon-climate models that assume little to no GPP growth predicted trajectories of COS concentration over the anthropogenic era that differ from those observed. Continued COS monitoring may be useful for detecting ongoing changes in GPP while extending the ice core record to glacial cycles could provide further opportunities to evaluate earth system models.

  20. A boy with fever, cough and gross haematuria.

    Science.gov (United States)

    Cozzi, Giorgio; Maschio, Massimo; Poillucci, Gabriele; Pennesi, Marco; Barbi, Egidio

    2017-08-28

    A 5 year-old boy presented with 2-days of fever and cough. On examination, he had mild dyspnoea and chest pain, with crackles and hypoventilation at the right lung base. Blood tests showed: WBC 39.1×10(9)/L; N 28.9×10(9)/L; Hb 11.3gr/dL; PLT 375×10(9)/L; CRP 28.7mg/dL; ESR 41mm/h. Chest x-ray confirmed a pulmonary consolidation in the right lower lobe (figure 1), with an associated pleural effusion. Bacterial pneumonia was diagnosed and intravenous ceftriaxone 100mg/kg/die was started. The following day, he developed palpebral oedema and his urine became tea coloured. His blood pressure was 126/82mmHg (>99th percentile).(1) Serum creatinine rose from 0.45mg/dl to 1.09mg/dl (39.8µmol/L - 93.4µmol/L) and C3 was 9mg/dl (n.r. 90-180mg/dl). Urinalysis revealed gross hematuria and 3+ proteinuria, with microscopicy showing dysmorphic red blood cells with casts. Ultrasounds showed enlarged kidneys with increased echogenicity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Peer-Assisted Learning in a Gross Anatomy Dissection Course.

    Science.gov (United States)

    Han, Eui-Ryoung; Chung, Eun-Kyung; Nam, Kwang-Il

    2015-01-01

    Peer-assisted learning encourages students to participate more actively in the dissection process and promotes thoughtful dissection. We implemented peer-assisted dissection in 2012 and compared its effects on students' self-assessments of learning and their academic achievement with those of faculty-led dissection. All subjects performed dissections after a lecture about upper-limb gross anatomy. Experimental group (n = 134) dissected a cadaver while guided by peer tutors who had prepared for the dissection in advance, and control group (n = 71) dissected a cadaver after the introduction by a faculty via prosection. Self-assessment scores regarding the learning objectives related to upper limbs were significantly higher in experimental group than in control group. Additionally, experimental group received significantly higher academic scores than did control group. The students in peer-assisted learning perceived themselves as having a better understanding of course content and achieved better academic results compared with those who participated in faculty-led dissection. Peer-assisted dissection contributed to self-perception and to the ability to retain and explain anatomical knowledge.

  2. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  3. Surgical versus non-surgical management for pleural empyema.

    Science.gov (United States)

    Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L

    2017-03-17

    Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared

  4. Surgical bleeding in microgravity

    Science.gov (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  5. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA

    2012-09-01

    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  6. 20 CFR 418.1115 - What are the modified adjusted gross income ranges?

    Science.gov (United States)

    2010-04-01

    ... gross income range amounts by any percentage increase in the Consumer Price Index rounded to the nearest...) of this section. We will use your modified adjusted gross income amount together with your tax filing... from his/her spouse for the entire tax year for the year we use to make our income-related...

  7. Balloon-occluded percutaneous transheptic obliteration of isolated vesical varices causing gross hematuria

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Dong Hoon; Kim, Dong Hyun; Kim, Min Seok; Kim, Chul Sung [Department of Urology, College of Medicine, Chosun University, Gwangju (Korea, Republic of)

    2013-01-15

    Gross hematuria secondary to vesical varices is an unusual presentation. We report such a case recurrent gross hematuria in a male patient who had a history of bladder substitution with ileal segments that had been treated by balloon-occluded percutaneous transhepatic obliteration of vesical varices.

  8. De Gross Motor Function Measure (GMFM): een onderzoek naar de responsiviteit van de Nederlandse vertaling.

    NARCIS (Netherlands)

    Veenhof, C.; Ketelaar, M.; Petegem-van Beek, E. van; Vermeer, A.

    2003-01-01

    This article is about the psychometric characteristics of the Dutch translation of the Gross Motor Function Measure (GMFM). It describes the responsiveness to change. The article "Gross Motor Function Measure (GMFM): a reliability study of the Dutch translation" focuses on the reliability of the GMF

  9. De Gross Motor Function Measure (GMFM): een onderzoek naar de betrouwbaarheid van de Nederlandse vertaling.

    NARCIS (Netherlands)

    Veenhof, C.; Ketelaar, M.; Petegem-van Beek, E. van

    2003-01-01

    This article is about the psychometric characteristics of the Dutch translation of the Gross Motor Function Measure (GMFM). It describes the reliability of the instrument. The article "Gross Motor Function Measure" (GMFM): a validity study of the Dutch translation focusses on the responsiveness of t

  10. Brief Assessment of Motor Function: Content Validity and Reliability of the Upper Extremity Gross Motor Scale

    Science.gov (United States)

    Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn

    2011-01-01

    Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and…

  11. Fixed Point of Generalized Eventual Cyclic Gross in Fuzzy Norm Spaces for Contractive Mappings

    Directory of Open Access Journals (Sweden)

    S. A. M. Mohsenialhosseini

    2015-01-01

    Full Text Available We define generalized eventual cyclic gross contractive mapping in fuzzy norm spaces, which is a generalization of the eventual cyclic gross contractions. Also we prove the existence of a fixed point for this type of contractive mapping on fuzzy norm spaces.

  12. 46 CFR 129.315 - Power sources for OSVs of 100 or more gross tons.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Power sources for OSVs of 100 or more gross tons. 129.315 Section 129.315 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OFFSHORE SUPPLY VESSELS ELECTRICAL INSTALLATIONS Power Sources and Distribution Systems § 129.315 Power sources for OSVs of 100 or more gross tons. (a) The...

  13. Combined climate factors alleviate changes in gross soil nitrogen dynamics in heathlands

    DEFF Research Database (Denmark)

    Bjorsne, Anna-Karin; Rutting, Tobias; Ambus, Per

    2014-01-01

    of exposure to three climate change factors, i.e. warming, elevated CO2 (eCO(2)) and summer drought, applied both in isolation and in combination. By conducting laboratory N-15 tracing experiments we show that warming increased both gross N mineralization and nitrification rates. In contrast, gross...

  14. 26 CFR 1.1332-1 - Inclusion in gross income of war loss recoveries.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Inclusion in gross income of war loss recoveries. 1.1332-1 Section 1.1332-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES War Loss Recoveries § 1.1332-1 Inclusion in gross income of...

  15. Comparison of Gross Anatomy Test Scores Using Traditional Specimens vs. Quicktime Virtual Reality Animated Specimens

    Science.gov (United States)

    Maza, Paul Sadiri

    2010-01-01

    In recent years, technological advances such as computers have been employed in teaching gross anatomy at all levels of education, even in professional schools such as medical and veterinary medical colleges. Benefits of computer based instructional tools for gross anatomy include the convenience of not having to physically view or dissect a…

  16. The Effects of Basketball Basic Skills Training on Gross Motor Skills Development of Female Children

    Science.gov (United States)

    Bayazit, Betul

    2015-01-01

    The purpose of this study was to investigate the effects of basketball basic skills training on gross motor skills development of female children in Turkey. For that purpose, 40 female children took part in the study voluntarily. Basketball basic skills test was used to improve the gross motor skills of the female children in the study. Also,…

  17. The Effects of Basketball Basic Skills Training on Gross Motor Skills Development of Female Children

    Science.gov (United States)

    Bayazit, Betul

    2015-01-01

    The purpose of this study was to investigate the effects of basketball basic skills training on gross motor skills development of female children in Turkey. For that purpose, 40 female children took part in the study voluntarily. Basketball basic skills test was used to improve the gross motor skills of the female children in the study. Also,…

  18. 25 CFR 215.21 - Payment of gross production tax on lead and zinc.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Payment of gross production tax on lead and zinc. 215.21... ZINC MINING OPERATIONS AND LEASES, QUAPAW AGENCY § 215.21 Payment of gross production tax on lead and zinc. The superintendent of the Quapaw Indian Agency is hereby authorized and directed to pay at...

  19. 26 CFR 1.61-3 - Gross income derived from business.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Gross income derived from business. 1.61-3 Section 1.61-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME... Taxable Income § 1.61-3 Gross income derived from business. (a) In general. In a...

  20. 26 CFR 1.804-3 - Gross investment income of a life insurance company.

    Science.gov (United States)

    2010-04-01

    ... law) shall be excluded from the gross investment income of a life insurance company. However, section... company. 1.804-3 Section 1.804-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... insurance company. (a) Gross investment income defined. For purposes of part I, subchapter L, chapter 1 of...

  1. 17 CFR 1.58 - Gross collection of exchange-set margins.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Gross collection of exchange-set margins. 1.58 Section 1.58 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION GENERAL REGULATIONS UNDER THE COMMODITY EXCHANGE ACT Miscellaneous § 1.58 Gross collection of exchange-set...

  2. Comparison of Gross Anatomy Test Scores Using Traditional Specimens vs. Quicktime Virtual Reality Animated Specimens

    Science.gov (United States)

    Maza, Paul Sadiri

    2010-01-01

    In recent years, technological advances such as computers have been employed in teaching gross anatomy at all levels of education, even in professional schools such as medical and veterinary medical colleges. Benefits of computer based instructional tools for gross anatomy include the convenience of not having to physically view or dissect a…

  3. Gross Motor Development of Malaysian Hearing Impaired Male Pre- and Early School Children

    Science.gov (United States)

    Zawi, Khairi; Lian, Denise Koh Choon; Abdullah, Rozlina Tan

    2014-01-01

    Acquisition of gross motor skill is a natural developmental process for children. This aspect of human development increases with one's chronological age, irrespective of any developmental conditions. The purpose of this study was to assess the level of gross motor skill development among pre- and early school-aged children with motor disability.…

  4. Confirmatory Factor Analysis of the Test of Gross Motor Development-2

    Science.gov (United States)

    Wong, Ka Yee Allison; Cheung, Siu Yin

    2010-01-01

    The purpose of this study was to examine the underlying structure of the second edition of the Test of Gross Motor Development-2 (Ulrich, 2000) as applied to Chinese children. The Test of Gross Motor Development-2 was administered to 626 Hong Kong Chinese children. The outlier test with standard scoring was utilized. After data screening, a total…

  5. Developmental and physical-fitness associations with gross motor coordination problems in Peruvian children.

    Science.gov (United States)

    de Chaves, Raquel Nichele; Bustamante Valdívia, Alcibíades; Nevill, Alan; Freitas, Duarte; Tani, Go; Katzmarzyk, Peter T; Maia, José António Ribeiro

    2016-01-01

    The aims of this cross-sectional study were to examine the developmental characteristics (biological maturation and body size) associated with gross motor coordination problems in 5193 Peruvian children (2787 girls) aged 6-14 years from different geographical locations, and to investigate how the probability that children suffer with gross motor coordination problems varies with physical fitness. Children with gross motor coordination problems were more likely to have lower flexibility and explosive strength levels, having adjusted for age, sex, maturation and study site. Older children were more likely to suffer from gross motor coordination problems, as were those with greater body mass index. However, more mature children were less likely to have gross motor coordination problems, although children who live at sea level or at high altitude were more likely to suffer from gross motor coordination problems than children living in the jungle. Our results provide evidence that children and adolescents with lower physical fitness are more likely to have gross motor coordination difficulties. The identification of youths with gross motor coordination problems and providing them with effective intervention programs is an important priority in order to overcome such developmental problems, and help to improve their general health status.

  6. Net primary production of forests: a constant fraction of gross primary production?

    Science.gov (United States)

    Waring, R. H.; Landsberg, J. J.; Williams, M.

    1998-02-01

    Considerable progress has been made in our ability to model and measure annual gross primary production (GPP) by terrestrial vegetation. But challenges remain in estimating maintenance respiration (R(m)) and net primary production (NPP). To search for possible common relationships, we assembled annual carbon budgets from six evergreen and one deciduous forest in Oregon, USA, three pine plantations in New South Wales, Australia, a deciduous forest in Massachusetts, USA, and a Nothofagus forest on the South Island of New Zealand. At all 12 sites, a standard procedure was followed to estimate annual NPP of foliage, branches, stems, and roots, the carbon expended in synthesis of these organs (R(g)), their R(m), and that of previously produced foliage and sapwood in boles, branches, and large roots. In the survey, total NPP ranged from 120 to 1660 g C m(-2) year(-1), whereas the calculated fraction allocated to roots varied from 0.22 to 0.63. Comparative analysis indicated that the total NPP/GPP ratio was conservative (0.47 +/- 0.04 SD). This finding supports the possibility of greatly simplifying forest growth models. The constancy of the NPP/GPP ratio also provides an incentive to renew efforts to understand the environmental factors affecting partitioning of NPP above and belowground.

  7. The effects of training on gross efficiency in cycling: a review.

    Science.gov (United States)

    Hopker, J; Passfield, L; Coleman, D; Jobson, S; Edwards, L; Carter, H

    2009-12-01

    There has been much debate in the recent scientific literature regarding the possible ability to increase gross efficiency in cycling via training. Using cross-sectional study designs, researchers have demonstrated no significant differences in gross efficiency between trained and untrained cyclists. Reviewing this literature provides evidence to suggest that methodological inadequacies may have played a crucial role in the conclusions drawn from the majority of these studies. We present an overview of these studies and their relative shortcomings and conclude that in well-controlled and rigorously designed studies, training has a positive influence upon gross efficiency. Putative mechanisms for the increase in gross efficiency as a result of training include, muscle fibre type transformation, changes to muscle fibre shortening velocities and changes within the mitochondria. However, the specific mechanisms by which training improves gross efficiency and their impact on cycling performance remain to be determined.

  8. Paul of Aegina's surgical instruments: a complete surgical instrumentarium in the seventh century AD.

    Science.gov (United States)

    Papadakis, Marios; de Bree, Eelco; Trompoukis, Constantinos; Manios, Andreas

    2015-03-02

    Although current progress in surgical instruments is oriented towards stapler devices, minimally invasive instrumentation and advanced cautery tools, it definitely seems intriguing to determine what instruments were used in antiquity and to appraise their use. Most adequate information can be retrieved from manuscripts of early medical authors, of whom Paul of Aegina (AD 625-690), also being a most important surgeon, is the most recent. The aim of this study is to present surgical instruments used in his practice. Surgical instruments mentioned in the original Greek text of his monumental work named Epitome of Medicine were sought using computer software. Further, similar research was performed on other significant manuscripts of earlier Greek medical writers to determine whether some of the instruments were exclusively mentioned by Paul of Aegina. In total, 121 different surgical instruments were identified and described in detail in the Epitome of Medicine. Thirty-three instruments (27%) were exclusively reported by Paul of Aegina. In antiquity a large number of surgical instruments were already being used. Paul of Aegina described in detail a large variety of fine, as well as a substantial number of, original surgical instruments, which he himself used in a wide spectrum of surgical operations. © 2015 Royal Australasian College of Surgeons.

  9. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas

    2010-10-01

    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  10. Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

    Directory of Open Access Journals (Sweden)

    André de Macedo Bianco

    2013-01-01

    Full Text Available A retrospective study of 81 patients with low-grade astrocytoma (LGA comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS and progression- free survival (PFS. Degree of tumor resection was classified as gross total resection (GTR, subtotal resection (STR or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013, whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33. Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

  11. Identifying the association between contrast enhancement pattern, surgical resection, and prognosis in anaplastic glioma patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yinyan; Jiang, Tao [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Wang, Kai; Li, Shaowu; Ma, Jun [Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China); Wang, Jiangfei [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Dai, Jianping [Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China)

    2016-04-15

    Contrast enhancement observable on magnetic resonance (MR) images reflects the destructive features of malignant gliomas. This study aimed to investigate the relationship between radiologic patterns of tumor enhancement, extent of resection, and prognosis in patients with anaplastic gliomas (AGs). Clinical data from 268 patients with histologically confirmed AGs were retrospectively analyzed. Contrast enhancement patterns were classified based on preoperative T1-contrast MR images. Univariate and multivariate analyses were performed to evaluate the prognostic value of MR enhancement patterns on progression-free survival (PFS) and overall survival (OS). The pattern of tumor contrast enhancement was associated with the extent of surgical resection in AGs. A gross total resection was more likely to be achieved for AGs with focal enhancement than those with diffuse (p = 0.001) or ring-like (p = 0.024) enhancement. Additionally, patients with focal-enhanced AGs had a significantly longer PFS and OS than those with diffuse (log-rank, p = 0.025 and p = 0.031, respectively) or ring-like (log-rank, p = 0.008 and p = 0.011, respectively) enhanced AGs. Furthermore, multivariate analysis identified the pattern of tumor enhancement as a significant predictor of PFS (p = 0.016, hazard ratio [HR] = 1.485) and OS (p = 0.030, HR = 1.446). Our results suggested that the contrast enhancement pattern on preoperative MR images was associated with the extent of resection and predictive of survival outcomes in AG patients. (orig.)

  12. GROSS ANATOMY AND BLOOD SUPPLY OF SMALL INTESTINE IN FOETUSES

    Directory of Open Access Journals (Sweden)

    Anwer Unisa

    2015-06-01

    Full Text Available AIM OF STUDY: To develop charts of length and width of small intestine, origin, length and branching pattern of celiac trunk and Superior mesenteric artery. This will help us to know any congenital anomaly in the small intestine, and abnormal origin, length, variation i n the branching pattern. MATERIALS AND METHOD S: The material used for the present study of 100 foetuses of different stages of gestation collected from Government maternity Hospital, Hanamkonda, ChandaKantha Memorial Hospital Warangal and private nursing h omes of Warangal D istrict of Andhra Pradesh within 10 hours of death. The dead foetuses were preserved in the hospital in 10% formalin. The foetuses were embalmed by injecting with 20 cc to 100 cc 10% formalin in to the cranial cavity and trunk depending o n the stage of gestation. Foetuses were dissected to expose small intestine and the blood vessels which supply it systematically in the following manner. OBSERVATIONS: The present study conducted has shown that length, width of small intestine was found to be increasing with foetal age. The length of celiac trunk, the length of superior mesenteric artery was found to increase proportionality with the foetal age. The causes of death in foetuses related to small intestine are intussusceptions intestional malr otation such as ladd’s bands, volvulus, cystic fibrosis, intestional infections and necrotizing enterocolitis. Knowledge related to gross anatomy and blood supply of small intestine is important because of these causes which may lead to death in foetus e s. In the present study no anomalies related to small intestine are found.

  13. Extreme events in gross primary production: a characterization across continents

    Directory of Open Access Journals (Sweden)

    J. Zscheischler

    2014-01-01

    Full Text Available Climate extremes can affect the functioning of terrestrial ecosystems, for instance via a reduction of the photosynthetic capacity or alterations of respiratory processes. Yet the dominant regional and seasonal effects of hydrometeorological extremes are still not well documented. Here we quantify and characterize the role of large spatiotemporal extreme events in gross primary production (GPP as triggers of continental anomalies. We also investigate seasonal dynamics of extreme impacts on continental GPP anomalies. We find that the 50 largest positive (increase in uptake and negative extremes (decrease in uptake on each continent can explain most of the continental variation in GPP, which is in line with previous results obtained at the global scale. We show that negative extremes are larger than positive ones and demonstrate that this asymmetry is particularly strong in South America and Europe. Most extremes in GPP start in early summer. Our analysis indicates that the overall impacts and the spatial extents of GPP extremes are power law distributed with exponents that vary little across continents. Moreover, we show that on all continents and for all data sets the spatial extents play a more important role than durations or maximal GPP anomaly when it comes to the overall impact of GPP extremes. An analysis of possible causes implies that across continents most extremes in GPP can best be explained by water scarcity rather than by extreme temperatures. However, for Europe, South America and Oceania we identify also fire as an important driver. Our findings are consistent with remote sensing products. An independent validation against a literature survey on specific extreme events supports our results to a large extent.

  14. Gross and Histomorphological Studies of Femoral Head Resurfacing in Dog

    Directory of Open Access Journals (Sweden)

    D. Sharifi

    2006-01-01

    Full Text Available The foetal skull bone as a biological graft was investigated. This study was conducted on Fifteen adult mixed - breed normal dogs 12 to 24 months with weighing 21.4=3.6 Kg .Dogs were randomly divided into 3 groups of 5 animals each. The foetal skull bone of 45 days old was collected from one pregnant bitch via cesarean method. The right femoral head cartilage was removed completely in all dogs of 3 groups.. Group I acted as control one, whereas in II group, resurfacing was done by using foetal skull bone which was fixed by using 0.8 mm cerclage wire in criss-cross fashion, but in III group, it was done similar to II group and the hip joint additionally was fixed by using 2 mm steinmenn pin.The clinical observations was made accordingly for 60 days in all groups. The gross changes of femoral head in group I & II were quite smooth and slippy, but in III group were uneven and rough due to secondary changes and ankylosis, but on micropscopic interpertation there was a remarkable compatibility of the graft with femoral head.The reconstruction of articular cartilage was faster in group II and even group III animals than group I animals. There was single row of chondrocyte in scatter area of samples in group . The complete and uniform hyaline cartilage in group II and fibro - cartilage and mixture of connective tissues in group III animals were observed. The results indicated that the foetal skull bone due to its pleuripotent calvarium easily can orient itself into the chondrocytes and cartilagenous tissues in articular surface of the hip joint, if there is suitable enviroment before complete ossification,so that normal joint motion could expect.

  15. Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

    Directory of Open Access Journals (Sweden)

    Anna Maria Fleury

    2011-01-01

    Full Text Available INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically. Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20% for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively. The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%. CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance.

  16. [Optimizing surgical hand disinfection].

    Science.gov (United States)

    Kampf, G; Kramer, A; Rotter, M; Widmer, A

    2006-08-01

    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  17. The surgical management of spasticity.

    Science.gov (United States)

    Lazorthes, Y; Sol, J-C; Sallerin, B; Verdié, J-C

    2002-05-01

    Neurosurgery is only considered for severe spasticity following the failure of noninvasive management (adequate medical and physical therapy). The patients are carefully selected, based on rigorous multidisciplinary clinical assessment. In this we evaluate the contribution of the spasticity to the disability and any residual voluntary motor function. The goals for each patient are: (a) improvement of function and autonomy; (b) control of pain; and (c) prevention of orthopaedic disorders. To achieve these objectives, the surgical procedure must be selective and reduce the excessive hypertonia without suppressing useful muscle tone and limb functions. The surgical procedures are: (1) Classical neuro-ablative techniques (peripheral neurotomies, dorsal rhizotomies) and their modern modifications using microsurgery and intra-operative neural stimulation (dorsal root entry zone: DREZotomy). These techniques are destructive and irreversible, with the reduced muscle tone reflecting the nerve topography. It is mainly indicated when patients have localized spasticity without useful mobility. (2) Conservative techniques based on a neurophysiological control mechanism. These procedures are totally reversible. The methods involve chronic neurostimulation of the spinal cord or the cerebellum. There are only a few patients for whom this is indicated. Conversely, chronic intrathecal administration of baclofen, using an implantable pump, is well established in the treatment of diffuse spasticity of spinal origin. From reports in the literature, we critically review the respective indications in terms of function, clinical progression and the topographic extent of the spasticity.

  18. The total artificial heart.

    Science.gov (United States)

    Cook, Jason A; Shah, Keyur B; Quader, Mohammed A; Cooke, Richard H; Kasirajan, Vigneshwar; Rao, Kris K; Smallfield, Melissa C; Tchoukina, Inna; Tang, Daniel G

    2015-12-01

    The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.

  19. 极重度脊柱侧后凸患者的后路一期小切口撑开联合二期全脊柱截骨术治疗%Surgical treatment of extremely severe scoliokyphosis by posterior approach:distraction at the ifrst stage by small incisions combined with total spinal osteotomy at the second stage

    Institute of Scientific and Technical Information of China (English)

    谭荣; 马华松; 吴继功; 陈晓明; 陈志明; 汪东; 刘涛; 崔凯

    2015-01-01

    目的:探讨后路一期小切口撑开联合二期全脊柱截骨术治疗极重度脊柱侧后凸的疗效和安全性。方法对26例行后路一期小切口撑开联合二期全脊柱截骨术的极重度脊柱侧后凸病例进行回顾性研究。其中男7例,女19例,年龄13~26岁,平均16.8岁。术前侧凸 Cobb’s 角98°~175°,平均135.33°;术前后凸 Cobb’s 角96°~170°,平均133.33°,后路矫形采用分期手术,一期采用小切口撑开矫形,使侧凸和后凸得到部分矫正。术后3~6个月再进行后路二期矫形,行后路截骨矫形内固定、剃刀背切除和植骨融合术,随访12~34个月,平均22个月。记录所有患者术前、一次术后、二次术前、二次术后和末次随访的影像学和临床资料以及围手术期并发症。结果所有病例均顺利完成手术,一期手术平均矫正侧凸61.43°(43.4%),二次手术矫正25.49°(34.45%)。间隔期矫形丢失率3.13%,总矫形率61.8%,随访末次矫形平均丢失率2.92%,最终总矫形率58.83%。术前后凸 Cobb’s 角95°~175°,平均133.33°,一期手术矫正后平均后凸 Cobb’s 角79.67°,二次手术矫正后平均后凸 Cobb’s 角45°,末次随访平均后凸 Cobb’s 角47.26°。躯干和双肩的失平衡均得到显著改善。无严重脊髓、呼吸系统等并发症出现。结论对于极重度脊柱侧后凸采用后路分两期手术治疗,降低了手术难度,提高了二次手术耐受力;可以获得良好的畸形矫形效果,手术安全性得到提高。%Objective To explore the effectiveness and safety of surgical treatment of extremely severe scoliokyphosis by two stages of posterior distraction and total spinal osteotomy technique.Methods Twenty-six patients with extremely severe scoliokyphosis ( 9 males, 17 females ) were retrospective analyzed. The mean age was 16.8 years ( range: 13-26 years ). The mean preoperative Cobb’s angles were 135

  20. Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty

    Science.gov (United States)

    2017-01-10

    Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

  1. Floating Offshore Wind in California: Gross Potential for Jobs and Economic Impacts from Two Future Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Speer, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Keyser, David [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tegen, Suzanne [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-04-18

    Construction of the first offshore wind farm in the United States began in 2015, using fixed platform structures that are appropriate for shallow seafloors, like those located off of the East Coast and mid-Atlantic. However, floating platforms, which have yet to be deployed commercially, will likely need to anchor to the deeper seafloor if deployed off of the West Coast. To analyze the employment and economic potential for floating offshore wind along the West Coast, the Bureau of Ocean Energy Management (BOEM) has commissioned the National Renewable Energy Laboratory (NREL) to analyze two hypothetical, large-scale deployment scenarios for California: 16 GW of offshore wind by 2050 (Scenario A) and 10 GW of offshore wind by 2050 (Scenario B). The results of this analysis can be used to better understand the general scales of economic opportunities that could result from offshore wind development. Results show total state gross domestic product (GDP) impacts of $16.2 billion in Scenario B or $39.7 billion in Scenario A for construction; and $3.5 billion in Scenario B or $7.9 billion in Scenario A for the operations phases.

  2. Integrating gross pathology into teaching of undergraduate medical science students using human cadavers.

    Science.gov (United States)

    Gopalan, Vinod; Dissabandara, Lakal; Nirthanan, Selvanayagam; Forwood, Mark R; Lam, Alfred King-Yin

    2016-09-01

    Human cadavers offer a great opportunity for histopathology students for the learning and teaching of tissue pathology. In this study, we aimed to implement an integrated learning approach by using cadavers to enhance students' knowledge and to develop their skills in gross tissue identification, handling and dissection techniques. A total of 35 students enrolled in the undergraduate medical science program participated in this study. A 3-hour laboratory session was conducted that included an active exploration of cadaveric specimens to identify normal and pathological tissues as well as tissue dissection. The majority of the students strongly agreed that the integration of normal and morbid anatomy improved their understanding of tissue pathology. All the students either agreed or strongly agreed that this laboratory session was useful to improve their tissue dissection and instrument handling skills. Furthermore, students from both cohorts rated the session as very relevant to their learning and recommended that this approach be added to the existing histopathology curriculum. To conclude, an integrated cadaver-based practical session can be used effectively to enhance the learning experience of histopathology science students, as well as improving their manual skills of tissue treatment, instrument handling and dissection.

  3. Increasing Medical Student Exposure to IR through Integration of IR into the Gross Anatomy Course.

    Science.gov (United States)

    DePietro, Daniel M; Kiefer, Ryan M; Redmond, Jonas W; Workman, Alan D; Nadolski, Gregory J; Gade, Terence P; Trerotola, Scott O; Hunt, Stephen J

    2017-10-01

    To compare medical student knowledge of and interest in interventional radiology (IR) before and after the integration of an IR lecture series within the gross anatomy course. Four elective IR lectures were scheduled to coincide with the relevant anatomy dissection curriculum. Anonymous surveys were distributed to 146 students before and after the lectures regarding students' knowledge of and interest in IR, responsibilities of an IR physician, and IR training pathways. Those who did not attend served as controls. Response rates were 67% (n = 98) in the prelecture group, 55% (n = 22) in the group who attended the lecture, and 28% (n = 30) in the control group. A total of 73% of the prelecture group reported little knowledge of IR compared with other specialties. This decreased to 27% in those who attended the lecture (P attended believed they had more knowledge of IR than any other specialty, compared with 7% of controls (P value not significant) and 2% of the prelecture group (P attendance could name a significantly greater number of IR procedures (mean, 1.82) than the prelecture group (mean, 0.57; P attended would consider a career in IR, compared with 24% in the prelecture group and 33% in the control group (P attended had knowledge of the IR residency, compared with 5% in the prelecture group and 33% in the control group (P students about IR and generating interest in the field. Copyright © 2017 SIR. All rights reserved.

  4. Modeling the Philippines' real gross domestic product: A normal estimation equation for multiple linear regression

    Science.gov (United States)

    Urrutia, Jackie D.; Tampis, Razzcelle L.; Mercado, Joseph; Baygan, Aaron Vito M.; Baccay, Edcon B.

    2016-02-01

    The objective of this research is to formulate a mathematical model for the Philippines' Real Gross Domestic Product (Real GDP). The following factors are considered: Consumers' Spending (x1), Government's Spending (x2), Capital Formation (x3) and Imports (x4) as the Independent Variables that can actually influence in the Real GDP in the Philippines (y). The researchers used a Normal Estimation Equation using Matrices to create the model for Real GDP and used α = 0.01.The researchers analyzed quarterly data from 1990 to 2013. The data were acquired from the National Statistical Coordination Board (NSCB) resulting to a total of 96 observations for each variable. The data have undergone a logarithmic transformation particularly the Dependent Variable (y) to satisfy all the assumptions of the Multiple Linear Regression Analysis. The mathematical model for Real GDP was formulated using Matrices through MATLAB. Based on the results, only three of the Independent Variables are significant to the Dependent Variable namely: Consumers' Spending (x1), Capital Formation (x3) and Imports (x4), hence, can actually predict Real GDP (y). The regression analysis displays that 98.7% (coefficient of determination) of the Independent Variables can actually predict the Dependent Variable. With 97.6% of the result in Paired T-Test, the Predicted Values obtained from the model showed no significant difference from the Actual Values of Real GDP. This research will be essential in appraising the forthcoming changes to aid the Government in implementing policies for the development of the economy.

  5. Multidisciplinary collaborative gross tumour volume definition for lung cancer radiotherapy: a prospective study.

    Science.gov (United States)

    Hollingdale, Abigail E; Roques, Tom W; Curtin, John; Martin, W M Craig; Horan, Gail; Barrett, Ann

    2011-12-07

    Variability in gross tumour volume (GTV) definition is a major source of systematic error in conformal radiotherapy. This prospective study assesses the role of multidisciplinary collaboration between oncologists and radiologists in defining lung cancer volumes. Twenty patients with non-small cell lung cancer due to receive three-dimensional conformal radiotherapy formed the study population. GTVs were defined by a radiologist (GTVrad) and an oncologist (GTVonc) using available clinical information and imaging. A collaborative meeting was then held to agree on a final, common GTV (GTVfin) to be used for treatment planning, and differences analysed. The collaboration changed the GTV in 19/20 patients with a total of 50 regions being edited. Changes made were categorized as (a) differentiation of tumour from atelectasis or ground glass shadowing, (b) separation of tumour from vasculature, and (c) defining mediastinal extent of tumour. Oncologists were more confident in the GTVfin than the GTVonc. The radiologist took longer to define the GTV than the oncologist. Real-time collaborative GTV definition by a radiologist and oncologist is practical and feasible. This approach allows specific areas of uncertainty to be categorized and focussed on, reducing systematic error in GTV definition. The physician's approach to risk and decision making for each patient may also play a role.

  6. GROSS AND MICRO - ANATOMICAL OBSERVATIONS ON Fulani Zebu PLACENTOME AND ITS RELATIONSHIP WITH SOME FOETAL PARAMETERS

    Directory of Open Access Journals (Sweden)

    Okafor C Lilian

    2013-11-01

    Full Text Available This study aims to investigate the gross and micro -anatomy of the placentome of Fulani zebu (Bosindicus and its relationship with some foetal parameters over the gestation period. Eighteen pregnant uteri of the Fulani zebu cow were collected from slaughtered pregnant cows. The foetal age was estimated using Richardson’s formula. Other foetal param eters such as the foetal sex, location in the uteri, foetal weight, placentome weight, total number of placentomes and placentome size were taken. The Placentome counts showed a great deal of variability from 51 to 128. The distribution of pregnancies was (66.6% in the right horn and 33.3% in the left horn. Regression analysis was used to establish the relationship between the estimated age and other foetal parameters. The regression analysis yielded a statistically significant relationship (r 2 = 0.4549; p0.01 with the number of placentome. In conclusion, this study has shown that the Fulani zebu placenta is synepitheliochorial with convex Placentomes. The placentome size increases with gestation age in response to greater nutrient/metabolic requirement of the foetus, as the pregnancy progresses

  7. Load profile impact on the gross energy requirement of stand-alone photovoltaic systems

    Energy Technology Data Exchange (ETDEWEB)

    Thiaux, Y.; Seigneurbieux, J.; Multon, B.; Ben Ahmed, H. [SATIE, ENS CACHAN Bretagne, CNRS, UEB, Avenue Robert Schuman, F-35170 Bruz (France)

    2010-03-15

    The sizing optimization of a Stand-Alone Photovoltaic system (SAPV) is a very complex issue. Therefore, a compromise solution must be made between having an acceptable energy and economic cost for the consumer, and a relatively correct energy supply quality. The Gross Energy Requirement (GER) of an SAPV system corresponds to the primary energy total amount required for the production, the maintenance and the recycling of this system. Reducing the GER is thus, an effective way to promote the development of SAPV systems. Therefore, the load profile management, in order to get closer to the ideal 'solar' consumer, allows the downsizing of the system. In this paper, a methodology for studying the impact of load profiles on GER is proposed. Two different modifications parameters have been considered theoretically on idealized load and production profiles: the load shifting which seems simpler to implement in the reality, and the amplitude modulation. Furthermore, the NSGA-II genetic algorithm has been used to confirm theoretical outcomes and to optimize SAPV system sizing for three realistic load profiles, with the aim of quantifying the GER reduction, by minimizing the storage capacity (taking into account the replacements due to cycling) which is one of the weak points of such a system, and by PV panels downsizing. (author)

  8. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia

    2012-01-01

    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  9. Spacecraft surgical scrub system

    Science.gov (United States)

    Abbate, M.

    1980-01-01

    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  10. Gossypiboma—Retained Surgical Sponge

    Directory of Open Access Journals (Sweden)

    Hung-Shun Sun

    2007-11-01

    Full Text Available Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

  11. Hepatic surgical anatomy.

    Science.gov (United States)

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros

    2004-04-01

    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  12. Louis Pasteur surgical revolution.

    Science.gov (United States)

    Toledo-Pereyra, Luis H

    2009-01-01

    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  13. Guideline implementation: Surgical attire.

    Science.gov (United States)

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  14. Integration of MODIS land and atmosphere products with a coupled-process model to estimate gross primary productivity and evapotranspiration from 1 km to global scales

    Science.gov (United States)

    Ryu, Youngryel; Baldocchi, Dennis D.; Kobayashi, Hideki; van Ingen, Catharine; Li, Jie; Black, T. Andy; Beringer, Jason; van Gorsel, Eva; Knohl, Alexander; Law, Beverly E.; Roupsard, Olivier

    2011-12-01

    We propose the Breathing Earth System Simulator (BESS), an upscaling approach to quantify global gross primary productivity and evapotranspiration using MODIS with a spatial resolution of 1-5 km and a temporal resolution of 8 days. This effort is novel because it is the first system that harmonizes and utilizes MODIS Atmosphere and Land products on the same projection and spatial resolution over the global land. This enabled us to use the MODIS Atmosphere products to calculate atmospheric radiative transfer for visual and near infrared radiation wave bands. Then we coupled atmospheric and canopy radiative transfer processes, with models that computed leaf photosynthesis, stomatal conductance and transpiration on the sunlit and shaded portions of the vegetation and soil. At the annual time step, the mass and energy fluxes derived from BESS showed strong linear relations with measurements of solar irradiance (r2 = 0.95, relative bias: 8%), gross primary productivity (r2 = 0.86, relative bias: 5%) and evapotranspiration (r2 = 0.86, relative bias: 15%) in data from 33 flux towers that cover seven plant functional types across arctic to tropical climatic zones. A sensitivity analysis revealed that the gross primary productivity and evapotranspiration computed in BESS were most sensitive to leaf area index and solar irradiance, respectively. We quantified the mean global terrestrial estimates of gross primary productivity and evapotranpiration between 2001 and 2003 as 118 ± 26 PgC yr-1 and 500 ± 104 mm yr-1 (equivalent to 63,000 ± 13,100 km3 yr-1), respectively. BESS-derived gross primary productivity and evapotranspiration estimates were consistent with the estimates from independent machine-learning, data-driven products, but the process-oriented structure has the advantage of diagnosing sensitivity of mechanisms. The process-based BESS is able to offer gridded biophysical variables everywhere from local to the total global land scales with an 8-day interval over

  15. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  16. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies.

    Science.gov (United States)

    Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin

    2017-04-01

    The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  17. 5 CFR 890.1112 - Denial of continuation of coverage due to involuntary separation for gross misconduct.

    Science.gov (United States)

    2010-01-01

    ... involuntary separation for gross misconduct. 890.1112 Section 890.1112 Administrative Personnel OFFICE OF... involuntary separation for gross misconduct. (a) Notice of denial. (1) When an employing office determines that the offense for which an employee is being removed constitutes gross misconduct for the purpose...

  18. Debridement for surgical wounds.

    Science.gov (United States)

    Dryburgh, Nancy; Smith, Fiona; Donaldson, Jayne; Mitchell, Melloney

    2008-07-16

    Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing. Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (Streptokinase/streptodornase) with saline-soaked dressings and reported the time to complete debridement. Four of the trials compared the effectiveness of dextranomer beads or paste with other products (different comparator

  19. Surgical management of common canine prostatic conditions.

    Science.gov (United States)

    Freitag, Thurid; Jerram, Richard M; Walker, Alex M; Warman, Chris G A

    2007-11-01

    Prostatic diseases commonly warrant surgical intervention. Early castration may prevent the development of benign prostatic hyperplasia, prostatitis, and cavitary lesions (prostatic abscesses or cysts). In intact dogs that present with these disorders, castration should always be part of the specific surgical treatment because it enhances treatment success and may prevent recurrence. The current treatment of choice for cavitary lesions is prostatic omentalization, which results in lower postoperative mortality, faster recovery, and fewer incidences of recurrence than other prostatic drainage techniques. Prostatic neoplasia without evidence of metastasis may be managed with total prostatectomy, subtotal prostatectomy in conjunction with intraoperative radiotherapy, or postoperative chemotherapy. Understanding the neurovascular supply of the prostate and surrounding tissues is essential to decrease the risk for urinary incontinence, severe hemorrhage, and avascular necrosis. Postoperative management includes analgesia, appropriate antibiotic therapy, and in cases of subtotal or total prostatectomy, temporary urinary catheterization.

  20. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy

    NARCIS (Netherlands)

    Vos, Rimke C.; Becher, Jules G.; Voorman, Jeanine M.; Gorter, Jan Willem; van Eck, Mirjam; van Meeteren, Jetty; Smits, Dirk Wouter; Twisk, Jos W.; Dallmeijer, Annet J.

    2016-01-01

    Objective: To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). Design: A prospective cohort study. Setting: Rehabilitation departments of university medical centers and rehabilitations c

  1. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy

    NARCIS (Netherlands)

    Vos, Rimke C.; Becher, Jules G.; Voorman, Jeanine M.; Gorter, Jan Willem; van Eck, Mirjam; van Meeteren, Jetty; Smits, Dirk Wouter; Twisk, Jos W.; Dallmeijer, Annet J.; van Schie, P. E M; Schuengel, C.; Ketelaar, M.; Lindeman, E.; Jongmans, M.; Roebroeck, M. E.; Tan, S. S.; Wiegerink, D. J H G; Reinders-Messelink, H. A.; Verheijden, J.

    2016-01-01

    Objective To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). Design A prospective cohort study. Setting Rehabilitation departments of university medical centers and rehabilitations cent

  2. The central role of trunk control in the gross motor function of children with cerebral palsy

    DEFF Research Database (Denmark)

    Curtis, Derek John; Butler, Penny; Saavedra, Sandy;

    2015-01-01

    Aim Improvement of gross motor function and mobility are primary goals of physical therapy in children with cerebral palsy (CP). The purpose of this study was to investigate the relationship between segmental control of the trunk and the corresponding gross motor function in children with CP....... Method This retrospective cross-sectional study was based on 92 consecutive referrals of children with CP in Gross Motor Function Classification System (GMFCS) levels I to V, 39 females, 53 males (median age 4y [range 1–14y]), and 77, 12, and 3 with spastic, dyskinetic, and ataxic CP respectively....... The participants were tested using the Gross Motor Function Measure (GMFM), the Pediatric Evaluation of Disability Inventory (PEDI), and the Segmental Assessment of Trunk Control (SATCo). Results Linear regression analysis showed a positive relationship between the segmental level of trunk control and age...

  3. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy

    NARCIS (Netherlands)

    Vos, Rimke C.; Becher, Jules G.; Voorman, Jeanine M.; Gorter, Jan Willem; van Eck, Mirjam; van Meeteren, Jetty; Smits, Dirk Wouter; Twisk, Jos W.; Dallmeijer, Annet J.

    Objective: To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). Design: A prospective cohort study. Setting: Rehabilitation departments of university medical centers and rehabilitations

  4. Longitudinal Association Between Gross Motor Capacity and Neuromusculoskeletal Function in Children and Youth With Cerebral Palsy

    NARCIS (Netherlands)

    Vos, Rimke C.; Becher, Jules G.; Voorman, Jeanine M.; Gorter, Jan Willem; van Eck, Mirjam; van Meeteren, Jetty; Smits, Dirk Wouter; Twisk, Jos W.; Dallmeijer, Annet J.; van Schie, P. E M; Schuengel, C.; Ketelaar, M.; Lindeman, E.; Jongmans, M.; Roebroeck, M. E.; Tan, S. S.; Wiegerink, D. J H G; Reinders-Messelink, H. A.; Verheijden, J.

    2016-01-01

    Objective To examine associations over longitudinal measurements between neuromusculoskeletal function and gross motor capacity in children and youth with cerebral palsy (CP). Design A prospective cohort study. Setting Rehabilitation departments of university medical centers and rehabilitations

  5. Envelope Periodic Solutions to One-Dimensional Gross-Pitaevskii Equation in Bose-Einstein Condensation

    Institute of Scientific and Technical Information of China (English)

    LIU Shi-Kuo; GAO Bin; FU Zun-Tao; LIU Shi-Da

    2009-01-01

    In this paper, applying the dependent and independent variables transformations as well as the Jacobi elliptic function expansion method, the envelope periodic solutions to one-dimensional Gross-Pitaevskii equation in Bose-Einstein condensates are obtained.

  6. Effect of physical therapy frequency on gross motor function in children with cerebral palsy

    OpenAIRE

    Park, Eun-Young

    2016-01-01

    [Purpose] This study attempted to investigate the effect of physical therapy frequency based on neurodevelopmental therapy on gross motor function in children with cerebral palsy. [Subjects and Methods] The study sample included 161 children with cerebral palsy who attended a convalescent or rehabilitation center for disabled individuals or a special school for children with physical disabilities in South Korea. Gross Motor Function Measure data were collected according to physical therapy fr...

  7. Analysis of historical gross gamma logging data from BY tank farm

    Energy Technology Data Exchange (ETDEWEB)

    MYERS, D.A.

    1999-10-13

    Gross gamma ray logs, recorded from January 1975 through mid-year 1994 as part of the Single-Shell Tank Farm Dry Well Surveillance Program, have been reanalyzed for the BY tank farm to locate the presence of mobile radionuclides in the subsurface. This report presents the BY tank farm gross gamma ray data in such a way as to assist others in their study of vadose zone mechanisms.

  8. Class numbers of cyclic 2-extensions and Gross conjecture over Q

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    The Gross conjecture over Q was first claimed by Aoki in 1991.However,the original proof contains too many mistakes and false claims to be considered as a serious proof.This paper is an attempt to find a sound proof of the Gross conjecture under the outline of Aoki.We reduce the conjecture to an elementary conjecture concerning the class numbers of cyclic 2-extensions of Q.

  9. New Frontiers in Surgical Innovation.

    Science.gov (United States)

    Jackson, Ryan S; Schmalbach, Cecelia E

    2017-08-01

    It is an exciting time for head and neck surgical innovation with numerous advances in the perioperative planning and intraoperative management of patients with cancer, trauma patients, and individuals with congenital defects. The broad and rapidly changing realm of head and neck surgical innovation precludes a comprehensive summary. This article highlights some of the most important innovations from surgical planning with sentinel node biopsy and three-dimensional, stereolithic modeling to intraoperative innovations, such as transoral robotic surgery and intraoperative navigation. Future surgical innovations, such as intraoperative optical imaging of surgical margins, are also highlighted. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Encapsulating peritonitis: computed tomography and surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kadow, Juliana Santos; Fingerhut, Carla Jeronimo Peres; Fernandes, Vinicius de Barros; Coradazzi, Klaus Rizk Stuhr; Silva, Lucas Marciel Soares; Penachim, Thiago Jose, E-mail: vinicius.barros.fernandes@gmail.com [Pontificia Universidade Catolica de Campinas (PUC-Campinas), Campinas, SP (Brazil). Hospital e Maternidade Celso Pierro

    2014-07-15

    Sclerosing encapsulating peritonitis is a rare and frequently severe entity characterized by total or partial involvement of small bowel loops by a membrane of fibrous tissue. The disease presents with nonspecific clinical features of intestinal obstruction, requiring precise imaging diagnosis to guide the treatment. The present report emphasizes the importance of computed tomography in the diagnosis of this condition and its confirmation by surgical correlation. (author)

  11. Surgical risks associated with winter sport tourism.

    Science.gov (United States)

    Sanchez, Stéphane; Payet, Cécile; Lifante, Jean-Christophe; Polazzi, Stéphanie; Chollet, François; Carty, Matthew J; Duclos, Antoine

    2015-01-01

    Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context. We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics. A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists' influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716). Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies.

  12. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  13. energy use and gross margin analysis for sesame production in ...

    African Journals Online (AJOL)

    Prof. Adipala Ekwamu

    As the negative impacts of energy by-products affect the climate, the knowledge and efficient use of ... Diesel and labour energy inputs dominated the total energy inputs for the two systems. .... such as output of sesame, quantity and type of.

  14. The relationship between spasticity and gross motor capability in nonambulatory children with spastic cerebral palsy.

    Science.gov (United States)

    Katusic, Ana; Alimovic, Sonja

    2013-09-01

    Spasticity has been considered as a major impairment in cerebral palsy (CP), but the relationship between this impairment and motor functions is still unclear, especially in the same group of patients with CP. The aim of this investigation is to determine the relationship between spasticity and gross motor capability in nonambulatory children with spastic CP. Seventy-one children (30 boys, 41 girls) with bilateral spastic cerebral palsy and with Gross Motor Function Classification System (GMFCS) levels IV (n=34) and V (n=37) were included in the study. The spasticity level in lower limbs was evaluated using the Modified Modified Ashworth Scale and the gross motor function with the Gross Motor Function Measure (GMFM-88). Spearman's correlation analysis was used to determine the nature and the strength of the relationship. The results showed a moderate correlation between spasticity and gross motor skills (ρ=0.52 for the GMFCS level; ρ=0.57 for the GMFM-88), accounting for less than 30% of the explained variance. It seems that spasticity is just one factor among many others that could interfere with gross motor skills, even in children with severe forms of spastic CP. Knowledge of the impact of spasticity on motor skills may be useful in the setting of adequate rehabilitation strategies for nonambulatory children with spastic CP.

  15. SOFT TISSUE BALANCING IN TOTAL HIP ARTHROPLASTY.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-03-01

    Full Text Available We present our experience with the soft tissue balancing in total hip arthroplasty. Detailed indications, planning and surgical technique are presented. The described procedures are performed on 278 hips for a period of 6 years (2008-2014. We conclude that the outcome of a THA can be improved by balancing the stability, ROM, muscle strength and limb length equality.

  16. Analysis of surgical intervention populations using generic surgical process models.

    Science.gov (United States)

    Neumuth, Thomas; Jannin, Pierre; Schlomberg, Juliane; Meixensberger, Jürgen; Wiedemann, Peter; Burgert, Oliver

    2011-01-01

    According to differences in patient characteristics, surgical performance, or used surgical technological resources, surgical interventions have high variability. No methods for the generation and comparison of statistical 'mean' surgical procedures are available. The convenience of these models is to provide increased evidence for clinical, technical, and administrative decision-making. Based on several measurements of patient individual surgical treatments, we present a method of how to calculate a statistical 'mean' intervention model, called generic Surgical Process Model (gSPM), from a number of interventions. In a proof-of-concept study, we show how statistical 'mean' procedure courses can be computed and how differences between several of these models can be quantified. Patient individual surgical treatments of 102 cataract interventions from eye surgery were allocated to an ambulatory or inpatient sample, and the gSPMs for each of the samples were computed. Both treatment strategies are exemplary compared for the interventional phase Capsulorhexis. Statistical differences between the gSPMs of ambulatory and inpatient procedures of performance times for surgical activities and activity sequences were identified. Furthermore, the work flow that corresponds to the general recommended clinical treatment was recovered out of the individual Surgical Process Models. The computation of gSPMs is a new approach in medical engineering and medical informatics. It supports increased evidence, e.g. for the application of alternative surgical strategies, investments for surgical technology, optimization protocols, or surgical education. Furthermore, this may be applicable in more technical research fields, as well, such as the development of surgical workflow management systems for the operating room of the future.

  17. Gross-beta activity in ground water: natural sources and artifacts of sampling and laboratory analysis

    Science.gov (United States)

    Welch, Alan H.

    1995-01-01

    Gross-beta activity has been used as an indicator of beta-emitting isotopes in water since at least the early 1950s. Originally designed for detection of radioactive releases from nuclear facilities and weapons tests, analysis of gross-beta activity is widely used in studies of naturally occurring radioactivity in ground water. Analyses of about 800 samples from 5 ground-water regions of the United States provide a basis for evaluating the utility of this measurement. The data suggest that measured gross-beta activities are due to (1) long-lived radionuclides in ground water, and (2) ingrowth of beta-emitting radionuclides during holding times between collection of samples and laboratory measurements.Although40K and228Ra appear to be the primary sources of beta activity in ground water, the sum of40K plus228Ra appears to be less than the measured gross-beta activity in most ground-water samples. The difference between the contribution from these radionuclides and gross-beta activity is most pronounced in ground water with gross-beta activities > 10 pCi/L, where these 2 radionuclides account for less than one-half the measured ross-beta activity. One exception is groundwater from the Coastal Plain of New Jersey, where40K plus228Ra generally contribute most of the gross-beta activity. In contrast,40K and228Ra generally contribute most of beta activity in ground water with gross-beta activities measure all beta activity in ground water. Although3H contributes beta activity to some ground water, it is driven from the sample before counting and therefore is not detected by gross-beta measurements. Beta-emitting radionuclides with half-lives shorter than a few days can decay to low values between sampling and counting. Although little is known about concentrations of most short-lived beta-emitting radionuclides in environmental ground water (water unaffected by direct releases from nuclear facilities and weapons tests), their activities are expected to be low.Ingrowth of

  18. Comparison of analytical and predictive methods for water, protein, fat, sugar, and gross energy in marine mammal milk.

    Science.gov (United States)

    Oftedal, O T; Eisert, R; Barrell, G K

    2014-01-01

    Mammalian milks may differ greatly in composition from cow milk, and these differences may affect the performance of analytical methods. High-fat, high-protein milks with a preponderance of oligosaccharides, such as those produced by many marine mammals, present a particular challenge. We compared the performance of several methods against reference procedures using Weddell seal (Leptonychotes weddellii) milk of highly varied composition (by reference methods: 27-63% water, 24-62% fat, 8-12% crude protein, 0.5-1.8% sugar). A microdrying step preparatory to carbon-hydrogen-nitrogen (CHN) gas analysis slightly underestimated water content and had a higher repeatability relative standard deviation (RSDr) than did reference oven drying at 100°C. Compared with a reference macro-Kjeldahl protein procedure, the CHN (or Dumas) combustion method had a somewhat higher RSDr (1.56 vs. 0.60%) but correlation between methods was high (0.992), means were not different (CHN: 17.2±0.46% dry matter basis; Kjeldahl 17.3±0.49% dry matter basis), there were no significant proportional or constant errors, and predictive performance was high. A carbon stoichiometric procedure based on CHN analysis failed to adequately predict fat (reference: Röse-Gottlieb method) or total sugar (reference: phenol-sulfuric acid method). Gross energy content, calculated from energetic factors and results from reference methods for fat, protein, and total sugar, accurately predicted gross energy as measured by bomb calorimetry. We conclude that the CHN (Dumas) combustion method and calculation of gross energy are acceptable analytical approaches for marine mammal milk, but fat and sugar require separate analysis by appropriate analytic methods and cannot be adequately estimated by carbon stoichiometry. Some other alternative methods-low-temperature drying for water determination; Bradford, Lowry, and biuret methods for protein; the Folch and the Bligh and Dyer methods for fat; and enzymatic and reducing

  19. [Duane vertical surgical treatment].

    Science.gov (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G

    2014-04-01

    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  20. Diverticulitis: selective surgical management.

    Science.gov (United States)

    Rugtiv, G M

    1975-08-01

    The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.

  1. Gender differences in the acquisition of surgical skills

    DEFF Research Database (Denmark)

    Ali, Amir; Subhi, Yousif; Ringsted, Charlotte

    2015-01-01

    BACKGROUND: Females are less attracted than males to surgical specialties, which may be due to differences in the acquisition of skills. The aim of this study was to systematically review studies that investigate gender differences in the acquisition of surgical skills. METHODS: We performed...... a comprehensive database search using relevant search phrases and MeSH terms. We included studies that investigated the role of gender in the acquisition of surgical skills. RESULTS: Our search yielded 247 studies, 18 of which were found to be eligible and were therefore included. These studies included a total...... conditions). Male medical students tended to outperform females, while no gender differences were found among residents. Gaming experience and interest in surgery correlated with better acquisition of surgical skills, regardless of gender. Although initial levels of surgical abilities seemed lower among...

  2. Medical students pursuing surgical fields have no greater innate motor dexterity than those pursuing nonsurgical fields.

    Science.gov (United States)

    Lee, Jason Y; Kerbl, David C; McDougall, Elspeth M; Mucksavage, Phillip

    2012-01-01

    Medical students pursue different career paths based on a variety of factors. We sought to examine the impact of innate manual dexterity, both perceived and objective, on the career interests of medical students. Third-year medical students from the University of California, Irvine were recruited for this study. Subjects completed a pretest questionnaire followed by assessment of gross and fine motor dexterity using the Purdue Pegboard test. A total of 6 independent trials were performed, 3 for each hand. The scores were recorded as an integer value between 0 and 25. A statistical analysis was performed using student t tests, the Fischer exact test, or the χ(2) test, where appropriate. A total of 100 students completed the questionnaire while 58 completed the dexterity testing. Students interested in a surgical field (SF) were similar in handedness, gender, video game exposure, and learning style as those interested in a nonsurgical field (NSF). In the SF group, "personal skill set" was reported as the most common factor influencing career selection, and "interest in disease process/patient population" was reported most commonly by NSF students (p = 0.015). Although a perceived innate manual dexterity was higher among SF students compared with NSF students (p = 0.032), no significant objective differences were found in right hand, left hand, or combined dexterity scores. Perceived "personal skill set" may influence strongly a medical student's career choice. Despite greater perceived manual dexterity, students interested in an SF do not have greater objective innate manual dexterity than those interested in an NSF. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horse-shoe kidney

    Directory of Open Access Journals (Sweden)

    Pezeshki Rad Masoud

    2012-04-01

    Full Text Available 【Abstract】Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas. Self-inflicted abdominal stab wound, a rare type of abdominal injury, accounts for only a small percentage of suicidal at-tempts and may be infrequently encountered by physicians in trauma centers. Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing. Here we report a rare case of self-stabbing of a horseshoe kidney. The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our department of radiology due to re-occurred gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs. A horseshoe kidney was incidentally found in the patient’s abdominal computed tomography. Renal angiography revealed active contrast extravasation from one of the segmental arteries. Selective transarterial embolization with a coil was successfully performed to con-trol the hematuria. Key words: Embolization, therapeutic; Kidney; Wounds, stab

  4. Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horseshoe kidney

    Institute of Scientific and Technical Information of China (English)

    Masoud Pezeshki Rad; Hassan Ahmadnia; Mahboobeh Abedi; Mohammad Sadegh Abedi

    2012-01-01

    Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas.Selfinflicted abdominal stab wound,a rare type of abdominal injury,accounts for only a small percentage of suicidal attempts and may be infrequently encountered by physicians in trauma centers.Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing.Here we report a rare case of self-stabbing of a horseshoe kidney.The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our department of radiology due to re-occurred gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs.A horseshoe kidney was incidentally found in the patient's abdominal computed tomography.Renal angiography revealed active contrast extravasation from one of the segmental arteries.Selective transarterial embolization with a coil was successfully performed to control the hematuria.

  5. The Optimal Analgesic Block for Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bendtsen, Thomas Fichtner; Moriggl, Bernhard; Chan, Vincent W

    2016-01-01

    Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography ...

  6. Minimally invasive surgical technique for tethered surgical drains

    Directory of Open Access Journals (Sweden)

    Shane R Hess

    2017-01-01

    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  7. Evaluation of free i-applications for tertiary level gross anatomy education

    Directory of Open Access Journals (Sweden)

    Matthew F. Pollard

    2012-04-01

    Full Text Available BackgroundThe use of electronic resources in education, including i-applications used on portable handheld devices, is increasing. Apple® handheld devices are popular, with free applications the most prevalent download form. Many gross anatomy i-applications are available, however no information on the quality of free anatomy products is available. Rating such products could therefore guide product recommendations.AimTo evaluate the quality and range of free iPod® applications that are applicable for tertiary level gross anatomy education.MethodsA search of the iTunes® Application Store with keywords anatomy, free, medical, functional, clinical, gross, and human was performed, with inclusion based on free applications containing human gross anatomy usable for tertiary education purposes. Application specification was noted; each was trialled independently and rated for usability, specification, academic level, and quality (image and programme.ResultsSixty-three applications were identified and eleven met inclusion criteria. Two provided gross anatomy of the entire body, nine examined specific regions or systems. Five were judged introductory in academic level, five intermediate, and one advanced. One application was rated low quality, and four excellent. None were considered difficult to use (six easy, five medium. Application size ranged between 1.2MB and 229MB (mean 27MB.ConclusionsThere are few free i-applications for learning gross anatomy and most concentrate on individual body systems, with the academic level and usability of all products well rated. Results suggest some free I-applications could be suitable adjuncts for gross anatomy education at both an undergraduate and graduate level.

  8. Baseline urologic surgical skills among medical students: Differentiating trainees.

    Science.gov (United States)

    Gupta, Vishaal; Lantz, Andrea G; Alzharani, Tarek; Foell, Kirsten; Lee, Jason Y

    2014-07-01

    Urology training programs seek to identify ideal candidates with the potential to become competent urologic surgeons. It is unclear whether innate technical ability has a role in this selection process. We aimed to determine whether there are any innate differences in baseline urologic technical skills among medical students. Second-year medical students from the University of Toronto were recruited for this study and stratified into surgical and non-surgical cohorts based on their reported career aspirations. After a pre-test questionnaire, subjects were tested on several urologic surgical skills: laparoscopy, cystoscopy and robotic surgery. Statistical analysis was performed using chi-squared test, student t-tests and Spearman's correlation where appropriate. A total of 29 students participated in the study and no significant baseline differences were found between cohorts with respect to demographics and prior surgical experience. For laparoscopic skills, the surgical cohort outperformed the non-surgical cohort on several exercises: Lap Beans Missed (4.9 vs. 9.3, p robotic surgery performance metrics: Task Time (50.6 vs. 76.3, p robotics, may differ between early trainees interested in a surgical career compared to those interested in a non-surgical career. Further studies are required to illicit what impact such differences have on future performance and competence.

  9. WHO Surgical Checklist and Its Practical Application in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Shady Abdel-Rehim

    2011-01-01

    Full Text Available The WHO surgical checklist was introduced to most UK surgical units following the WHO “Safe Surgery Saves Lives” initiative. The aim of this audit was to review patient's safety in the delivery of surgical care and to evaluate the practical application of the new WHO surgical checklist. We conducted a retrospective audit of patients who received operative treatment under general anaesthesia at our Plastic Surgery Department, involving a total number of 90 patients. The WHO form was compared to its former equivalents. Complications or incidents occurring during or after surgery were recorded. Using the department's previous surgical checklist, “Time out” was only performed in only 30% of cases. One patient arrived at theatre reception without a completed consent form, and two clinical incidents were reported without patients suffering harm. Following introduction of current WHO surgical checklist, “Time out” was recorded in 80% of cases. In all cases, the new WHO surgical checklist was used and no incidents were reported. The WHO surgical checklist provides a structured frame work that standardizes the delivery of care across hospitals and specialized units; however, it will take some time and practice for teams to learn to use the checklist effectively and reliably.

  10. Artifacts in conventional computed tomography (CT) and free breathing four-dimensional CT induce uncertainty in gross tumor volume determination

    DEFF Research Database (Denmark)

    Persson, Gitte Fredberg; Nygaard, Ditte Eklund; Af Rosenschöld, Per Munck;

    2011-01-01

    PURPOSE: Artifacts impacting the imaged tumor volume can be seen in conventional three-dimensional CT (3DCT) scans for planning of lung cancer radiotherapy but can be reduced with the use of respiration-correlated imaging, i.e., 4DCT or breathhold CT (BHCT) scans. The aim of this study...... was to compare delineated gross tumor volume (GTV) sizes in 3DCT, 4DCT, and BHCT scans of patients with lung tumors. METHODS AND MATERIALS: A total of 36 patients with 46 tumors referred for stereotactic radiotherapy of lung tumors were included. All patients underwent positron emission tomography (PET)/CT, 4DCT......, and BHCT scans. GTVs in all CT scans of individual patients were delineated during one session by a single physician to minimize systematic delineation uncertainty. The GTV size from the BHCT was considered the closest to true tumor volume and was chosen as the reference. The reference GTV size...

  11. Characterization of large area ZnS(Ag) detector for gross alpha and beta activity measurements in tap water plants

    Energy Technology Data Exchange (ETDEWEB)

    Lunardon, M.; Cester, D.; Mistura, G.; Moretto, S.; Stevanato, L.; Viesti, G. [Department of Physics and Astronomy ' Galileo Galilei' , University of Padova, (Italy); Schotanus, P.; Bodewits, E. [SCIONIX Holland BV, (Netherlands)

    2015-07-01

    In this work we present the characterization of a large area 200 x 200 mm{sup 2} EJ-444 scintillation detector to be used for monitoring gross alpha and beta activity in tap water plants. Specific tests were performed to determine the best setup to readout the light from the detector side in order to have the possibility to stack many detectors and get a compact device with total active area of the order of 1 m{sup 2}. Alpha/Beta discrimination, efficiency and homogeneity tests were carried out with alpha and beta sources. Background from ambient radioactivity was measured as well. Alpha/beta real-time monitoring in drinking water is a goal of the EU project TAWARA{sub R}TM. (authors)

  12. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  13. A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas

    Directory of Open Access Journals (Sweden)

    Kuiken Todd A

    2011-10-01

    Full Text Available Abstract Background Surgical treatment of neuromas involves excision of neuromas proximally to the level of grossly "normal" fascicles; however, proximal changes at the axonal level may have both functional and therapeutic implications with regard to amputated nerves. In order to better understand the retrograde "zone of injury" that occurs after nerve transection, we investigated the gross and histologic changes in transected nerves using a rabbit forelimb amputation model. Methods Four New Zealand White rabbits underwent a forelimb amputation with transection and preservation of the median, radial, and ulnar nerves. After 8 weeks, serial sections of the amputated nerves were then obtained in a distal-to-proximal direction toward the brachial plexus. Quantitative histomorphometric analysis was performed on all nerve specimens. Results All nerves demonstrated statistically significant increases in nerve cross-sectional area between treatment and control limbs at the distal nerve end, but these differences were not observed 10 mm more proximal to the neuroma bulb. At the axonal level, an increased number of myelinated fibers were seen at the distal end of all amputated nerves. The number of myelinated fibers progressively decreased in proximal sections, normalizing at 15 mm proximally, or the level of the brachial plexus. The cross-sectional area of myelinated fibers was significantly decreased in all sections of the treatment nerves, indicating that atrophic axonal changes proceed proximally at least to the level of the brachial plexus. Conclusions Morphologic changes at the axonal level extend beyond the region of gross neuroma formation in a distal-to-proximal fashion after nerve transection. This discrepancy between gross and histologic neuromas signifies the need for improved standardization among neuroma models, while also providing a fresh perspective on how we should view neuromas during peripheral nerve surgery.

  14. Predisposing factors and surgical outcome of complicated liver hydatid cysts

    Institute of Scientific and Technical Information of China (English)

    Alper; Akcan; Erdogan; Sozuer; Hizir; Akyildiz; Zeki; Yilmaz; Ahmet; Ozturk; Altay; Atalay

    2010-01-01

    AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the pred...

  15. Higher Inpatient Medical Surgical Bed Occupancy Extends Admitted Patients’ Stay

    OpenAIRE

    Krall, Scott P.; O'Connor, Robert E.; Maercks, Lisa

    2009-01-01

    Objective: Determine the effect that increased medical surgical (med/surg) bed occupancy has on the time interval from admission order to arrival in the bed for the patients admitted from the emergency department (ED). Methods: This retrospective observational study compares the total hospital bed occupancy rate and the medical surgical inpatient bed occupancy rate to daily averages for the time interval from admission order (patient posting for admission) to the patient’s arrival in...

  16. Pig model vs sheep model in undergraduate periodontal surgical training.

    OpenAIRE

    Larsen, Patryk Daniel; Tronsen, Eyvind; Bøen, Kim Reisæter

    2013-01-01

    Objective: The objective of this study was to further develop the sheep model for periodontal surgical training to undergraduate students, and compare it to the more commonly used pig model. Method: Periodontal measurements as pocket depth and gingival width were measured on a total number of 10 sheep and 9 pigs, and a pre-established list of surgical procedures were performed on both types of specimen in different areas of the dentition; gingivectomy, modified access flap w...

  17. Early neurovascular monitoring and staged total solution surgical treatment of tibial plateau fracture-dislocation%胫骨平台骨折合并膝关节脱位的早期评估与分期全修复治疗

    Institute of Scientific and Technical Information of China (English)

    徐青镭; 李飞; 韩国一; 王英振

    2016-01-01

    目的 探讨应用损伤控制原则对胫骨平台骨折合并膝关节脱位进行早期血管、神经评估和亚急性期骨折、韧带全修复的疗效.方法 回顾性分析2010年7月至2014年6月治疗的78例(81膝)胫骨平台骨折合并膝关节脱位患者资料,男53例,女25例;年龄19~51岁,平均37.8岁.骨折Schatzker分型:Ⅱ型16例(16膝),Ⅳ型31例(31膝),Ⅴ型6例(6膝),Ⅵ型4例(4膝);未纳入Schatzker分型的胫骨平台边缘撕脱压缩骨折21例(24膝).所有患者按损伤控制原则进行早期血管、神经评估,血管和软组织条件稳定后进行骨折复位内固定和韧带修补加强重建的全修复,术后评估膝关节稳定性、关节活动范围等.结果 71例(74膝)患者术后获24 ~ 71个月(平均40.2个月)随访.Ⅱ型、Ⅳ型、Ⅴ型、Ⅵ型骨折和胫骨平台边缘撕脱压缩骨折的腓总神经和腘动脉损伤比例分别为15.4% (2/13)、17.2% (5/29)、60.0% (3/5)、66.7% (2/3)、45.8% (11/24);其韧带损伤比例分别为46.2% (6/13)、20.7% (6/29)、60.0% (3/5)、66.7% (2/3)、83.3% (20/24).术后KT-1000测量30°前向松弛度健侧与患侧差值平均1.6 mm;TELOS测量90°后向松弛度健侧与患侧差值平均为2.3 mm、0°外翻平均为0.8 mm、30°外翻平均为1.5 mm、0°内翻平均为1.2mm、30°内翻平均为2.2 mm.末次随访时Lysholm评分平均为85.1分(72~ 95)分;Tegner评分平均为6.5分(4~8分);其中91.5% (65/71)的患者重返伤前同级或低一级的活动水平.术后无一例患者伸膝受限,屈膝角度对比患侧平均损失15.5°.结论 胫骨平台骨折合并膝关节脱位早期应重视血管、神经的评估,血管和软组织条件稳定后,骨折复位固定的同时行修补重建韧带一期全修复可缩短康复时间,内侧副韧带修补、后交叉韧带和后外侧复合体重建有助于提高治疗效果.%Objective To evaluate early neurovascular monitoring and staged total solution

  18. GROSS MORPHOLOGY OF THE HIP ARTICULATION OF BUFFALO CALVES (BUBALUS BUBALIS

    Directory of Open Access Journals (Sweden)

    Supriya. B

    2014-11-01

    Full Text Available Back ground: The vulnerability of the buffalo to the luxation of the hip articulation previous to and during parturition encouraged the investigation in this species. The literature reviewed did not reveal complete anatomical descriptions of the coxofemoral articulation of buffalo. Hence the study was undertaken. Purpose: to study the different anatomical aspects of the hip joint which are specific to buffaloes. Methods and Results: A total number of fifteen hip joints of buffalo calves procured from the local slaughter house and department of Veterinary Anatomy were studied in the Department of Veterinary Anatomy, College of Veterinary Science, Tirupati irrespective of breed, sex and nutritional status. The gross morphology of joints and relations were studied. The round ligament of buffalo was stronger compared to cattle. A thick fibrous stratum of articular capsule was present. A few arched and semi-circular fibers were seen in the articular capsule but zona orbicularis was absent. The best developed periarticular ligament in the buffalo hip was the iliofemoral ligament. It was a thick cord of connective tissue extending from a nodule below and behind the ischiatic spine and spreaded over the capsula articularis and finally attached to the trochanter major and trochanteric ridge. The pubocapsular ligament was located on the ventral surface of the joint capsule and blended with it. Compared to the most of other quadripeds the periarticular ligaments were well developed in buffalo. The iliofemoral ligament was mostly helpful in preventing the hip from excessive extension and adduction. The relative development of the periarticular ligaments in the biped and quadrupeds were probably in accordance with comparative weight that this articulation must support. Potential implications: An understanding of the basic anatomy of the hip helps in understanding pathology and can greatly assist the surgeon in appropriately diagnosing and treating the

  19. A geostatistical synthesis study of factors affecting gross primary productivity in various ecosystems of North America

    Directory of Open Access Journals (Sweden)

    V. Yadav

    2010-02-01

    Full Text Available A coupled Bayesian model selection and geostatistical regression modeling approach is adopted for empirical analysis of gross primary productivity (GPP at six AmeriFlux sites, including the Kennedy Space Center Scrub Oak, Vaira Ranch, Tonzi Ranch, Blodgett Forest, Morgan Monroe State Forest, and Harvard Forest sites. The analysis is performed at a continuum of temporal scales ranging from daily to monthly, for a period of seven years. A total of 10 covariates representing environmental stimuli and indices of plant physiology are considered in explaining variations in GPP. Similar to other statistical methods, the proposed approach estimates regression coefficients and uncertainties associated with the covariates in a selected regression model. However, unlike traditional regression methods, the presented approach also estimates the uncertainty associated with the selection of a single "best" model of GPP. In addition, the approach provides an enhanced understanding of how the importance of specific covariates changes with temporal resolutions. An examination of trends in the importance of specific covariates reveals scaling thresholds above or below which covariates become significant in explaining GPP. Results indicate that most sites (especially those with a stronger seasonal cycle exhibit at least one prominent scaling threshold between daily to 20-day temporal scale. This demonstrates that environmental variables that explain GPP at synoptic scales are different from those that capture its seasonality. At shorter time scales, radiation, temperature, and vapor pressure deficit exert most significant influence on GPP at most examined sites. However, at coarser time scales, the importance of these covariates in explaining GPP declines. Overall, unique best models are identified at most sites at the daily scale, whereas multiple competing models are identified at larger time scales. In addition, the selected models are able to explain a larger

  20. A geostatistical synthesis study of factors affecting gross primary productivity in various ecosystems of North America

    Directory of Open Access Journals (Sweden)

    V. Yadav

    2010-09-01

    Full Text Available A coupled Bayesian model selection and geostatistical regression modeling approach is adopted for empirical analysis of gross primary productivity (GPP at six AmeriFlux sites, including the Kennedy Space Center Scrub Oak, Vaira Ranch, Tonzi Ranch, Blodgett Forest, Morgan Monroe State Forest, and Harvard Forest sites. The analysis is performed at a continuum of temporal scales ranging from daily to monthly, for a period of seven years. A total of 10 covariates representing environmental stimuli and indices of plant physiology are considered in explaining variations in GPP. Similarly to other statistical methods, the presented approach estimates regression coefficients and uncertainties associated with the covariates in a selected regression model. Unlike traditional regression methods, however, the approach also estimates the uncertainty associated with the selection of a single "best" model of GPP. In addition, the approach provides an enhanced understanding of how the importance of specific covariates changes with the examined timescale (i.e. temporal resolution. An examination of changes in the importance of specific covariates across timescales reveals thresholds above or below which covariates become important in explaining GPP. Results indicate that most sites (especially those with a stronger seasonal cycle exhibit at least one prominent scaling threshold between the daily and 20-day temporal scales. This demonstrates that environmental variables that explain GPP at synoptic scales are different from those that capture its seasonality. At shorter time scales, radiation, temperature, and vapor pressure deficit exert the most significant influence on GPP at most examined sites. At coarser time scales, however, the importance of these covariates in explaining GPP declines. Overall, unique best models are identified at most sites at the daily scale, whereas multiple competing models are identified at longer time scales.