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Sample records for optimising corticosteroid injection

  1. Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: A protocol for a randomised control trial with placebo comparison

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    Brooks Peter

    2009-06-01

    Full Text Available Abstract Background Corticosteroid injection and physiotherapy are two commonly prescribed interventions for management of lateral epicondylalgia. Corticosteroid injections are the most clinically efficacious in the short term but are associated with high recurrence rates and delayed recovery, while physiotherapy is similar to injections at 6 weeks but with significantly lower recurrence rates. Whilst practitioners frequently recommend combining physiotherapy and injection to overcome harmful effects and improve outcomes, study of the benefits of this combination of treatments is lacking. Clinicians are also faced with the paradox that the powerful anti-inflammatory corticosteroid injections work well, albeit in the short term, for a non-inflammatory condition like lateral epicondylalgia. Surprisingly, these injections have not been rigorously tested against placebo injections. This study primarily addresses both of these issues. Methods A randomised placebo-controlled clinical trial with a 2 × 2 factorial design will evaluate the clinical efficacy, cost-effectiveness and recurrence rates of adding physiotherapy to an injection. In addition, the clinical efficacy and adverse effects of corticosteroid injection beyond that of a placebo saline injection will be studied. 132 participants with a diagnosis of lateral epicondylalgia will be randomly assigned by concealed allocation to one of four treatment groups – corticosteroid injection, saline injection, corticosteroid injection with physiotherapy or saline injection with physiotherapy. Physiotherapy will comprise 8 sessions of elbow manipulation and exercise over an 8 week period. Blinded follow-up assessments will be conducted at baseline, 4, 8, 12, 26 and 52 weeks after randomisation. The primary outcome will be a participant rating of global improvement, from which measures of success and recurrence will be derived. Analyses will be conducted on an intention-to-treat basis using linear

  2. Corticosteroid Injections for Common Musculoskeletal Conditions.

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    Foster, Zoë J; Voss, Tyler T; Hatch, Jacquelynn; Frimodig, Adam

    2015-10-15

    Family physicians considering corticosteroid injections as part of a comprehensive treatment plan for musculoskeletal diagnoses will find few high-quality studies to assist with evidence-based decision making. Most studies of corticosteroid injections for the treatment of osteoarthritis, tendinopathy, bursitis, or neuropathy include only small numbers of patients and have inconsistent long-term follow-up. Corticosteroid injections for the treatment of adhesive capsulitis result in short-term improvements in pain and range of motion. For subacromial impingement syndrome, corticosteroid injections provide short-term pain relief and improvement in function. In medial and lateral epicondylitis, corticosteroid injections offer only short-term improvement of symptoms and have a high rate of symptom recurrence. Corticosteroid injections for carpal tunnel syndrome may help patients avoid or delay surgery. Trigger finger and de Quervain tenosynovitis may be treated effectively with corticosteroid injections. Patients with hip or knee osteoarthritis may have short-term symptom relief with corticosteroid injections.

  3. Injectable Corticosteroids: Take Precautions and Use Caution.

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    Freire, Véronique; Bureau, Nathalie J

    2016-11-01

    Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions.

  4. Corticosteroid injection for de Quervain's tenosynovitis

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    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Jong, Betty Meyboom-de

    2009-01-01

    Back ground De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. Objectives To summarise evidence on the efficacy and safety of corticostero

  5. Corticosteroid injection for de Quervain's tenosynovitis

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Jong, Betty Meyboom-de

    2009-01-01

    Back ground De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. Objectives To summarise evidence on the efficacy and safety of

  6. Corticosteroid injection for trigger finger in adults

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Meyboom-de Jong, Betty

    2009-01-01

    Background Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting. Objectives To summarize the evidence on the efficacy and safety of

  7. Plantar fascia rupture associated with corticosteroid injection.

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    Sellman, J R

    1994-07-01

    A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.

  8. Incidence of plantar fascia ruptures following corticosteroid injection.

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    Kim, Chul; Cashdollar, Michael R; Mendicino, Robert W; Catanzariti, Alan R; Fuge, LaDonna

    2010-12-01

    Plantar fasciitis is commonly treated with corticosteroid injections to decrease pain and inflammation. Therapeutic benefits often vary in terms of efficacy and duration. Rupture of the plantar fascia has been reported as a possible complication following corticosteroid injection. A retrospective chart review of 120 patients who received corticosteroid injection for plantar fasciitis was performed at the authors' institution to determine the incidence of plantar fascia rupture. The plantar fascia rupture was diagnosed clinically and confirmed with magnetic resonance imaging. Various factors were analyzed, including the number of injections, interval between injections, body mass index (BMI), and activity level. Four patients (2.4%) consequently experienced plantar fascia rupture following an average of 2.67 injections. The average BMI of these patients was 38.6 kg/m². The authors conclude that corticosteroid injection therapy appears to be a safe and effective form of nonoperative treatment with minimal complications and a relatively low incident of plantar fascia rupture.

  9. Can intramuscular corticosteroid injection cause nonarteritic anterior ischemic optic neuropathy?

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    Bakbak B

    2013-03-01

    Full Text Available Berker Bakbak, Banu Turgut Ozturk, Sansal Gedik, Bengu Ekinci Koktekir, Saban Gonul Selcuk University Medical Faculty, Department of Ophthalmology, Konya, Turkey Abstract: A 56-year-old man noted a sudden decrease of vision in his right eye 4 hours after intramuscular triamcinolone acetonide (TA injection. A diagnosis of unilateral nonarteritic anterior ischemic optic neuropathy (NAION was made, and the patient was counseled to discontinue using TA. Examination for possible risk factors revealed controlled hypertension. Final visual acuity was finger counting at 1 m, and the optic disc was pale in his right eye. This is the first reported case of unilateral NAION that has occurred in a patient after intramuscular corticosteroid injection. Although a cause-and-effect relationship is difficult to prove, the short duration between the TA injection and the NAION is noteworthy. The history of corticosteroid injection should be questioned in cases with predisposing conditions such as hypertension. Keywords: ischemic optic neuropathy, corticosteroids, optic disc edema

  10. Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder

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    Wang, Wei; Shi, Mingmin; Zhou, Chenhe; Shi, Zhongli; Cai, Xunzi; Lin, Tiao; Yan, Shigui

    2017-01-01

    Abstract Background: Primary adhesive capsulitis is mainly characterized by spontaneous chronic shoulder pain and the gradual loss of shoulder motion. The main treatment for adhesive capsulitis is a trial of conservative therapies, including analgesia, exercise, physiotherapy, oral nonsteroidal anti-inflammation drugs, and intra-articular corticosteroid injections. Previously, it was reported that intra-articular corticosteroid lead to fast pain relief and improvement of range of motion (ROM). The objective of this study was to determine whether corticosteroid injections would lead to better pain relief and greater improvement in ROM. Methods: We searched PubMed, Medline, and the Cochrane library. We included 5 articles of the 1166 articles identified. Totally injection group included 115 patients and placebo group included 110 patients. We calculated the weighted mean differences to evaluate the pain relief as the primary outcome. We determined the ROM as the secondary outcome. Study quality was evaluated using the 12-item scale. We also used the criteria of the Grading of Recommendations Assessment, Development and Evaluation to evaluate the quality of evidence. Results: In total, 5 studies were included, 4 of which were randomized clinical trials, with a sample size of 225 patients with adhesive capsulitis of the shoulders. The overall pooled data demonstrated that, compared with placebo as control treatment, intra-articular corticosteroid injections were more effective in reducing the pain score at 0 to 8 weeks, but there was no difference between the injection group and the control group at 9 to 24 weeks. Improvement of ROM in the injection group was greater than that of the control group both at 0 to 8 and 9 to 24 weeks. Conclusions: Intra-articular corticosteroid injections were more effective in pain relief in the short term, but this pain relief did not sustain in the long term. Intra-articular corticosteroid injection resulted in greater improvement in

  11. Anaphylactic reaction to intralesional corticosteroid injection.

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    Laing, M E; Fallis, B; Murphy, G M

    2007-08-01

    We report the case of anaphylactic reaction to carboxymethylcellulose, a dispersant in corticosteroid preparation and contrast media. Skin prick testing in this patient revealed a positive response to carboxymethylcellulose at a dilution of 1/1000. Anaphylaxis secondary to carboxymethylcellulose has previously been reported. To avoid further problems, this patient was advised to alert medical staff for the presence of allergy to carboxymethylcellulose in the event of the need for further interventional procedures. Care should be taken when giving intradermal steroids to patients with a history of anaphylaxis after contrast media.

  12. Subconjunctival mycetoma after sub-Tenon's corticosteroid injection.

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    Galor, Anat; Karp, Carol L; Forster, Richard K; Dubovy, Sander R; Gaunt, Morgan L; Miller, Darlene

    2009-09-01

    To describe a case of a subconjunctival mycetoma that developed after a patient received a sub-Tenon's injection of triamcinolone acetonide. Case report. A 76-year-old white male presented with a subconjunctival mass in the area of a previous posterior sub-Tenon's corticosteroid injection for wet age-related macular degeneration. Microbiologic and pathologic analysis of the mass revealed the causative organism to be the pigmented fungus Exophiala jeanselmei. This is the first published case of an Exophiala-associated subconjunctival mycetoma.

  13. Effectiveness of Corticosteroid Injections for Treatment of de Quervain's Tenosynovitis.

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    Oh, Jinhee K; Messing, Susan; Hyrien, Ollivier; Hammert, Warren C

    2017-07-01

    Although surgery can provide definitive treatment for de Quervain's tenosynovitis, nonoperative treatment could be preferable if symptoms are predictably relieved. We sought to determine the effectiveness of corticosteroid injections as treatment for de Quervain's tenosynovitis and to evaluate patient characteristics as predictors of treatment outcome. A retrospective study was conducted using our institutional database International Classification of Disease, version 9 (ICD-9) code list for de Quervain's tenosynovitis. Treatment success was defined as relief of symptoms after 1 or 2 injections. Relief was defined as resolution or improvement to the extent that the patient did not seek further intervention. Failure was defined as a subsequent surgical release or a third injection. Logistic regression analyses were performed to look for univariate associations between patient demographics/comorbidities and risk of treatment failure. The treatment outcome of 222 limbs from 199 patients was studied. Of the 222 limbs, 73.4% (95% confidence interval [CI], 66.9%-79.1%) experienced treatment success within 2 injections, and 51.8% (95% CI, 45.0%-58.6%) experienced success after 1 injection. Body mass index (BMI) >30 and female sex were found to be significantly associated with treatment failure, with a 2.4-fold increase (95% CI, 1.02%-5.72%) in odds and 3.23 times greater (95% CI, 1.08%-9.67%) odds of failure, respectively. Although not reaching statistical significance, African American race, hypothyroidism, and carpal tunnel syndrome suggested increased odds of failure. This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. This study also suggests that female sex and BMI >30 are associated with increased treatment failure.

  14. Complications of plantar fascia rupture associated with corticosteroid injection.

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    Acevedo, J I; Beskin, J L

    1998-02-01

    From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

  15. PERIOCULAR CORTICOSTEROID INJECTIONS IN UVEITIS: EFFECTS AND COMPLICATIONS

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    Sen, H. Nida; Vitale, Susan; Gangaputra, Sapna S.; Nussenblatt, Robert B.; Liesegang, Teresa L.; Levy-Clarke, Grace A.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Kempen, John H.

    2014-01-01

    Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. Design Multicenter retrospective cohort study. Participants A total of 914 patients (1192 eyes) who had received at least one periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. Main Outcome Measures Control of inflammation, improvement of visual acuity to 20/40 or better, improvement of visual acuity loss attributed to macular edema, incident cataract affecting visual acuity, cataract surgery, ocular hypertension and glaucoma surgery. Results Among 914 patients (1192 eyes) who received at least one periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% [95% confidence interval (95%CI): 69.1-76.3] of the eyes achieved complete control of inflammation and 49.7% [95%CI:45.5-54.1] showed an improvement in visual acuity (VA) from worse than 20/40 to 20/40 or better. Among the subset with VA worse than 20/40 attributed to macular edema, 33.1% [95%CI: 25.2-42.7] improved to 20/40 or better. By 12 months, the cumulative incidence of one or more visits with an intraocular pressure≥24 mmHg and ≥30 mmHg was 34.0% [95%CI: 24.8-45.4] and 15.0% [95%CI: 11.8-19.1] respectively; glaucoma surgery was performed in 2.4% [95%CI: 1.4-3.9] of eyes. Within 12 months, among phakic eyes initially 20/40 or better, the incidence of a reduction in VA to worse than 20/40 attributed to cataract was 20.2% [95%CI: 15.9-25.6]; cataract surgery was performed within 12 months in 13.8 % [95%CI: 11.1-17.2] of the initially phakic eyes

  16. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

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    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  17. [Anaphylaxis after injection of corticosteroid preparations--carboxymethylcellulose as a hidden allergen].

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    Oppliger, Roland; Hauser, Conrad

    2004-11-01

    Two patients developed anaphylaxis after injection of a corticosteroid preparation containing carboxymethylcellulose (E466). In both cases skin tests yielded positive immediate type reactions to pure carboxymethylcellulose. This hydrophilic derivative of cellulose has found wide application in the pharmaceutical, cosmetics and food industry. The diagnosis is based on skin testing as 9% of the normal population was found to have serum IgE antibodies to this compound. In case of anaphylaxis after injection of corticosteroids, carboxymethylcellulose in addition to corticosteroids should be included for skin testing.

  18. Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL.

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    Drakos, Mark; Birmingham, Patrick; Delos, Demetris; Barnes, Ronnie; Murphy, Conor; Weiss, Leigh; Warren, Russell

    2014-07-01

    Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data. The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player's ability to return to play and possible adverse effects. Athletes from a single National Football League team who received at least one corticosteroid or anesthetic injection for either a muscle strain or ligament sprain during three consecutive seasons were retrospectively reviewed. Thirty-seven injections were given over the three seasons. Injections were either performed blindly or by using ultrasound guidance. Twice as many defensive players were injected than offensive players. The average number of days of conservative treatment before injection was 6.5 days. All players returned to play after injection. There were no complications from any of the injections. Seventeen (55%) players did not miss a single game, and nine (30%) did not miss a single day. Quadriceps strains were associated with the most missed games (four) and the most missed days (36.5). Proximal hamstring strains were second with an average of three missed games and 28 missed days. Corticosteroid injections are a safe and effective therapeutic intervention for treating muscle strains and ligament sprains in order to enable athletes to return to competition earlier.

  19. Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder

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    Alexander w. Aleem

    2017-09-01

    Full Text Available Background: Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasingpain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucoselevels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections onblood glucose levels in diabetic patients with shoulder pathology.Methods: Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromialcorticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucoseand most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily toconfirm their fasting morning glucose level for 10 days post-injection.Results: Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of

  20. Cluster of postinjection abscesses related to corticosteroid injections and use of benzalkonium chloride.

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    Olson, R K; Voorhees, R E; Eitzen, H E; Rolka, H; Sewell, C M

    1999-01-01

    Benzalkonium chloride (BC) is an unreliable disinfectant. A matched case-control study and environmental investigation were conducted to determine the cause of and risk factors for a cluster of postinjection abscesses at a private medical clinic where BC was used as a disinfectant. Twenty-eight case-patients who had an abscess at the injection site were matched with 126 control patients who had received an intramuscular injection at the clinic on the same day. Risk factors for abscess development in a multivariable logistic model were corticosteroid injection and being female. All case-patients had received a corticosteroid injection from a multidose vial. Cultures of abscesses from 20 of 23 case-patients grew Pseudomonas aeruginosa. Cultures of BC prepared at the clinic also grew P aeruginosa, suggesting that BC was the source of infection. Injection site cleaning with BC did not appear to be the route of infection since use of BC at the time of injection was not associated with abscess development. A more likely route of infection was injection of contaminated corticosteroid from multidose vials that could have been inoculated with pseudomonads via needle puncture after vial septa were wiped with contaminated BC. Benzalkonium chloride should not be used to clean injection vial septa or injection sites. PMID:10214100

  1. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow.

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    Verhaar, J A; Walenkamp, G H; van Mameren, H; Kester, A D; van der Linden, A J

    1996-01-01

    We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion of the wrist, and patient satisfaction. At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group. In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group. Thirty-five patients who had injections and 14 who had physiotherapy were satisfied with the outcome of treatment at six weeks. At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group. There was a significant increase in grip strength in both groups but those with injections had a significantly better result. After one year there were no significant differences between the two groups. Half of the patients, however, had received only the initial treatment, 20% had had combined therapy and 30% had had surgery. We conclude that at six weeks, treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action, reduction of pain and absence of side-effects.

  2. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.

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    Zonghuan Li

    Full Text Available BACKGROUND: It is controversial whether ultrasound-guided injection of corticosteroid is superior to palpation-guided injection for plantar fasciitis. This meta-analysis was performed to compare the effectiveness of ultrasound-guided and palpation-guided injection of corticosteroid for the treatment of plantar fasciitis. METHODS: Databases (MEDLINE, Cochrane library and EMBASE and reference lists were searched from their establishment to August 30, 2013 for randomized controlled trials (RCTs comparing ultrasound-guided with palpation-guided injection for plantar fasciitis. The Cochrane risk of bias (ROB tool was used to assess the methodological quality. Outcome measurements were visual analogue scale (VAS, tenderness threshold (TT, heel tenderness index (HTI, response rate, plantar fascia thickness (PFT, hypoechogenicity and heel pad thickness (HPT. The statistical analysis was performed with software RevMan 5.2 and Stata 12.0. When I2<50%, the fixed-effects model was adopted. Otherwise the randomized-effects model was adopted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE system was used to assess the quality of evidence. RESULTS: Five RCTs with 149 patients were identified and analyzed. Compared with palpation-guided injection, ultrasound-guided injection was superior with regard to VAS, TT, response rate, PFT and hypoechogenicity. However, there was no statistical significance between the two groups for HPT and HTI. CONCLUSION: Ultrasound-guided injection of corticosteroid tends to be more effective than palpation-guided injection. However, it needs to be confirmed by further research.

  3. EFFECT OF SHOCK WAVE THERAPYVERSUS CORTICOSTEROID INJECTION IN MANAGEMENT OFKNEE OSTEOARTHRITIS

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    Ahmed Ebrahim Elerian

    2016-04-01

    Full Text Available Background: knee Osteoarthritis is the most common cause of musculoskeletal pain and disability. Shockwaves have been used as an alternative treatment for musculoskeletal disorders; intra-articular injection of steroid is a common treatment for osteoarthritis of the knee. This study aimed to investigate the efficacy of Shock wave therapy versus Corticosteroid intra articular injection in case of knee osteoarthritis. Methods: Sixty patients were diagnosed mild to moderate knee osteoarthritis; they were included in the study. Their ages were 43:65 years with mean age 50 ± 3.5 years. Patients were divided randomly into three equal groups, group (A received shock wave therapy, group (B received two intra-articular injections of corticosteroid at 1-month intervals and group (C received sham shock wave. The outcome measurements were Western Ontario and McMaster Universities arthritis index (WOMAC values, knee ROM, and pain severity using the visual analogue scale (VAS were recorded. The patients were evaluated for these parameters before allocated in their groups then after 1, 2, and 6months later. Results: compared to sham group there were significant improvement of VAS and ROM of shock wave group and corticosteroid injection group than sham (placebo group (p<0.000, (p<0.006, and 0.02 respectively. Furthermore there was significant improve of shock wave group than corticosteroid injection group where p was <0.000 for VAS, ROM and (WOMAC. Conclusion: The results of this study suggested that shock wave therapy may provide effective modality for relieving pain, increase Range of motion and improve function in knee osteoarthritis patient than intra articular corticosteroid injection.

  4. Effectiveness of local tenoxicam versus corticosteroid injection for plantar fasciitis treatment.

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    Guner, Savas; Onder, Haci; Guner, Sukriye Ilkay; Ceylan, Mehmet Fethi; Gökalp, Mehmet Ata; Keskin, Siddik

    2013-10-01

    Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

  5. Adverse effects of extra-articular corticosteroid injections: A systematic review

    NARCIS (Netherlands)

    A. Brinks (Tineke); B.W. Koes (Bart); A.C. Volkers (Aloysius); J.A.N. Verhaar (Jan); S.M. Bierma-Zeinstra (Sita)

    2010-01-01

    textabstractBackground. To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. Methods. A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case

  6. Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature

    OpenAIRE

    2010-01-01

    Lateral epicondylitis or tennis elbow is a painful and functionally limiting entity affecting the upperextremity and is frequently treated by hand surgeons. Corticosteroid injection is one of the most common interventions for lateral epicondylitis or tennis elbow. Here, a review of the medical literature on this treatment is presented.

  7. Corticosteroid injection for tennis elbow or lateral epicondylitis: a review of the literature.

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    Saccomanni, Bernardino

    2010-07-15

    Lateral epicondylitis or tennis elbow is a painful and functionally limiting entity affecting the upperextremity and is frequently treated by hand surgeons. Corticosteroid injection is one of the most common interventions for lateral epicondylitis or tennis elbow. Here, a review of the medical literature on this treatment is presented.

  8. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy

    DEFF Research Database (Denmark)

    Kongsgaard, M; Kovanen, V; Aagaard, P

    2009-01-01

    A randomized-controlled single-blind trial was conducted to investigate the clinical, structural and functional effects of peritendinous corticosteroid injections (CORT), eccentric decline squat training (ECC) and heavy slow resistance training (HSR) in patellar tendinopathy. Thirty-nine male...

  9. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow

    NARCIS (Netherlands)

    J.A.N. Verhaar (Jan); G.H.I.M. Walenkamp; H. van Mameren; A.D.M. Kester; A.J. van der Linden

    1996-01-01

    textabstractWe performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion o

  10. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis.

    Science.gov (United States)

    Ang, Teck Wee Andrew

    2015-08-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.

  11. Adverse effects of extra-articular corticosteroid injections: A systematic review

    NARCIS (Netherlands)

    A. Brinks (Tineke); B.W. Koes (Bart); A.C. Volkers (Aloysius); J.A.N. Verhaar (Jan); S.M. Bierma-Zeinstra (Sita)

    2010-01-01

    textabstractBackground. To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. Methods. A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case re

  12. Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; Winters, Jan C.; Groenier, Klaas H.; Meyboom-deJong, Betty

    2009-01-01

    Background: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local

  13. Ultrasound-guided Corticosteroid Injection for the Treatment of Athletic Pubalgia: A Series of 12 Cases

    OpenAIRE

    Jean Jose; Buller, Leonard T.; Alex Fokin Jr.; Ross Wodicka; Ty Subhawong; Bryson Lesniak

    2015-01-01

    Surgical treatment for athletic pubalgia is the standard of care, however, it poses risks. This study investigated the use of ultrasound-guided corticosteroid injections as an alternative treatment. Twelve consecutive patients underwent injections into the area of degeneration in the rectus abdominis and/or adductor longus aponeurosis. The Western Ontario and McMaster Universities (WOMAC) scores were used to evaluate treatment effectiveness. The average WOMAC score was 90.9. With a mean follo...

  14. Ultrasound-guided Corticosteroid Injection for the Treatment of Athletic Pubalgia: A Series of 12 Cases

    Directory of Open Access Journals (Sweden)

    Jean Jose

    2015-06-01

    Full Text Available Surgical treatment for athletic pubalgia is the standard of care, however, it poses risks. This study investigated the use of ultrasound-guided corticosteroid injections as an alternative treatment. Twelve consecutive patients underwent injections into the area of degeneration in the rectus abdominis and/or adductor longus aponeurosis. The Western Ontario and McMaster Universities (WOMAC scores were used to evaluate treatment effectiveness. The average WOMAC score was 90.9. With a mean follow up of 8.7 months (range, 6–19 months, eight of the 12 patients reported complete symptom resolution. In conclusion, corticosteroid injections alleviate pain in patients with athletic pubalgia and provide an alternative to surgery.

  15. Short-term assessment of periradicular corticosteroid injections in lumbar radiculopathy associated with disc pathology

    Energy Technology Data Exchange (ETDEWEB)

    Viton, J.M.; Rubino, T.; Delarque, A. [Departement Universitaire de Reeducation et Readaptation, Marseille (France); Peretti-Viton, P.; Salamon, N. [Service de Neuroradiologie, C. H. U. de la Timone, 264 Rue Saint-Pierre, F-13385 Marseille Cedex 05 (France)

    1998-01-01

    We evaluated periradicular injection of corticosteroids performed by neuroradiologists under fluoroscopic guidance in the treatment of lumbosacral nerve root pain in 40 patients (average age 48 years) presenting with lumbosciatica or radiculopathy not responding to conservative treatment. Patients with root pain due to infectious, neoplastic or inflammatory diseases were excluded, as were patients who needed immediate surgery. Pain was evaluated using a visual analogue scale (VAS) 10 and 90 days after the injection. After 10 days a substantial decrease in root pain was observed, with a statistically significant decrease in mean VAS. This decrease was observed in 90 % of patients, and it persisted after 90 days in 85 %. Side effects were rare, mild and disappeared spontaneously. They were related to the drug injected (corticosteroids). (orig.) With 2 figs., 3 tabs., 24 refs.

  16. Intratympanic corticosteroids injections: a systematic review of literature.

    Science.gov (United States)

    Lavigne, Philippe; Lavigne, François; Saliba, Issam

    2016-09-01

    The objective of the study was to determine the evidence of intratympanic steroids injections (ITSI) for efficacy in the management of the following inner ear diseases: Ménière's disease, tinnitus, noise-induced hearing loss (NIHL) and idiopathic sudden sensorineural hearing loss (ISSNHL). The data sources were literature review from 1946 to December 2014, PubMed and Medline. A systematic review of the existing literature was performed. Databases were searched for all human prospective randomized clinical trials using ITSI in at least one treatment group. The authors identified 29 prospective randomized clinical trials investigating the benefits of an intratympanic delivery of steroids. Six articles on Ménière's disease were identified, of which one favored ITSI over placebo in vertigo control. Of the five randomized clinical trials on tinnitus therapy, one study found better tinnitus control with ITSI. The only available trial on NIHL showed significant hearing recovery with combination therapy (ITSI and oral steroids therapy). Seventeen studies were identified on ISSNHL, of which 10 investigated ITSI as a first-line therapy and 7 as a salvage therapy. Studies analysis found benefits in hearing recovery in both settings. Due to heterogeneity in treatment protocols and follow-up, a meta-analysis was not performed. Given the low adverse effects rates of ITSI therapy and good patient tolerability, local delivery should be considered as an interesting adjunct to the therapy of the ISSNHL and NIHL. Only one article over six where ITSI therapy offers potential benefits to patients with Ménière's disease in the control of tinnitus and vertigo was found. ITSI does not seem to be effective in the treatment of tinnitus.

  17. Physical therapy, corticosteroid injection, and extracorporeal shock wave treatment in lateral epicondylitis. Clinical and ultrasonographical comparison.

    Science.gov (United States)

    Gündüz, Rukiye; Malas, Fevziye Ünsal; Borman, Pınar; Kocaoğlu, Seher; Özçakar, Levent

    2012-05-01

    The aim of this study was to compare--clinically and ultrasonographically--the therapeutic effects of physical therapy modalities (hot pack, ultrasound therapy, and friction massage), local corticosteroid injection, and extracorporeal shock wave treatment (ESWT) in lateral epicondylitis (LE). Fifty-nine elbows of 59 patients with LE were randomized into three treatment groups receiving either physical therapy, a single corticosteroid injection, or ESWT. Visual analogue scale (VAS) was used to assess pain intensity, Jamar hydraulic dynamometer for grip strength, finger dynamometer for pinch strength (before treatment, on the first, third, and sixth months of treatment). All subjects were also evaluated with ultrasonography before and 6 months after treatment. In all groups, VAS scores of the patients were found to decrease significantly on the first, third, and sixth months of treatment. With respect to grip strength evaluations, the increase after treatment was significant only on the first month in group II; on the first and third months in group I; and on the first, third, and sixth months of treatment in group III. Pinch strength and ultrasonographical findings did not change during follow-up in any group. We imply that physical therapy modalities, corticosteroid injection, and ESWT have favorable effects on pain and grip strength in the early period of LE treatment. The increase in grip strength lasts longer with ESWT. On the other hand, ultrasonographic findings do not change in the first six months of these treatment methods.

  18. Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome.

    Science.gov (United States)

    Roh, Y H; Lee, B K; Baek, J R; Park, M H; Noh, J H; Gong, H S; Baek, G H

    2016-11-01

    Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome.

  19. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice : Randomised, single blind study

    NARCIS (Netherlands)

    Winters, Jan C.; Sobel, J.S.; Groenier, Klaas H.; Arendzen, J.H.; Meyboom-de Jong, B.

    1997-01-01

    Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice. Design: Randomised, single blind study. Setting: Seven general practices in the Netherlands. Subjects: 198 patients with shoulder compla

  20. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice : Randomised, single blind study

    NARCIS (Netherlands)

    Winters, Jan C.; Sobel, J.S.; Groenier, Klaas H.; Arendzen, J.H.; Meyboom-de Jong, B.

    1997-01-01

    Objective: To compare the efficacy of physiotherapy, manipulation, and corticosteroid injection for treating patients with shoulder complaints in general practice. Design: Randomised, single blind study. Setting: Seven general practices in the Netherlands. Subjects: 198 patients with shoulder

  1. Treatment of degenerative chronic low back pain with fluoroscopically guided epidural procaine-corticosteroid injection

    Directory of Open Access Journals (Sweden)

    Ćulafić Slobodan

    2008-01-01

    Full Text Available Background/Aim. Low back pain is one of the most common painful conditions in the modern age. Therefore, it is very important to establish the most effective protocol for the treatment of this condition. The aim of this study was to find out if fluoroscopically, guided epidural procainecorticosteroid injection is effective in the treatment of degenerative chronic low back pain. Methods. This prospective cohort study was performed in the Military Medical Academy from September 2005 to June 2006 and included 60 patients of both sexes, 34-85 years of age. Degenerative changes of lumbosacral spine were determined by magnetic resonance imaging. The intensity of low back pain was evaluated by subjective (Roland's scale and objective parameter (Lazarevic sign. Epidural procaine-corticosteroid injection was applied in the patients with low back pain not responding to conservative therapy. After the application of injection, effects of the therapy were followed up. Results. In 92% of the patients there was a reduction of pain intensity for three months, in 4.8% a reduction for a month, but after another injection they felt pain reduction for the next three months. One patient (2.3% had pain reduction for one month. Conclusion. In the treatment of degenerative chronic low back pain, not responding to conservative therapy with nonsteroidal anti-inflammatory drugs, epidural procaine-corticosteroid injection have a satisfactory short-term as well as a long-term analgesic effect.

  2. Subcutaneous Rupture of the Extensor Pollicis Longus Tendon after Corticosteroid Injections for DeQuervain’s Stenosing Tenovaginitis

    OpenAIRE

    Hassan Boussakri; Amara Bouali

    2014-01-01

    DeQuervain’s stenosing tenovaginitis is a common condition. Nonsurgical treatment by corticosteroid injection has significantly improved the management of this disease. The authors describe a case of subcutaneous rupture of the extensor pollicis longus tendon at the wrist, three months after two corticosteroid injections for DeQuervain’s stenosing tenovaginitis. The etiological history has not found any trauma history of the wrist. The aim of our work is to draw attention to this rare complic...

  3. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.

    Science.gov (United States)

    Shams, Ahmed; El-Sayed, Mohamed; Gamal, Osama; Ewes, Waled

    2016-12-01

    Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0-5 scale. Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in

  4. Corticosteroid injection with or without thumb spica cast for de Quervain tenosynovitis.

    Science.gov (United States)

    Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Bahrami, Farzaneh; Hashemi-Motlagh, Kevyan; Saheb-Ekhtiari, Khashayar; Akhoondzadeh, Niloofar

    2014-01-01

    To compare the corticosteroid injection (CSI) with or without thumb spica cast (TSC) for de Quervain tendinitis. In this prospective trial, 67 eligible patients with de Quervain tenosynovitis were randomly assigned into CSI + TSC (33 cases) and CSI (34 cases) groups. All patients received 40 mg of methylprednisolone acetate with 1 cc lidocaine 2% in the first dorsal compartment at the area of maximal point tenderness. The primary outcome was the treatment success rate, and the secondary outcome was the scale and quality of the treatment method using Quick Disabilities of Arm, Shoulder and Hand and visual analog scale scores. The groups had no differences in mean age, sex, and occupation. The visual analog scale and Quick Disabilities of the Arm, Shoulder and Hand scores were similar in both groups before the treatment. The treatment success rate was 93% in the CSI + TSC group and 69% in the CSI group. Although both methods improved the patients' conditions significantly in terms of relieving pain and functional ability, CSI + TSC had a significantly higher treatment success rate. The combined technique of corticosteroid injection and thumb spica casting was better than injection alone in the treatment of de Quervain tenosynovitis in terms of treatment success and functional outcomes. Therapeutic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report.

    Science.gov (United States)

    Kabataş, Serdar; Gümüş, Burçak; Yilmaz, Cem; Caner, Hakan

    2008-07-01

    The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It is an important cause of buttock pain that may often be accompanied by sciatica. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The diagnosis relies on the clinical presentation and the electromyelography (EMG) findings. Other causes of symptoms should be excluded by careful examination and detailed neuroradiological studies of the lumbosacral spine, sacro-iliac and hip joints. A case of this syndrome seen in a 36-year-old man who recovered by CT-guided corticosteroid injection is reported.

  6. Effectiveness of intramuscular corticosteroid injection versus placebo injection in patients with hip osteoarthritis: design of a randomized double-blinded controlled trial

    Directory of Open Access Journals (Sweden)

    Dorleijn Desirée MJ

    2011-12-01

    Full Text Available Abstract Background Recent international guidelines recommend intra-articular corticosteroid injections for patients with hip osteoarthritis who have moderate to severe pain and do not respond satisfactorily to oral analgesic/anti-inflammatory agents. Of the five available randomized controlled trials, four showed positive effects with respect to pain reduction. However, intra-articular injection in the hip is complex because the joint is adjacent to important neurovascular structures and cannot be palpated. Therefore fluoroscopic or ultrasound guidance is needed. The systemic effect of corticosteroids has been studied in patients with impingement shoulder pain. Gluteal corticosteroid injection was almost as effective as ultrasound-guided subacromial corticosteroid injection. Such a clinically relevant effect of a systemic corticosteroid injection offers a less complex alternative for treatment of patients with hip osteoarthritis not responsive to oral pain medication. Methods/Design This is a double-blinded, randomized controlled trial. A total of 135 patients (aged > 40 years with hip osteoarthritis and persistent pain despite oral analgesics visiting a general practitioner or orthopaedic surgeon will be included. They will be randomized to a gluteal intramuscular corticosteroid injection or a gluteal intramuscular placebo (saline injection. The randomization will be stratified for setting (general practitioner and outpatient clinics of department of orthopaedics. Treatment effect will be evaluated by questionnaires at 2, 4, 6, and 12 weeks follow-up and a physical examination at 12 weeks. Primary outcome is severity of hip pain reported by the patients at 2-week follow-up. Statistical analyses will be based on the intention-to-treat principle. Discussion This study will evaluate the effectiveness of an intramuscular corticosteroid injection on pain in patients with hip osteoarthritis. Patient recruitment has started. Trial Registration This

  7. Comparative study on the effectiveness of corticosteroid injections between trigger fingers with and without proximal interphalangeal joint flexion contracture.

    Science.gov (United States)

    Shinomiya, R; Sunagawa, T; Nakashima, Y; Kawanishi, Y; Masuda, T; Ochi, M

    2016-02-01

    Trigger fingers with proximal interphalangeal joint flexion contracture are suggested to have a poorer response to corticosteroid injection than those without contracture, though this has not been proven scientifically. We compared the clinical response to corticosteroid injection between trigger fingers with and without proximal interphalangeal joint contracture, and investigated the influence of the injection on the A1 pulley and flexor digitorum tendons using ultrasonography. One month after injection, pain was significantly reduced in the no contracture group, and 56% of trigger fingers with proximal interphalangeal joint contracture resolved. Before injection, relative thickening of the A1 pulley and flexor digitorum tendons, and a partial hypoechoic lesion of the flexor digitorum superficialis tendon were observed in the contracture group. One month after injection, the thickening of the tendons and the A1 pulley was reduced, but the partial hypoechoic lesion was still observed in significant numbers. We have demonstrated that the presence of a proximal interphalangeal joint contracture was associated with a reduced clinical response to corticosteroid injection, and we suggest that the pathologic change in the flexor digitorum superficialis tendon, represented by the partial hypoechoic lesion, contributed to corticosteroid injection resistance. IV. © The Author(s) 2015.

  8. A randomized clinical trial on comparison of corticosteroid injection with or without splinting versus saline injection with or without splinting in patients with lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Tahririan

    2014-01-01

    Full Text Available Background: Lateral epicondylitis is a common problem affecting 1-3% of the population. There has been much debate about the best treatment modality for this condition. There is, however, no conclusive evidence in support of any of the proposed treatment modalities. In this trial, we have studied the effect of corticosteroid injection (with or without splinting with normal saline injection (with or without splinting. Materials and Methods: In this double-blind, randomized clinical trial, individuals were randomly assigned to either of four treatment groups and received either 40 mg depomedrol injection alone, 40 mg depomedrol injection with splinting, normal saline injection alone, or normal saline injection with splinting. They were evaluated using the visual analog scale (VAS at weeks 2, 4 and 24 and with the Oxford elbow scale (OES at 24 weeks. Results: A total of 79 patients were participated in the study. The corticosteroid injection groups had better pain relief as measured by VAS at 2 and 4 weeks compared with the two saline injection groups. Mean VAS difference at week 0 versus week 2 was 4.5 ± 0.9 and 2.8 ± 0.6 in corticosteroid injection groups and saline injection groups respectively (P < 0.01 but at 24 weeks, there was only moderate benefit reported for the group which received steroid injection and splinting (P < 0.01 compared to the saline injection groups. The saline injection groups reported better improvement in OES scores (20.1 ± 3.7 at the end of the trial compared corticosteroid injection groups (16.1 ± 2.9 (P < 0.05. Conclusion: Our results indicate that despite the clear pain reduction benefit associated with steroid injection in short term, this benefit in comparison with normal saline injection fades by the 24 th week of follow-up.

  9. Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus.

    Science.gov (United States)

    Catalano, Louis W; Glickel, Steven Z; Barron, O Alton; Harrison, Richard; Marshall, Astrid; Purcelli-Lafer, Marissa

    2012-12-01

    Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. The purpose of this study was to examine the systemic impact of extra-articularly administered corticosteroids in the hand and wrist on serum glucose concentration in patients with diabetes mellitus.Twenty-three patients with diabetes mellitus received a 1-mL triamcinolone acetonide injection for de Quervain's tenosynovitis, trigger finger, flexor carpi ulnaris tendonitis, or carpal tunnel syndrome. Patients recorded their daily morning blood glucose levels for 1 week before injection and for 4 weeks after injection. Average blood glucose levels increased slightly from baseline after injection, reaching statistical significance 1, 5, and 6 days after injection, but were not clinically significant (average increase, 14.2, 9.7, and 32.7 mg/dL, respectively). Isolated increases more than 2 times the standard deviation of preinjection values occurred at least once in the majority of patients. The frequency of hyperglycemic episodes increased after injection, but the proportions of patients with at least 1 hyperglycemic episode before and after injection were not significantly different.These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk.

  10. Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practice

    Directory of Open Access Journals (Sweden)

    Verhaar Jan AN

    2007-09-01

    Full Text Available Abstract Background Regional pain in the hip in adults is a common cause of a general practitioner visit. A considerable part of patients suffer from (greater trochanteric pain syndrome or trochanteric bursitis. Local corticosteroid injections is one of the treatment options. Although clear evidence is lacking, small observational studies suggest that this treatment is effective in the short-term follow-up. So far, there are no randomised controlled trials available evaluating the efficacy of injection therapy. This study will investigate the efficacy of local corticosteroid injections in the trochanter syndrome in the general practice, using a randomised controlled trial design. The cost effectiveness of the corticosteroid injection therapy will also be assessed. Secondly, the role of co-morbidity in relation to the efficacy of local corticosteroid injections will be investigated. Methods/Design This study is a pragmatic, open label randomised trial. A total of 150 patients (age 18–80 years visiting the general practitioner with complaints suggestive of trochanteric pain syndrome will be allocated to receive local corticosteroid injections or to receive usual care. Usual care consists of analgesics as needed. The randomisation is stratified for yes or no co-morbidity of low back pain, osteoarthritis of the hip, or both. The treatment will be evaluated by means of questionnaires at several time points within one year, with the 3 month and 1 year evaluation of pain and recovery as primary outcome. Analyses of primary and secondary outcomes will be made according to the intention-to-treat principle. Direct and indirect costs will be assessed by questionnaires. The cost effectiveness will be estimated using the following ratio: CE ratio = (cost of injection therapy minus cost of usual care/(effect of injection therapy minus effect of usual care. Discussion This study design is appropriate to estimate effectiveness and cost-effectiveness of the

  11. Conceptual Optimisation of the TDI and TCDD Protections for LHC Injection Lines

    CERN Document Server

    Sala, P R; CERN. Geneva. AB Department

    2003-01-01

    The TDI (Injection Stoppers) and TCDD (Injection Collimators) for LHC are mobile beam obstacles that will protect the superconducting machine elements during injection. Simulations have been performed to investigate the TDI and TCDD performances and optimise their design. Mechanical aspects are not treated in the present work, and further definition of the details of the design is left to a conclusive report. The need for the TCDD collimator has been demonstrated. The original design goal, that was to prevent quenches in pilot bunch operation and damage in all faulty conditions, has been upgraded to prevent quenches in all cases not involving a MKI (Injection kicker) failure.

  12. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy

    DEFF Research Database (Denmark)

    Kongsgaard, M.; Kovanen, V.; Aagaard, P.

    2009-01-01

    A randomized-controlled single-blind trial was conducted to investigate the clinical, structural and functional effects of peritendinous corticosteroid injections (CORT), eccentric decline squat training (ECC) and heavy slow resistance training (HSR) in patellar tendinopathy. Thirty-nine male...... patients were randomized to CORT, ECC or HSR for 12 weeks. We assessed function and symptoms (VISA-p questionnaire), tendon pain during activity (VAS), treatment satisfaction, tendon swelling, tendon vascularization, tendon mechanical properties and collagen crosslink properties. Assessments were made at 0...... weeks, 12 weeks and at follow-up (half-year). All groups improved in VISA-p and VAS from 0 to 12 weeks (P tendon swelling decreased (-13 +/- 9% and -12 +/- 13%, P

  13. CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, Eugenio; Rossi, Giuseppe [Istituto Ortopedico Rizzoli, University of Bologna, Department of Radiology and Interventional Angiographic Radiology, Bologna (Italy); Mavrogenis, Andreas F. [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Orthopaedic Oncology Service, Bologna (Italy); Ussia, Giuseppe; Angelini, Andrea [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Ruggieri, Pietro [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Bologna (Italy)

    2011-06-15

    To evaluate the clinical and imaging outcome of patients with symptomatic eosinophilic granuloma of the spine treated with CT-guided intralesional methylprednisolone injection after biopsy. Patients (n =19) with symptomatic solitary eosinophilic granuloma of the spine treated by CT-guided intralesional methylprednisolone injection were retrospectively studied. There were 12 males and seven females with a mean age of 17 years (range, 3-43 years). The mean follow-up was 6 years (median, 4 years; range, 0.5-19 years). Spinal location included the cervical (two patients), thoracic (seven patients), lumbar spine (eight patients), and the sacrum (two patients). Vertebra plana was observed in two patients. All patients had biopsies before treatment. Complete resolution of pain and healing of the lesion was observed in 17 patients (89.5%); none of these patients had recurrence at the latest examination. Reconstitution of the T1 and L1 vertebra plana was observed in both patients. Two patients initially diagnosed and treated for a solitary eosinophilic granuloma had constant pain after the procedure; in these patients, 6 and 12 months after the procedure, respectively, imaging showed multifocal disease and systemic therapy was administered. Complications related to the procedure were not observed. General anesthesia was administered in two patients because of intolerable pain during the procedure. In view of the benign clinical course of eosinophilic granuloma, in patients with symptomatic lesions, CT-guided intralesional corticosteroid injection is a safe and effective outpatient treatment with a low complication rate. (orig.)

  14. Efficacy of spirulina as an antioxidant adjuvant to corticosteroid injection in management of oral submucous fibrosis.

    Science.gov (United States)

    Shetty, Prathima; Shenai, Prashanth; Chatra, Laxmikanth; Rao, Prasanna Kumar

    2013-01-01

    Oral submucous fibrosis (OSF) is a chronic condition of the oral cavity which results in permanent disability. A number of studies have proven that the management of premalignant diseases should include antioxidants. Therefore, a study was carried out to evaluate the efficacy of spirulina as an antioxidant adjuvant to corticosteroid injections in the management of 40 oral submucous fibrosis subjects of south Karnataka and north Kerala. An intervention study was conducted on 40 oral submucous fibrosis cases, 40 patients were divided into two groups, group A (spirulina group) and group B (placebo group). Group A received spirulina 500 mg twice daily and biweekly intralesional steroid injection of Betamethasone 4 mg/ml for 3 months and group B was given placebo capsules twice daily and biweekly intralesional steroid injection of Betamethasone 4 mg/ml for 3 months. The results were analyzed with the paired "t" test and the unpaired "t" test. Clinical improvements in mouth opening was significant in the posttreatment period in both Spirulina and placebo groups. Both the groups showed statistically significant reduction in burning sensation. However, when both groups were compared, mouth opening and burning sensation was found to be statistically very highly significant in favor of the spirulina group. Spirulina can bring about clinical improvements in OSF patients. The observed effects suggest that spirulina can be used as an adjuvant therapy in the initial management of OSF patients. However, studies involving larger samples and longer period of treatment follow up are suggested in the future.

  15. The Effectiveness of Corticosteroid Injection for De Quervain’s Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Rowland, Patrick; Phelan, Nigel; Gardiner, Sean; Linton, Kenneth N; Galvin, Rose

    2015-01-01

    De Quervain’s stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group. Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST. PMID:26587059

  16. The Effectiveness of Corticosteroid Injection for De Quervain's Stenosing Tenosynovitis (DQST): A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Rowland, Patrick; Phelan, Nigel; Gardiner, Sean; Linton, Kenneth N; Galvin, Rose

    2015-01-01

    De Quervain's stenosing tenosynovitis (DQST) treatments include corticosteroid injection around the tendon sheath; however there is some ambiguity concerning the efficacy of this treatment. The aim of this systematic review and meta-analysis is to examine the totality of evidence relating to the use of corticosteroid injection in DQST when compared to placebo or other active treatments. A systematic literature search was conducted in July 2014. Only randomized control trials (RCTs) were included. Outcome measures included impairment, activity limitation and participation restriction. Five RCTs were identified with 165 patients, 88 in the treatment group and 77 in the control group.Patients who received corticosteroid injection (n=142) had a higher rate of resolution of symptoms [RR 2.59, 95% CI: 1.25 to 5.37, p=0.05, I2=62%]. This group reported greater pain relief as assessed by Visual Analogue Scale (VAS) at first assessment [mean difference -2.51, 95% CI: -3.11 to -1.90, p=0.0003, I2=65%] and demonstrated a statistically significant improvement in function (n=78) as measured by the DASH score and Dutch AIMS-HFF score [SMD -0.83, 95% CI: -1.54 to -0.12, p=0.02, I2=48]. This review confirms that corticosteroid injection results in a statistically significant increase in resolution of symptoms, pain relief and increased function in the treatment of DQST.

  17. Endoscopic Corticosteroid Injections Do Not Reduce Dysphagia After Endoscopic Dilation Therapy in Patients With Benign Esophagogastric Anastomotic Strictures

    NARCIS (Netherlands)

    Hirdes, Meike M. C.; van Hooft, Jeanin E.; Koornstra, Jan J.; Timmer, Robin; Leenders, Max; Weersma, Rinse K.; Weusten, Bas L. A. M.; van Hillegersberg, Richard; Henegouwen, Mark I. van Berge; Plukker, John T. M.; Wiezer, Renee; Bergman, Jaques G. H. M.; Vleggaar, Frank P.; Fockens, Paul; Siersema, Peter D.

    2013-01-01

    BACKGROUND & AIMS: Benign anastomotic strictures are often difficult to treat. We assessed the efficacy of adding corticosteroid injections to endoscopic dilation therapy with Savary bougienage. METHODS: In a multicenter, double-blind trial, 60 patients (mean age, 63 +/- 9 years; 78% male) with an u

  18. Effect of corticosteroid injection for trochanter pain syndrome: Design of a randomised clinical trial in general practice

    NARCIS (Netherlands)

    A. Brinks (Tineke); R.M. van Rijn (Rogier); A.M. Bohnen (Arthur); G.L.J. Slee (Gabriël); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2007-01-01

    textabstractBackground. Regional pain in the hip in adults is a common cause of a general practitioner visit. A considerable part of patients suffer from (greater) trochanteric pain syndrome or trochanteric bursitis. Local corticosteroid injections is one of the treatment options. Although clear

  19. Effect of corticosteroid injection for trochanter pain syndrome: Design of a randomised clinical trial in general practice

    NARCIS (Netherlands)

    A. Brinks (Tineke); R.M. van Rijn (Rogier); A.M. Bohnen (Arthur); G.L.J. Slee (Gabriël); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2007-01-01

    textabstractBackground. Regional pain in the hip in adults is a common cause of a general practitioner visit. A considerable part of patients suffer from (greater) trochanteric pain syndrome or trochanteric bursitis. Local corticosteroid injections is one of the treatment options. Although clear evi

  20. Effectiveness of intramuscular corticosteroid injection versus placebo injection in patients with hip osteoarthritis: Design of a randomized double-blinded controlled trial

    NARCIS (Netherlands)

    D.M.J. Dorleijn (Desirée); P.A.J. Luijsterburg (Pim); M. Reijman (Max); M. Kloppenburg (Margreet); J.A.N. Verhaar (Jan); P.J.E. Bindels (Patrick); P.K. Bos (Koen); S.M. Bierma-Zeinstra (Sita)

    2011-01-01

    textabstractBackground: Recent international guidelines recommend intra-articular corticosteroid injections for patients with hip osteoarthritis who have moderate to severe pain and do not respond satisfactorily to oral analgesic/anti- inflammatory agents. Of the five available randomized controlled

  1. Plasma-cell cheilitis: successful treatment with intralesional injections of corticosteroids.

    Science.gov (United States)

    Tseng, J T-P; Cheng, C-J; Lee, W-R; Wang, K-H

    2009-03-01

    Plasma-cell cheilitis is a rare inflammatory disorder of the lip characterized histologically by a band-like infiltrate of plasma cells in the upper dermis. It is considered an oral counterpart of plasma-cell balanitis. Clinically, it presents as a circumscribed, flat to slightly raised, eroded area of the lip. The cause of plasma-cell cheilitis is unknown, and the treatment is often disappointing. We describe a 55-year-old woman who had a long-lasting painful, swollen, and eroded area on her lips, which responded poorly to various topical treatments. Biopsy showed a band-like infiltrate composed mainly of mature plasma cells in the dermis. A diagnosis of plasma-cell cheilitis was made after excluding contact dermatitis, lichen planus, bacterial, fungal and spirochaete infections, and an extramedullary plasmacytoma. Dramatic improvements were observed after intralesional injections of corticosteroids. The lesion cleared up after two treatments, and there has been no recurrence in 1 year of follow-up.

  2. Comparative study of the therapeutic effects of corticosteroid injection accompanied by casting and heel pad in treatment of heel pain

    Directory of Open Access Journals (Sweden)

    Mehdi Motififard

    2008-08-01

    Full Text Available

    • BACKGROUND: Heel pain is a common condition in adults that may cause significant discomfort and disability. This study was conducted to evaluate the therapeutic effects of corticosteroid injection accompanied by casting, compared with heel pad utilization in treatment of heel pain.
    • METHODS: In this randomized clinical trial study, among patients referred to orthopedic clinics in Isfahan, Iran, from December 2004 to December 2006, 90 patients with heel pain were enrolled. They were randomly assigned into two groups. Heel pad was the only therapeutic method utilized in group A for six months. Corticosteroid injection accompanied by casting was performed for patients in group B. The evaluated information was compared before and after treatment.
    •  RESULTS: Among patients in group A, after 6 months of heel pad utilization, heel pain was completely improved in 3 patients (6.7%, relatively decreased in 22 patients (48.9% and didn't change in 20 patients (44.4%. However, among patients in group B, heel pain was completely improved in 11 patients (24.5%, decreased in 29 patients (64.4% and didn't change in 5 patients (11.1% after the treatment completed.
    • CONCLUSIONS: It seemed that corticosteroid injection in companion with casting was a more effective therapeutic method in heel pain treatment than heel pad utilization.
    • KEYWORDS: Corticosteroid injection, casting, heel pad, heel pain.

  3. Use of primary corticosteroid injection in the management of plantar fasciopathy: is it time to challenge existing practice?

    Science.gov (United States)

    Kirkland, Paul; Beeson, Paul

    2013-01-01

    Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option.

  4. A fast alternative to core plug tests for optimising injection water salinity for EOR

    DEFF Research Database (Denmark)

    Hassenkam, Tue; Andersson, Martin Peter; Hilner, Emelie Kristin Margareta

    2014-01-01

    the relationship between the wettability of pore surfaces and water salinity. We functionalise AFM tips with organic molecules and use them to represent tiny oil droplets of nonpolar or polar molecules and we use sand grains removed from core plugs to represent the pore walls in sandstone. We bring our "oil" close......Core tests have demonstrated that decreasing the salinity of injection water can increase oil recovery. Although recovery is enhanced by simply decreasing salt content, optimising injection water salinty would offer a clear economic advantage for several reasons. Too low salinity risks swelling...... of the clays which would lead to permanent reservoir damage but evidence of effectiveness at moderate salinity would offer the opportunity to dispose of produced water. The goal is to define boundary conditions so injection water salinity is high enough to prevent reservoir damage and low enough to induce...

  5. Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee

    DEFF Research Database (Denmark)

    Henriksen, Marius; Christensen, Robin; Klokker, Louise

    2015-01-01

    placebo injection given before exercise therapy at an OA outpatient clinic from October 1, 2012, through April 2, 2014. The participants had radiographic confirmation of clinical OA of the knee, clinical signs of localized inflammation in the knee, and knee pain during walking (score >4 on a scale of 0...... to 10). INTERVENTIONS: Participants were randomly allocated (1:1) to an intra-articular 1-mL injection of the knee with methylprednisolone acetate (Depo-Medrol), 40 mg/mL, dissolved in 4 mL of lidocaine hydrochloride (10 mg/mL) (corticosteroid group) or a 1-mL isotonic saline injection mixed with 4 m......L of lidocaine hydrochloride (10 mg/mL) (placebo group). Two weeks after the injections, all participants started a 12-week supervised exercise program. MAIN OUTCOMES AND MEASURES: The primary outcome was change in the Pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire (range...

  6. The effectiveness of injections of hyaluronic acid or corticosteroid in patients with subacromial impingement: a three-arm randomised controlled trial.

    Science.gov (United States)

    Penning, L I F; de Bie, R A; Walenkamp, G H I M

    2012-09-01

    A total of 159 patients (84 women and 75 men, mean age of 53 (20 to 87)) with subacromial impingement were randomised to treatment with subacromial injections using lidocaine with one of hyaluronic acid (51 patients), corticosteroid (53 patients) or placebo (55 patients). Patients were followed up for 26 weeks. The primary outcome was pain on a visual analogue score (VAS), and secondary outcomes included the Constant Murley score, shoulder pain score, functional mobility score, shoulder disability questionnaire and pain-specific disability score. The different outcome measures showed similar results. After three, six and 12 weeks corticosteroid injections were superior to hyaluronic acid injections and only at six weeks significantly better than placebo injections. The mean short-term reduction in pain on the VAS score at 12 weeks was 7% (SD 2.7; 97.5% confidence interval (CI) 0.207 to 1.55; p = 0.084) in the hyaluronic acid group, 28% (SD 2.8; 97.5% CI 1.86 to 3.65; p hyaluronic acid group, 72% (38 of 53) of those in the corticosteroid group and 69% (38 of 55) of those in the placebo group. We were not able to show a convincing benefit from hyaluronic acid injections compared with corticosteroid or placebo injections. Corticosteroid injections produced a significant reduction in pain in the short term (three to 12 weeks), but in the long term the placebo injection produced the best results.

  7. Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study.

    Science.gov (United States)

    Lee, Doo-Hyung; Hong, Ji Yeon; Lee, Michael Young; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-05-01

    To evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. Prospective, longitudinal comparison study. University-affiliated tertiary care hospital. Patients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness 2mm and effusion thickness 2mm. A single subacromial injection with 20mg of triamcinolone acetonide. Visual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. There were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. A patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Image intensifier-guided injection of corticosteroid and local anesthetic agent for the treatment of recalcitrant plantar fasciitis.

    Science.gov (United States)

    Atkins, Kate L; Chin, Kuen Foo; Noorani, Ali M; Nairn, David S

    2010-08-01

    Plantar fasciitis is the most common cause of plantar heel pain. The condition is potentially self-limiting and can respond to conservative treatment, but patients may opt for surgery if the treatments fail. Surgical intervention is associated with potential complications. This study set out to explore the efficacy of the specific nonsurgical intervention offered to treatment-resistant cases in a local clinical setting. The technique involves image intensifier-guided injection of corticosteroid and local anesthetic agents under general anesthesia. Nineteen patients with recalcitrant plantar fasciitis of over 12 months' duration received injections. A simple follow-up questionnaire was given to patients after the procedure that focused on their subjective opinion of any change in their pain. They were also asked if the injection had solved their problems with heel pain. The improvements that the patients reported were found to be statistically significant (P = .012).

  9. Computed tomography-guided bupivacaine and corticosteroid injection for the treatment of symptomatic calcification in the great toe tendon

    Directory of Open Access Journals (Sweden)

    Karatoprak O

    2014-04-01

    Full Text Available Omer Karatoprak,1 Sinan Karaca,2 Mehmet Nuri Erdem,3 Ozgur Karaman,2 Azmi Hamzaoglu41Department of Orthopedic Surgery, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey; 2Department of Orthopedic Surgery, Fatih Sultan Mehmet Training and Research Hospital Atasehir, Istanbul, Turkey; 3Department of Orthopedics and Traumatology, Kolan International Hospital Sisli, Istanbul, Turkey; 4Department of Orthopedic Surgery, Istanbul Florence Nightingale Hospital, Istanbul TurkeyBackground: Calcification in the great toe tendon is a rare disorder that is characterized by the deposition of calcium on degenerative collagen fibrils.Case presentations: In this report, we present two cases of calcific tendonitis: one in the adductor hallucis and the other in the flexor hallucis longus tendon. We preferred computed tomography-guided steroid injection in our cases because of pain unresponsive to conservative treatment. Patients were free of symptoms at the follow-up visit, 4 weeks after injection.Conclusion: Calcification of the hallux tendons is a rare disorder. Treatment of tendonitis consists of nonsteroidal anti-inflammatory drugs. Local anesthetic and steroid injection may be considered in cases unresponsive to conservative treatment. Because of the anatomic location of tendons, injection could be difficult. Computed tomography guidance may improve the success rate of injections.Keywords: bupivacaine, calcification, great toe tendons, corticosteroid injection

  10. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Cunnington, Joanna

    2010-07-01

    Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.

  11. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

    Directory of Open Access Journals (Sweden)

    Eduardo Machado

    2013-10-01

    Full Text Available INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve patients' functions who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October of 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

  12. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

    Science.gov (United States)

    Beyazal, Münevver Serdaroğlu; Devrimsel, Gül

    2015-12-01

    [Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

  13. Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT: evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

    Directory of Open Access Journals (Sweden)

    Byford Sarah

    2006-09-01

    Full Text Available Abstract Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics. The Randomised Injectable Opioid Treatment Trial (RIOTT is a multisite, prospective open-label randomised controlled trial (RCT examining the role of treatment with injected opioids (methadone and heroin for the management of heroin dependence in patients not responding to conventional substitution treatment. Specifically, the study examines whether efforts should be made to optimise methadone treatment for such patients (e.g. regular attendance, supervised dosing, high oral doses, access to psychosocial services, or whether such patients should be treated with injected methadone or heroin. Eligible patients (in oral substitution treatment and injecting illicit heroin on a regular basis are randomised to one of three conditions: (1 optimized oral methadone treatment (Control group; (2 injected methadone treatment; or (3 injected heroin treatment (with access to oral methadone doses. Subjects are followed up for 6-months, with between-group comparisons on an intention-to-treat basis across a range of outcome measures. The primary outcome is the proportion of patients who discontinue regular illicit heroin use (operationalised as providing >50% urine drug screens

  14. Does Immediate Pain Relief After an Injection into the Sacroiliac Joint with Anesthetic and Corticosteroid Predict Subsequent Pain Relief?

    Science.gov (United States)

    Schneider, Byron J; Huynh, Lisa; Levin, Josh; Rinkaekan, Pranathip; Kordi, Ramin; Kennedy, David J

    2017-05-17

    To determine if immediate pain response following an injection with local anesthetic and corticosteroid predicts subsequent relief.  Prospective observational cohort.  An institutional review board-approved prospective study from a single academic medical center.  Patients with clinical diagnosis of sacroiliac (SIJ) pain and referred for SIJ injection were enrolled; 1 cc of 2% lidocaine and 1 cc of triamcinolone 40 mg/mL were injected into the SIJ. Pain score on 0-10 numeric rating scale (NRS) during provocation maneuvers was recorded immediately before injection, immediately after injection, and at two and four weeks of follow-up. Oswestry Disability Index (ODI) was also recorded.  Various cutoffs were identified to establish positive anesthetic response and successful outcomes at follow-up. These were used to calculated likelihood ratios. Of those with 100% anesthetic response, six of 11 (54.5%, 95% confidence interval [CI]+/-29.4%, +LR 2.6, 95% CI = 1.1-5.9) demonstrated 50% or greater pain relief at follow-up, and four of 11 (36.5%, 95% CI+/-28.4%, +LR 3.00, 95% CI = 1.4-5.1) had 100% relief at two to four weeks. Fourteen of 14 (100%, 95% CI+/-21.5%, -LR 0.0, 95% CI = 0.0-2.1) with an initial negative block failed to achieve 100% relief at follow-up.  Patients who fail to achieve initial relief after SIJ injection with anesthetic and steroid are very unlikely to achieve significant pain relief at follow-up; negative likelihood ratios (LR) in this study, based on how success is defined, range between 0 and 0.9. Clinically significant positive likelihood ratios of anesthetic response to SIJ injection are more limited and less robust, but are valuable in predicting 50% relief or 100% relief at two to four weeks.

  15. Treatment of esophageal stricture due to lichen planus with intralesional corticosteroid injection.

    Science.gov (United States)

    Köksal, Aydin S; Yildiz, Hakan; Odemiş, Bülent; Sengül, Ayşegül

    2014-02-01

    Herein we presented a male patient with esophageal stricture due to lichen planus successfully treated with repeated injections of intralesional triamcinolone and review the current literature on esophageal lichen planus with special emphasis on its treatment.

  16. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study.

    Science.gov (United States)

    Srivastava, Puja; Aggarwal, Amita

    2016-06-01

    Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site.

  17. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G

    2007-07-01

    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  18. Exercise therapy after ultrasound-guided corticosteroid injections in patients with subacromial pain syndrome

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Christensen, Robin; Rosager, Sara;

    2016-01-01

    BACKGROUND: Subacromial pain syndrome (SAPS) accounts for around 50 % of all cases of shoulder pain. The most commonly used treatments are glucocorticosteroid (steroid) injections and exercise therapy; however, despite treatment SAPS patients often experience relapse of their symptoms. Therefore...... the clinical effect of combining steroid and exercise therapy is highly relevant to clarify. The aim of this randomized controlled trial was to investigate if exercise therapy added to steroid injection in patients with SAPS will improve the effect of the injection therapy on shoulder pain. METHODS...... four pain measurements. The only difference between groups was seen by US examination at week 13, where fewer participants with impingement were observed in the intervention group compared with the controls (9 vs. 19 participants; P = 0.03). CONCLUSION: Exercise therapy in the painful shoulder in SAPS...

  19. The Risk of Vocal Fold Atrophy after Serial Corticosteroid Injections of the Vocal Fold.

    Science.gov (United States)

    Shi, Lucy L; Giraldez-Rodriguez, Laureano A; Johns, Michael M

    2016-11-01

    The aim of this study was to illustrate the risk of vocal fold atrophy in patients who receive serial subepithelial steroid injections for vocal fold scar. This study is a retrospective case report of two patients who underwent a series of weekly subepithelial infusions of 10 mg/mL dexamethasone for benign vocal fold lesion. Shortly after the procedures, both patients developed a weak and breathy voice. The first patient was a 53-year-old man with radiation-induced vocal fold stiffness. Six injections were performed unilaterally, and 1 week later, he developed unilateral vocal fold atrophy with new glottal insufficiency. The second patient was a 67-year-old woman with severe vocal fold inflammation related to laryngitis and calcinosis, Raynaud's phenomenon, esophagean dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. Five injections were performed bilaterally, and 1 week later, she developed bilateral vocal fold atrophy with a large midline glottal gap during phonation. In both cases, the steroid-induced vocal atrophy resolved spontaneously after 4 months. Serial subepithelial steroid infusions of the vocal folds, although safe in the majority of patients, carry the risk of causing temporary vocal fold atrophy when given at short intervals. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  20. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis.

    Science.gov (United States)

    Weinstein, P S; Canoso, J J; Wohlgethan, J R

    1984-01-01

    Forty-seven patients with traumatic olecranon bursitis were evaluated after a mean follow-up of 31 months (range 6 to 62 months). Twenty-two patients treated with bursal aspiration had delayed recovery and no complications of therapy. Twenty-five patients treated with intrabursal injection of 20 mg of triamcinolone hexacetonide had rapid recovery, usually within one week, but suffered complications such as infection (3 cases), skin atrophy (5 cases), and chronic local pain (7 cases). Since spontaneous resolution can be expected, a conservative approach is suggested in the treatment of traumatic olecranon bursitis. Images PMID:6696516

  1. Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

    Science.gov (United States)

    Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Hassanzadeh, Zabihallah; Mirbolook, Ahmadreza; Asadi, Kamran; Ettehad, Hossein; Hashemi-Motlagh, Keyvan; Saheb-Ekhtiari, Khashayar; Fallah-Alipour, Keyvan

    2015-01-01

    The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute ( .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes.

  2. Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: A protocol for a randomised, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Holmedal Øystein

    2009-12-01

    Full Text Available Abstract Background Lateral epicondylitis is a painful condition responsible for loss of function and sick leave for long periods of time. In many countries, the treatment guidelines recommend a wait-and-see policy, reflecting that no conclusions on the best treatment can be drawn from the available research, published studies and meta-analyses. Methods/Design Randomized double blind controlled clinical trial in a primary care setting. While earlier trials have either compared corticosteroid injections to physical therapy or to naproxen orally, we will compare the clinical effect of physiotherapy alone or physiotherapy combined with corticosteroid injection in the initial treatment of acute tennis elbow. Patients seeing their general practitioner with lateral elbow pain of recent onset will be randomised to one of three interventions: 1: physiotherapy, corticosteroid injection and naproxen or 2: physiotherapy, placebo injection and naproxen or 3: wait and see treatment with naproxen alone. Treatment and assessments are done by two different doctors, and the contents of the injection is unknown to both the treating doctor and patient. The primary outcome measure is the patient's evaluation of improvement after 6, 12, 26 and 52 weeks. Secondary outcome measures are pain, function and severity of main complaint, pain-free grip strength, maximal grip strength, pressure-pain threshold, the patient's satisfaction with the treatment and duration of sick leave. Conclusion This article describes a randomized, double blind, controlled clinical trial with a one year follow up to investigate the effects of adding steroid injections to physiotherapy in acute lateral epicondylitis. Trial Registration ClinicalTrials.gov Identifier: NCT00826462

  3. Optimisation thermique de moules d'injection construits par des processus génératifs

    Science.gov (United States)

    Boillat, E.; Glardon, R.; Paraschivescu, D.

    2002-12-01

    Une des potentialités les plus remarquables des procédés de production génératifs, comme le frittage sélectif par laser, est leur capacité à fabriquer des moules pour l'injection plastique équipés directement de canaux de refroidissement conformes, parfaitement adaptés aux empreintes Pour que l'industrie de l'injection puisse tirer pleinement parti de cette nouvelle opportunité, il est nécessaire de mettre à la disposition des moulistes des logiciels de simulation capables d'évaluer les gains de productivité et de qualité réalisables avec des systèmes de refroidissement mieux adaptés. Ces logiciels devraient aussi être capables, le cas échéant, de concevoir le système de refroidissement optimal dans des situations où l'empreinte d'injection est complexe. Devant le manque d'outils disponibles dans ce domaine, le but de cet article est de proposer un modèle simple de moules d'injection. Ce modèle permet de comparer différentes stratégies de refroidissement et peut être couplé avec un algorithme d'optimisation.

  4. Isolated iliotibial band rupture after corticosteroid injection as a cause of subjective instability and knee pain in a military special warfare trainee.

    Science.gov (United States)

    Pandit, Sandeep R; Solomon, Daniel J; Gross, Daniel J; Golijanin, Petar; Provencher, Matthew T

    2014-04-01

    Iliotibial band friction syndrome (ITBFS) of the knee is a common overuse injury in athletes, especially in runners. The syndrome occurs when the ITB, a lateral thickening of the fascia lata of the thigh moves repetitively over the lateral femoral condyle. A variety of nonoperative measures are used for ITBFS treatment, including stretching, core strengthening, and therapeutic injection. Isolated distal ITB rupture is a rare entity and has never yet to be reported in the orthopedic literature. We present a case of isolated ITB rupture as a cause of varus instability and knee pain in a Naval Special Warfare candidate diagnosed with ITBFS and previously treated with several local corticosteroid injections before ITB rupture. Because of continued knee pain and a sense of instability, along with an inability to return to his military special warfare duties, the ITB was surgically repaired. This case highlights the presentation and management of isolated distal ITB rupture and discusses some of the potential risk factors for rupture, including prior local corticosteroid injection.

  5. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial.

    Science.gov (United States)

    Forogh, Bijan; Mianehsaz, Elaheh; Shoaee, Shervan; Ahadi, Tannaz; Raissi, Gholam R; Sajadi, Simin

    2016-01-01

    Evidence on the effect of platelet-rich plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS). In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-Meter-Walk Test (20MW), active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. Forty-one participants (48 knees) were involved in the research (66.7% women; average age of 61.1±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df: 6, 35; F=11.0; P=0.007), symptom free (df:6, 35; F=23.0; P0.05). Our study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS.

  6. Emission Constrained Multiple-Pulse Fuel Injection Optimisation and Control for Fuel-Efficient Diesel Engines

    NARCIS (Netherlands)

    Luo, X.; Jager, B. de; Willems, F.P.T.

    2015-01-01

    With the application of multiple-pulse fuel injection profiles, the performance of diesel engines is enhanced in terms of low fuel consumption and low engine-out emission levels. However, the calibration effort increases due to a larger number of injection timing parameters. The difficulty of contro

  7. Emission Constrained Multiple-Pulse Fuel Injection Optimisation and Control for Fuel-Efficient Diesel Engines

    NARCIS (Netherlands)

    Luo, X.; Jager, B. de; Willems, F.P.T.

    2015-01-01

    With the application of multiple-pulse fuel injection profiles, the performance of diesel engines is enhanced in terms of low fuel consumption and low engine-out emission levels. However, the calibration effort increases due to a larger number of injection timing parameters. The difficulty of contro

  8. Optimising geological storage of CO2 by development of multiple injection sites in regionally extensive storage sandstones

    Science.gov (United States)

    Akhurst, Maxine; McDermott, Christopher; Williams, John; Mackay, Eric; Jin, Min; Tucker, Owain; Mallows, Tom; Hannis, Sarah; Pearce, Jonathan

    2016-04-01

    Carbon capture, transport and storage (CCS) is considered a key technology to provide secure, low-carbon energy supply and industrial processes to reduce the greenhouse gas emissions that contribute to the adverse effects of climatic change. Geological storage of carbon dioxide (CO2), captured during hydrocarbon production at the Sleipner Field, in strata beneath the Norwegian sector of the North Sea has been in operation since 1996. Projects to store CO2 captured at power plants in strata underlying the North Sea are currently in design. Storage of the CO2 is planned in depleted hydrocarbon fields or regionally extensive sandstones containing brine (saline aquifer sandstones). The vast majority of the UK potential storage resource is within brine-saturated sandstone formations. The sandstone formations are each hundreds to thousands of square kilometres in extent and underlie all sectors of the North Sea. The immense potential to store CO2 in these rocks can only be fully achieved by the operation of more than one injection site within each formation. Here we report an investigation into the operation of more than one injection site within a storage formation using a UK North Sea case study of the Captain Sandstone and the included Goldeneye Field, which is part of the mature hydrocarbon province offshore Scotland. Research by the CO2MultiStore project was targeted to increase understanding and confidence in the operation of two sites within the Captain Sandstone. Methods were implemented to reduce the effort and resources needed to characterise the sandstone, and increase understanding of its stability and performance during operation of more than one injection site. Generic learning was captured throughout the research relevant to the characterisation of extensive storage sandstones, management of the planned injection operations and monitoring of CO2 injection at two (or more) sites within any connected sandstone formation. The storage of CO2 can be optimised

  9. Optimising the Design Process of the Injection Camshaft by Critical Path Method (CPM)

    OpenAIRE

    Olga-Ioana Amariei; Codruţa Oana Hamat; Vadim Chistruga

    2016-01-01

    In the present paper a series of advantages of the CPM method are presented, focusing on the optimization of design duration of an injection camshaft, by cost criteria. The minimum duration of finalizing the design of the injection camshaft will be determined, as well as the total cost associated to this project, normally, and then under crash regime. At the end, two types of sensitivity analysis will be performed: Meeting the desire completation time and Meeting the desired...

  10. Optimising the Design Process of the Injection Camshaft by Critical Path Method (CPM

    Directory of Open Access Journals (Sweden)

    Olga-Ioana Amariei

    2016-10-01

    Full Text Available In the present paper a series of advantages of the CPM method are presented, focusing on the optimization of design duration of an injection camshaft, by cost criteria. The minimum duration of finalizing the design of the injection camshaft will be determined, as well as the total cost associated to this project, normally, and then under crash regime. At the end, two types of sensitivity analysis will be performed: Meeting the desire completation time and Meeting the desired budget cost

  11. A feasibility study of the effect of intra-articular corticosteroid injection on isokinetic muscle strength in children with juvenile idiopathic arthritis.

    Science.gov (United States)

    McKay, Damien; Ostring, Genevieve; Broderick, Carolyn; Chaitow, Jeffrey; Singh-Grewal, Davinder

    2013-05-01

    This study assessed the magnitude of changes in isokinetic muscle strength in children with juvenile idiopathic arthritis (JIA) before and after treatment with intra-articular corticosteroid injection and assessed the feasibility of a larger study of the same effect. Isokinetic dynamometry was used to measure peak knee extension and flexion torque in 12 children before and after treatment for unilateral knee arthritis. Extensor and flexor strength was reduced on the affected side before treatment (-0.56 Nm/kg, p = .004 and -0.24 Nm/kg, p = .02 respectively). Increases in extensor strength were observed at two weeks (p = .01) and twelve weeks postinjection (p = .03). Improvements at 6 weeks approached but did not reach statistical significance (p = .17). Improvements in flexor strength were not observed until 12 weeks postinjection (p = .03). Despite significant improvements in extensor strength, low peak knee extensor torque continued to be observed at 12 weeks (p = .01). Knee extensor and flexor strength is reduced in children with JIA with active arthritis and improves following intra-articular corticosteroid injection. Significant improvements in knee extensor and flexor strength were seen postinjection; however deficits in extensor strength were still evident at three months. Isokinetic dynamometry was safe and well tolerated in our sample of children with JIA with active arthritis.

  12. Design optimisation of a nanofluid injection system for LOCA events in a nuclear power plant

    Science.gov (United States)

    Călimănescu, I.; Stan, L. C.; Velcea, D. D.

    2016-08-01

    The safety issues inside a Nuclear Power Plant (NPP) are encompassing their capacity to ensure the heat sink, meaning the capacity of the systems to release the heat from the rector to the environment. The nanofluids having good heat transfer properties, are recommended to be used in such applications. The paper is solving the following scenario: considering the Safety Injection tank and the Nanofluid injection Tank, and considering the Nanofluid injection Tank filled with a 10% alumina-water nanofluid, how can we select the best design of the connecting point between the pipes of the SIT and the Nanofluid Tank and the pressures inside of any of these tanks in order to have the biggest density of nanoparticles leaving the tanks toward the cold leg. In conclusion the biggest influence over the rate of disposal of the nanofluid inside ECCS is that of the pressure inside the SIT followed in order by the injection pipe diameter and the pressure inside the nanofluid tank. The optimum balance of these three design parameters may be reached following the procedure shown in this paper.

  13. Corticosteroid osteoporosis.

    Science.gov (United States)

    Sambrook, P; Lane, N E

    2001-07-01

    Corticosteroids are widely used and effective agents for the control of many inflammatory diseases, but corticosteroid osteoporosis is a common problem associated with their long term high dose use. Prevention of corticosteroid osteoporosis is preferable to treatment of established corticosteroid bone loss. Several large double-blind controlled clinical trials in patients with corticosteroid osteoporosis have recently been published that provide new insights into its treatment. Based upon available evidence, the rank order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or an oestrogen type medication. Calcium alone appears to be unable to prevent rapid bone loss in patients starting corticosteroids, especially with prednisolone doses at 10 mg a day or greater. If an active vitamin D metabolite is used, calcium supplementation should be avoided unless dietary calcium intake is low. Hormone replacement therapy should be considered if hypogonadism is present. Since vertebral fracture is a common and important complication of high dose corticosteroid therapy, these findings suggest that rapid bone loss and hence fractures, can be prevented by prophylactic treatment. Although the follow-up data is limited, it is likely that such therapy needs to be continued beyond 12 months whilst patients continue significant doses of corticosteroid therapy.

  14. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Marlette Burger

    2016-02-01

    Full Text Available Background: Subacromial impingement syndrome (SIS is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs compared to physiotherapy in the management of SIS.Objective: To critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM and shoulder function in patients with SIS.Methodology:  Seven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots.Results: The PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6–7 weeks follow-up (p < 0.0001, no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1–3 months, mid- (6 months and long term (12 months.Conclusion: In patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.

  15. [Anchors and peroneous brevis tendon augmentation and plantaris muscle tendon covering for the reconstruction of achilles tendon rupture caused by corticosteroids injection].

    Science.gov (United States)

    Zhang, Li-Ning

    2014-02-01

    To investigate the clinical therapeutic effects of anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering on the reconstruction of achilles tendon rupture caused by corticosteroids injection. From March 2005 to April 2010, the clinical data of 10 patients with acute achilles tendon rupture repaired with suture anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering were retrospectively analyzed. The achilles tendon rupture was caused by corticosteroids injection. There were 8 males and 2 females with a mean age of (46.80 +/- 2.83) years old(ranged from 21 to 68 years). Postoperative complications, the range of movement of affected foot, number of consecutive heel raises and single leg jumpings were recorded. Functional recovery of achilles tendon were assessed according to ankle and hindfoot scores of the American Orthopedic Foot Ankle Society (AOFAS). All patients were followed up for 12 to 18 months with an average of 13.5 months. No wound infection, re-rupture and rejection reaction were found. At the last follow-up, there was no significant difference in the range of movement between affected foot (54.5 +/- 6.3) degrees and unaffected foot (56.8 +/- 3.8) degrees (t = 0.989, P = 0.336). The affected foot could raise heel and do single-leg hops for 10 times continuosly. There was significant difference in AOFAS between preoperative score (67.3 +/- 7.6) and postoperative score (95.5 +/- 7.6) (t = 8.297, P = 0.000);and there was no significant difference between affected foot scores (95.5 +/- 7.6)and unaffected foot scores (98.5 +/- 6.3) (t = 0.961, P = 0.349). Function recovery of achilles tendon: 9 cases were good, 1 case was fine. Anchors, peroneus brevis tendon augmentation and plantaris muscle tendon covering for the reconstruction of achilles tendon rupture caused by corticosteroids injection is a reliable and effective method, with advantage of simple operation, dependable fixation and less complications.

  16. Optimisation of current injection protocol based on a region of interest.

    Science.gov (United States)

    Faulkner, Mayo; Jehl, Markus; Aristovich, Kirill; Avery, James; Witkowska-Wrobel, Anna; Holder, David

    2017-03-29

    Electrical Impedance Tomography has the potential to image fast neural activity associated with physiological or epileptic activity throughout the brain. These applications pose a particular challenge as expected voltage changes on the electrodes are less than 1% and geometrical constraints of the body under investigation mean that electrodes can not be evenly distributed around its boundary. Unlike other applications, however, information regarding the location of expected activity is typically available. An informative method for choosing current paths that maximise sensitivity to specific regions is desirable. Two electrode addressing protocol generation methods based on current density vectors concentrated in a region of interest have been proposed. One focuses solely on maximising its magnitude while the other considers its distribution. The quality of reconstructed images using these protocols was assessed in a simulation study conducted in a human and rat mesh and compared to the protocol that maximises distance between injecting electrodes. When implementing the protocol that focused on maximising magnitude, the current density concentrated in a region of interest increased by up to a factor of 3. When the distribution of the current was maximised, the spread of current density vectors increased by up to fivefold. For the small conductivity changes expected in the applications explored, image quality was best when implementing the protocol that maximised current density. The average image error when using this protocol was 7% better than when employing other protocols. We conclude that for fast neural EIT applications, the protocol that maximises current density is the best protocol to implement.

  17. Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Cahill, Anne M.; Cho, Sandy S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Baskin, Kevin M. [Children' s Hospital of Philadelphia, Department of Pediatrics, Division of Rheumatology, Philadelphia, PA (United States); Beukelman, Timothy; Cron, Randy Q. [Children' s Hospital of Pittsburgh, Department of Radiology, Pittsburgh, PA (United States); Kaye, Robin D. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Towbin, Richard B.

    2007-06-15

    Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies. We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA). Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion. Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 {+-} 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02). Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability. (orig.)

  18. The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

    Science.gov (United States)

    Deniz, Orhan; Aygül, Recep; Kotan, Dilcan; Ozdemir, Gökhan; Odabaş, Faruk Omer; Kaya, M Dursun; Ulvi, Hızır

    2012-05-01

    The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

  19. Role of extracorporeal shockwave therapy and injectable corticosteroids in the treatment of lateral epicondylitis: a comparative study of 100 patients

    Directory of Open Access Journals (Sweden)

    Yogesh Sharma

    2016-09-01

    Results: The mean VAS in both groups reduced from 8.47 and 8.53 to 2.51 and 1.67 respectively at the end of the follow up (p <0.001 .The mean PRTEE score in Group A reduced from 80.59 to 26.53 (p<0.001 and Group B from 82.76 to 13.59 (p<0.05. In Group A (ESWT, the average reduction In PRTEE Score at the end of follow up was 54.06 and Group B (steroids was 69.16. The difference was found to be statistically significant (p<0.001 favouring steroid injections. Conclusions: Both ESWT and steroid injections were found to be effective in producing symptomatic pain relief and improving the functional disability in the management of lateral epicondylitis. The comparison of both modalities showed a statistically significant improvement in pain and functional disability in favour of steroids at a short duration of follow up i.e., 03 weeks, 06 weeks and 06 months. [Int J Res Med Sci 2016; 4(9.000: 4055-4060

  20. A multicentre randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injections

    Science.gov (United States)

    Deyle, Gail D; Gill, Norman W; Rhon, Daniel I; Allen, Chris S; Allison, Stephen C; Hando, Ben R; Petersen, Evan J; Dusenberry, Douglas I; Bellamy, Nicholas

    2016-01-01

    Introduction Corticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months. Methods and analysis We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8–12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups. Ethics and Dissemination The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source. Trial Registration

  1. CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months.

    Science.gov (United States)

    Althoff, Christian E; Bollow, Matthias; Feist, Eugen; Marticorena-Garcia, Stephan R; Eshed, Iris; Diekhoff, Torsten; Hamm, Bernd; Hermann, Kay Geert A

    2015-06-01

    Steroid injection of the sacroiliac joints is widely used for the management of active sacroiliitis in patients with spondyloarthritis (SpA). The aims of this study were to prospectively investigate the effectiveness of corticosteroid injection of the sacroiliac joints and to identify factors determining positive and negative outcome. Twenty-nine patients (18 female, 11 male) suffering from sacroiliitis were treated by computed tomography (CT)-guided administration of 40 or 60 mg triamcinolone acetonide per joint. Clinical outcome of the intervention was determined using a visual analog scale from days 1 to 7 as well as after 1, 3, and 6 months. Patients were grouped according to intra-articular (n = 22) and peri-articular positions (n = 7) of the tip of the puncture needle. In patients with intra-articular needle position (76 %), the mean pain score decreased significantly from 7.3 (±1.9) to 3.9 (±3.4) at day 7 and to 3.9 (±3.4) after 1 month, 4.2 (±3.3) after 3 months, and 5.2 (±2.9) after 6 months. The group with peri-articular needle position (24 %) did not show a statistically significant pain reduction throughout the entire 6-month follow-up period. A substantial reduction of inflammatory back pain (reduction of at least 4 visual analog scale (VAS) points) was reported by 55 % of patients after 3 months and 45 % of patients after 6 months. Our results demonstrate that intra-articular CT-guided steroid instillation can achieve sufficient pain and symptom control for 6 months in patients suffering from active sacroiliitis. It is therefore recommended to perform this intervention under appropriate image guidance to ensure proper positioning of the needle tip.

  2. Inhaled Corticosteroids

    Directory of Open Access Journals (Sweden)

    Peter J. Barnes

    2010-03-01

    Full Text Available Inhaled corticosteroids (ICS are the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2. Through suppression of airway inflammation ICS reduce airway hyperresponsiveness and control asthma symptoms. ICS are now first-line therapy for all patients with persistent asthma, controlling asthma symptoms and preventing exacerbations. Inhaled long-acting β2-agonists added to ICS further improve asthma control and are commonly given as combination inhalers, which improve compliance and control asthma at lower doses of corticosteroids. By contrast, ICS provide much less clinical benefit in COPD and the inflammation is resistant to the action of corticosteroids. This appears to be due to a reduction in HDAC2 activity and expression as a result of oxidative stress. ICS are added to bronchodilators in patients with severe COPD to reduce exacerbations. ICS, which are absorbed from the lungs into the systemic circulation, have negligible systemic side effects at the doses most patients require, although the high doses used in COPD has some systemic side effects and increases the risk of developing pneumonia.

  3. Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis.

    Science.gov (United States)

    Stoll, Matthew L; Good, Jennifer; Sharpe, Tyler; Beukelman, Timothy; Young, Daniel; Waite, Peter D; Cron, Randy Q

    2012-08-01

    The purpose of this study was to evaluate the safety and efficacy of intra-articular corticosteroid injections (IACIs) of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) when administered by an oral and maxillofacial surgeon without imaging guidance. This was a retrospective study of children with JIA, seen at a single center, who were selected based on having received IACIs of the TMJ. All subjects received the intervention, which consisted of referral to a single oral and maxillofacial surgeon for TMJ IACI with 5 to 10 mg triamcinolone hexacetonide, under general anesthesia. Primary outcomes assessed in all subjects were the safety of the procedure and efficacy as determined by the change in maximal incisal opening (MIO). In addition, a subset of 31 subjects underwent repeat magnetic resonance imaging of the TMJ, permitting analysis of the change in the acute and chronic findings of arthritis in those patients. Sixty-three patients (68% female) received 137 IACIs. The mean age for diagnosis of JIA was 8.5 years, and the mean age at presentation for TMJ injections was 10 years. The injections were well tolerated: only 1 patient developed the steroid complication of hypopigmentation, and none developed degeneration or ankylosis. In terms of efficacy, the mean MIO increased from 40.8 ± 0.93 to 43.5 ± 0.90 mm (P = .001); in addition, changing the unit of analysis to individual joints, in patients who underwent repeat magnetic resonance imaging examination, 51% of TMJs showed magnetic resonance imaging evidence of improvement of arthritic changes, of whom 18% had complete resolution of TMJ arthritis. The results indicate that IACI of the TMJ can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that IACI may be effective in the management of TMJ arthritis, although further studies are required. Copyright © 2012 American

  4. Response to injection of the navicular bursa with corticosteroid and hyaluronan following high-field magnetic resonance imaging in horses with signs of navicular syndrome: 101 cases (2000-2008).

    Science.gov (United States)

    Marsh, Chad A; Schneider, Robert K; Sampson, Sarah N; Roberts, Greg D

    2012-11-15

    To determine treatment outcome on the basis of pathological changes identified on MRI and lameness duration in horses with navicular syndrome that underwent injection of corticosteroid and hyaluronan into the navicular bursa. Retrospective case series. 101 horses with navicular syndrome. Medical records of horses with signs of navicular syndrome evaluated between January 2000 and December 2008 were reviewed. Data on signalment, use of the horse, history, affected limbs, duration of lameness, findings on lameness examination, radiographic findings, MRI findings, treatment, and outcome were collected from the medical records. Follow-up information was obtained a minimum of 10 months after navicular bursa injection. Following navicular bursa injection, 76 of 101 (75%) horses returned to their intended use for a mean of 9.66 months, and 35 (35%) were sound at follow-up. Horses that had been lame for horses that had a longer lameness history. Horses with primary deep digital flexor (DDF) tendonitis responded best to navicular bursa injection with rest and rehabilitation, followed by horses with navicular bursitis and horses with DDF tendonitis and adhesions to the collateral sesamoidean ligament of the distal sesamoid (navicular) bone. Horses with scar tissue in the proximal portion of the navicular bursa, adhesions from the navicular bone to the DDF tendon, or multiple abnormalities did not respond as well to treatment. Response to navicular bursa injection with corticosteroid and hyaluronan in horses with navicular syndrome was dependent on the disease process detected on MRI and duration of lameness.

  5. Precision of the reportable result. Simultaneous optimisation of number of preparations and injections for sample and reference standard in quantitative liquid chromatography.

    Science.gov (United States)

    Ermer, J; Agut, C

    2014-08-01

    In pharmaceutical analysis, the precision of the reportable result, i.e. the result which is to be compared to the specification limit, is relevant for the evaluation of the suitability of the analytical procedure. But also for other applications, the precision of the result is important and an optimisation often of interest. However, increasing the number of determinations (e.g. injections or preparations) will reduce only the variability (or standard error) of the corresponding precision level. Therefore, the knowledge of the individual variance contributions, obtained from reliable precision studies is important to determine on a scientific basis which format of the (reportable) result, i.e. the number of injections and sample preparations (or even series), should be used. In case of relative analytical procedures such as LC, the calibration model and format, i.e. the number of determinations of the reference standard is one of the factors (besides instrument, operator, reagents, etc.) affecting the between-series variance contribution at intermediate precision/reproducibility level. Consequently, the precision of the reportable result is only valid for the calibration format used to obtain intermediate precision/reproducibility. Instead of repeating the whole precision study to optimize the calibration format, the present paper describes a statistical approach using variability results from the original precision study.

  6. Corticosteroids reduce the tensile strength of isolated collagen fascicles

    DEFF Research Database (Denmark)

    Haraldsson, Bjarki Thor; Langberg, Henning; Aagaard, Per

    2006-01-01

    Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood.......Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood....

  7. Design of Injection and Extraction Systems with Optimisation of Lattice and Layout for the CERN PS2 Synchrotron

    CERN Document Server

    Bartmann, W

    2009-01-01

    The CERN Proton Synchrotron PS2 is one of the foreseen accelerators for the LHC injector upgrade. This upgrade aims first at increasing the instantaneous luminosity of LHC and second at providing a reliable beam for the CERN accelerator complex. From this aspect, the main characteristics of the PS2 are high reliability for high intensity beams. The goal of this thesis was the design of the machine’s lattice and injection/extraction systems meeting the constraints coming mainly from the LHC beam type but also from beam requirements of experiments at PS2 and the SPS. In the design, the given energy range together with filling schemes for different beam types and RF cogging were first used to define the circumference of the machine. Estimates on the space requirements of injection/extraction systems were made in order to divide the total machine length between arc and long straight section. Existing tunnels for transfer lines together with the minimisation of the total transfer line length favoured a race trac...

  8. 肱骨外上髁炎痛点封闭治疗220例护理观察%Local corticosteroid injection for lateral humeral epicondylitis: Observation of 220 cases

    Institute of Scientific and Technical Information of China (English)

    吴俊; 徐建达; 胡素琴; 程秀红

    2011-01-01

    目的 肱骨外上髁炎是肘部软组织损伤常见的疾病,治疗上多以保守治疗为主,且方法多样,文中旨在观察肱骨外上髁炎痛点封闭治疗的临床疗效及护理指导.方法 从2009年12月至2010年3月期间对220例肱骨外上髁炎病例进行局部痛点封闭注射醋酸泼尼松,观察临床疗效.结果 96%患者获得回访并取得了满意疗效,优良率为96.0%,半年后复发者4例,1年后复发者2例,复发率为3%.结论 局部痛点封闭治疗肱骨外上髁炎疗效确切,可作为保守治疗肱骨外上髁炎的首选方法.%Objective Lateral humeral epicondylitis is a common disease of soft tissue injuries of the elbow, and generally treated by corticosteroid injection. The authors investigated the clinical effectiveness of local corticosteroid injection in the treatment of lateral humeral epicondylitis. Methods A total of 220 patients with lateral humeral epicondylitis were injected with prednisone acetate deep into the myofascial tissue of the tender spot of the lateral humeral epicondyle, and the clinical effectiveness was observed. Results Satisfactory results were achieved in 201 of the patients, with an excellence rate of 96.0%. Occurrence was found in 4 cases 6 months later and in 2 cases 12 months later, with an occurrence rate of 3.0%. Conclusion Local corticosteroid injection is a pre ferable option for the treatment of lateral humeral epicondylitis.

  9. 关节腔注射皮质类固醇激素治疗幼年特发性关节炎%Intra-articular corticosteroid injections in the management of juvenile idiopathic arthritis

    Institute of Scientific and Technical Information of China (English)

    杨昌融; 唐雪梅

    2010-01-01

    @@ 幼年特发性关节炎(juvenile idiopathic arthritis,JIA)是儿科常见的风湿性疾病,也是儿童致残的重要原因之一.在欧美国家,关节腔注射皮质类固醇激素(intra-articular corticosteroid injections,IACIs)治疗JIA被证实是安全而有效的,通过类固醇激素在关节腔局部抑制滑膜炎症,达到迅速缓解关节症状,恢复关节功能的目的,目前已经成为治疗JIA的重要手段之一.

  10. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases)

    National Research Council Canada - National Science Library

    Teoh, Kar H; Jones, Sian A; Gurunaidu, Subramaniam; Pritchard, Mark G

    2015-01-01

    .... Subacromial septic bursitis is a recognized but rare complication. There have been no reports of methicillin-resistant Staphylococcus aureus infections of the subacromial bursa after subacromial injections in the literature...

  11. Hipersensitivity Reactions to Corticosteroids.

    Science.gov (United States)

    Berbegal, L; DeLeon, F J; Silvestre, J F

    2016-03-01

    Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  12. Type Ⅲ Collagen and histological change in treatment for rat rotator cuff injury with subacromial corticosteroid injection%肩峰下激素局部注射治疗大鼠肩袖损伤

    Institute of Scientific and Technical Information of China (English)

    韦民; 王伟; 刘祖德

    2008-01-01

    Objective To study the effect of corticosteroid on rat rotator cuff injury healing by observing histological change and quantifying the dynamic change of type Ⅲ collagen. Methods Thirty-six Sprague-Dawley rats were randomly divided into 4 groups:6 rats group A (normal rotator cuff) ,6 rats in group B (rotator cuff injury), 12 rats in group C (normal rotator cuff treated with corticosteroid) ,and 12 rats in group D (rotator cuff injury treated with corticosteroid). In the rats of groups B and D, a partialthickness rotator cuff injury was created by cutting 50% of thickness and 5 mm of width of the bilateral infraspinatus tendon 5 mm from its humeral insertion. 0.05 ml corticosteroid (Diprospan) was injected into the subacromial space of the rats in groups C and D. Total infraspinatus tendons were harvested for HE, Masson staining,immunohistochemical staining and type Ⅲ collagen quantification. Results istological change : In corticosteroid treatment groups, the normal arrangement of the collagen bundles was replaced by the disorganized collagen bundles with fragmentation of the collagen bundles and collagen necrosis at 3rd week, and the arrangement was improved very slightly at 6th week. Type In collagen : ( 1 ) The type Ⅲ collagen levels were significantly increased after the rotator cuff injury ( P < 0.05 ) ; (2) At 3rd week, the type Ⅲ collagen levels in corticoateroid treatment groups were significantly higher than in normal rotator cuff group and rotator cuff injury group ( P < 0.01 ) ; (3) At 6th week, the type Ⅲ collagen levels in rotator cuff injury treated with corticosteroid group remained on a very high level; (4) The type Ⅲ collagen levels in normal rotator cuff treated with corticosteroid group were significantly increased at 3rd week, and returned to the normal at 6th week (P > 0.05). Conclusion Corticosteroid can induce type Ⅲ collagen synthesis during rotator cuff healing, but even a single dose of corticosteriod can cause

  13. Facial Candida albicans cellulitis occurring in a patient with oral submucous fibrosis and unknown diabetes mellitus after local corticosteroid injection treatment.

    Science.gov (United States)

    Chen, Hsin-Ming; Shih, Chiang-Ching; Yen, K Lawrence; Wang, Sheng-Ming; Kuo, Ying-Shiung; Kuo, Mark Yen-Ping; Chiang, Chun-Pin

    2004-04-01

    Facial cellulitis caused by odontogenic bacterial infection is frequently encountered; however, facial cellulitis caused by Candida albicans infection is rarely found. A patient with oral submucous fibrosis (OSF) and unknown diabetes mellitus (DM) was treated in our out-patient dental clinic by biweekly submucosal injection of 40 mg triamcinolone acetonide into bilateral buccal mucosae plus forced mouth opening performed by the two hands of the clinician. The interincisal distance of the patient improved from 28 to 48 mm after four times of steroid injection. The symptoms and signs of OSF also improved markedly. Unfortunately, facial candidal cellulitis occurred 2 months after the last time of steroid injection treatment. The infection was cured by incision and drainage, intravenous administration of amphotericin B (100 mg once a day for a week), and an appropriate medical control of DM. No recurrence of facial cellulitis was found during the follow-up period of 18 months. To prevent the occurrence of facial cellulitis after a high-dose steroid therapy, some prophylactic procedures should be taken before the initiation of the steroid treatment.

  14. Orbital inflammation: Corticosteroids first.

    Science.gov (United States)

    Dagi Glass, Lora R; Freitag, Suzanne K

    2016-01-01

    Orbital inflammation is common, and may affect all ages and both genders. By combining a thorough history and physical examination, targeted ancillary laboratory testing and imaging, a presumptive diagnosis can often be made. Nearly all orbital inflammatory pathology can be empirically treated with corticosteroids, thus obviating the need for histopathologic diagnosis prior to initiation of therapy. In addition, corticosteroids may be effective in treating concurrent systemic disease. Unless orbital inflammation responds atypically or incompletely, patients can be spared biopsy.

  15. [Inhaled corticosteroids for COPD

    NARCIS (Netherlands)

    Dekhuijzen, P.N.R.

    2003-01-01

    Over 60% of patients with COPD are treated with inhaled corticosteroids (ICS), even though their use is still subject to debate. The inflammatory process in the lungs of patients with COPD is dominated by macrophages, CD8+ T-lymphocytes, neutrophilic granulocytes and mast cells, as well as an increa

  16. Corticosteroid treatment increases parasite numbers in murine giardiasis.

    OpenAIRE

    Nair, K V; Gillon, J.; Ferguson, A

    1981-01-01

    Corticosteroid therapy is known to be hazardous in patients with occult infection but the mechanism by which the host parasite relationship is altered by steroids is not known.We have used an intestinal protozoal parasite, Giardia muris, to examine the effects of corticosteroids on the number of parasites in the intestine in the course of a primary infection. A single injection of cortisone acetate, subcutaneously, one day before oral inoculation of CBA mice with 1000 cysts of Giardia muris, ...

  17. Prenatal corticosteroid exposure alters early developmental seizures and behavior

    OpenAIRE

    Velíšek, Libor

    2011-01-01

    In humans, corticosteroids are often administered prenatally to improve lung development in preterm neonates. Studies in exposed children as well as in children, whose mothers experienced significant stress during pregnancy indicate behavioral problems and possible increased occurrence of epileptic spasms. This study investigated whether prenatal corticosteroid exposure alters early postnatal seizure susceptibility and behaviors. On gestational day 15, pregnant rats were injected i.p. with hy...

  18. Update on corticosteroids for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Schwartz SG

    2016-09-01

    Full Text Available Stephen G Schwartz,1 Ingrid U Scott,2,3 Michael W Stewart,4 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 2Department of Ophthalmology, 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, 4Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA Abstract: Diabetic macular edema (DME remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME. Keywords: diabetic macular edema, vascular endothelial growth factor, triamcinolone acetonide, dexamethasone, fluocinolone acetonide, randomized clinical trial

  19. Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-guided intra-articular corticosteroid injection; Sakroiliitis bei Kinder mit Spondylarthropathie: Therapeutischer Effekt der CT-gestuetzten intraartikulaeren Kortikosteroid-Injektionen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, T.; Hermann, K.G.A.; Diekmann, F.; Hamm, B. [Humboldt-Universitaet, Berlin (Germany). Universitaetsklinikum Charite, Inst. fuer Radiologie; Biedermann, T. [HELIOS Klinikum Berlin (Germany). II. Klinik fuer Kinderheilkunde und Jugendmedizin, Abt. Kinderrheumatologie; Braun, J. [Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus (Germany); Bollow, M. [Augusta-Krankenhaus, Bochum (Germany). Inst. fuer Radiologie

    2003-06-01

    Purpose: The prospective investigation of the therapeutic effect of CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance imaging (MRI) in establishing the indication and monitoring the therapy. Materials and Methods: The study comprises 89 children with known jSpA who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after the diagnostic MRI, two groups were distinguished according to the clinical response of NSAIDS, with group 1 consisting of 22 responders and group 2 of 56 non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months. Follow-up by dynamic MRI was performed in all 56 children of group 2 and 15 of the 33 children of group 1 within 8{+-}4 months of the initial examination. Results: A total of 87.5% of the children in group 2 showed a statistically signficant decrease in their subjective complaints from 6.9{+-}3.4 to 1.8{+-}1.7 (p<0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5{+-}1.0 weeks after the intervention and lasted for a mean of 12{+-}6 months. The children in group 1 already showed similar improvement of the VAS from 6.8{+-}3.2 to 1.5{+-}1.4 (p<0.05) during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period

  20. Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat-tail tendon

    DEFF Research Database (Denmark)

    Haraldsson, B T; Aagaard, P; Crafoord-Larsen, D;

    2009-01-01

    . The present study examined the biomechanical effects of intratendinous corticosteroid injections on healthy rat-tail tendon collagen fascicles. A total of 24 Wistar male rats were divided into (A) a corticosteroid group where the animals were injected in the tail tendon with methylprednisolone acetate, 1.0 m......L of 40 mg/mL mixed with 1.0 mL 9% saline (n=12), and (B) a control group that was injected with 9% saline (n=12). Three days after the injections, the animals were sacrificed and single individual collagen fascicles were collected and underwent displacement to failure. Corticosteroid administration...

  1. Corticosteroid Treatment in Diabetic Macular Edema

    Directory of Open Access Journals (Sweden)

    Burcu Nurözler Tabakcı

    2017-06-01

    Full Text Available Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature.

  2. Common injections in musculoskeletal medicine.

    Science.gov (United States)

    Monseau, Aaron J; Nizran, Parminder Singh

    2013-12-01

    Musculoskeletal injections are a common procedure in primary care and sports medicine but can be intimidating for some clinicians. This article addresses current evidence for corticosteroid injections, and common injection indications and techniques, namely knee, subacromial bursa, glenohumeral joint, lateral epicondyle, de Quervain tenosynovitis, and greater trochanteric bursa injections. Preparation for injections and some evidence for ultrasound guidance are also reviewed.

  3. [Corticosteroids and septic shock].

    Science.gov (United States)

    Bouletreau, P; Petit, P; Latarjet, J

    1976-01-01

    According to the data in the literature, the authors attempted to sum-up present attitudes on the value of corticoids in the treatment of septic shock. If their cardiovascular effects after a period of enthusiasm, are presently rather controversial, their cellular and sub-cellular actions, on the lysosomal membranes, capillary permeability and perhaps the intimate mechanisms of cellular oxygenation seem to be more real. However, the contra-indications which persist in the results of clinical works have resulted in the fact that the exact place of cortico-steroids in the therapeutic arsenal of septic shock still remains to be specified.

  4. Four cases of a secondary Cushingoid state following local triamcinolone acetonide (Kenacort) injection

    NARCIS (Netherlands)

    Jansen, T L Th A; Van Roon, E N

    2002-01-01

    Intra-articular, paratendinous or other soft tissue corticosteroid injections are well-recognised treatment modalities for rheumatic conditions in which a debilitating inflammatory component persists. A corticosteroid injection that is locally administered only sporadically evokes adverse effects. W

  5. Optimisation of a selective method for the determination of organophosphorous triesters in outdoor particulate samples by pressurised liquid extraction and large-volume injection gas chromatography-positive chemical ionisation-tandem mass spectrometry.

    Science.gov (United States)

    Quintana, José Benito; Rodil, Rosario; López-Mahía, Purificación; Muniategui-Lorenzo, Soledad; Prada-Rodríguez, Darío

    2007-07-01

    A selective analytical method for the determination of nine organophosphate triesters and triphenylphosphine oxide (TPPO) in outdoor particulate matter is presented. It involves a fully automated pressurised liquid extraction (PLE) step, integrating an alumina clean-up process, and subsequent determination by large-volume injection gas chromatography-positive chemical ionisation-tandem mass spectrometry (LVI-GC-PCI-MS/MS). The extraction variables (solvent, amount of adsorbent, temperature, time and number of cycles) were optimised using a multicriteria strategy which implements a desirability function that maximises both extraction and clean-up efficiencies while searching for the best-compromise PLE conditions. The final method affords quantification limits of between 0.01 and 0.3 microg g(-1) and recoveries of >80%, with the exceptions of the most polar analytes, TCEP and TPPO (~65%) for both urban dust and PM10 samples. Moreover, the method permitted the levels of these compounds in dust deposited outdoors (between LOD and 0.5 microg g(-1) for TEHP) and PM10 samples (between LOD and 2.4 microg m(-3) for TiBP) to be measured and reported for the first time.

  6. In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism

    Directory of Open Access Journals (Sweden)

    Clayton W. Nuelle

    2017-01-01

    Conclusion: This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

  7. Anti-Inflammatories and Corticosteroids

    Science.gov (United States)

    ... to understand that anabolic steroids are not the type of steroids used in asthma or other lung diseases. Another common fear about corticosteroids is that they will cause growth suppression in children. To date, many studies ...

  8. Computer Based Optimisation Rutines

    DEFF Research Database (Denmark)

    Dragsted, Birgitte; Olsen, Flemmming Ove

    1996-01-01

    In this paper the need for optimisation methods for the laser cutting process has been identified as three different situations. Demands on the optimisation methods for these situations are presented, and one method for each situation is suggested. The adaptation and implementation of the methods...

  9. Computer Based Optimisation Rutines

    DEFF Research Database (Denmark)

    Dragsted, Birgitte; Olsen, Flemmming Ove

    1996-01-01

    In this paper the need for optimisation methods for the laser cutting process has been identified as three different situations. Demands on the optimisation methods for these situations are presented, and one method for each situation is suggested. The adaptation and implementation of the methods...

  10. Optimal optimisation in chemometrics

    NARCIS (Netherlands)

    Hageman, Joseph Albert

    2004-01-01

    The use of global optimisation methods is not straightforward, especially for the more difficult optimisation problems. Solutions have to be found for items such as the evaluation function, representation, step function and meta-parameters, before any useful results can be obtained. This thesis aims

  11. Étude des équilibres thermodynamiques des réactions de gazéification en vue de l'optimisation du rapport vapeur/comburant injecté dans un gazogène souterrain Study of Thermodynamic Equilibria in Gasification Reactions So As to Optimise the Steam/Oxidizer Ratio Injected Into an Underground Gas Generator

    OpenAIRE

    Pirard J. P.

    2006-01-01

    Le but de cette étude est de déterminer sur la base des équilibres thermodynamiques des réactions de gazéification le rapport vapeur/comburant à injecter dans un gazogène fonctionnant sous pression pour optimaliser les compositions, les pouvoirs calorifiques, les rendements de gazéification et la consommation d'agent gazéifiant. The aim of this study is to determine, on the basis of the thermodynamic equilibria of gazification reactions, the steam/oxidizer ratio to be injected into a gas g...

  12. Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

    Science.gov (United States)

    Mahindra, Pankaj; Yamin, Mohammad; Selhi, Harpal S; Singla, Sonia; Soni, Ashwani

    2016-01-01

    Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis.

  13. Systemic corticosteroids for acute sinusitis.

    Science.gov (United States)

    Venekamp, Roderick P; Thompson, Matthew J; Hayward, Gail; Heneghan, Carl J; Del Mar, Chris B; Perera, Rafael; Glasziou, Paul P; Rovers, Maroeska M

    2014-03-25

    Acute sinusitis is the inflammation and swelling of the nasal and paranasal mucous membranes and is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis. We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to February week 1, 2014) and EMBASE (January 2009 to February 2014). Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. Two review authors independently assessed the methodological quality of the trials and extracted data. Five RCTs with a total of 1193 adult participants met our inclusion criteria. We judged methodological quality to be moderate in four trials and high in one trial. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in four trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In four trials antibiotics were prescribed in addition to oral corticosteroids or control treatment, while one trial investigated the effects of oral corticosteroids as a monotherapy.When combining data from the five trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at days three to seven (risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1 to 1

  14. Étude des équilibres thermodynamiques des réactions de gazéification en vue de l'optimisation du rapport vapeur/comburant injecté dans un gazogène souterrain Study of Thermodynamic Equilibria in Gasification Reactions So As to Optimise the Steam/Oxidizer Ratio Injected Into an Underground Gas Generator

    Directory of Open Access Journals (Sweden)

    Pirard J. P.

    2006-11-01

    Full Text Available Le but de cette étude est de déterminer sur la base des équilibres thermodynamiques des réactions de gazéification le rapport vapeur/comburant à injecter dans un gazogène fonctionnant sous pression pour optimaliser les compositions, les pouvoirs calorifiques, les rendements de gazéification et la consommation d'agent gazéifiant. The aim of this study is to determine, on the basis of the thermodynamic equilibria of gazification reactions, the steam/oxidizer ratio to be injected into a gas generator operating under pressure so as to optimize the compositions, the heating values, the gasification efficiencies and the consumption of gasifying agent.

  15. Corticosteroid signaling in frog metamorphosis.

    Science.gov (United States)

    Kulkarni, Saurabh S; Buchholz, Daniel R

    2014-07-01

    Stress in fetal and larval life can impact later health and fitness in humans and wildlife. Long-term effects of early life stress are mediated by altered stress physiology induced during the process of relaying environmental effects on development. Amphibian metamorphosis has been an important model system to study the role of hormones in development in an environmental context. Thyroid hormone (TH) is necessary and sufficient to initiate the dramatic morphological and physiological changes of metamorphosis, but TH alone is insufficient to complete metamorphosis. Other hormones, importantly corticosteroid hormones (CSs), influence the timing and nature of post-embryonic development. Stressors or treatments with CSs delay or accelerate metamorphic change, depending on the developmental stage of treatment. Also, TH and CSs have synergistic, antagonistic, and independent effects on gene regulation. Importantly, the identity of the endogenous corticosteroid hormone or receptor underlying any gene induction or remodeling event has not been determined. Levels of both CSs, corticosterone and aldosterone, peak at metamorphic climax, and the corticosteroid receptors, glucocorticoid and mineralocorticoid receptors, have wide expression distribution among tadpole tissues. Conclusive experiments to identify the endogenous players have been elusive due to difficulties in experimental control of corticosteroid production and signaling. Current data are consistent with the hypothesis that the two CSs and their receptors serve largely overlapping functions in regulating metamorphosis and synergy with TH. Knowledge of the endogenous players is critical to understanding the basic mechanisms and significance of corticosteroid action in regulating post-embryonic development in environmental contexts.

  16. Interlaminar epidural corticosteroid injection in the treatment of lumbosciatic pain: a retrospective analysis Injeção epidural interlaminar de corticóide no tratamento da dor da lombociatalgia: análise retrospectiva

    Directory of Open Access Journals (Sweden)

    Renato Santiago Gomez

    2007-12-01

    Full Text Available Lumbosciatica is a common condition which is associated with significant pain and disability. The aim of the present study was to examine the efficacy of interlaminar epidural corticosteroid infiltration in the treatment of lumbosciatic pain. We evaluated retrospectively sixty patients with lumbosciatic pain that a sequential interlaminar epidural administration of 40 mg methylprednisolone in 7 mL bupivacaine 0.25% was administered. Each patient was interviewed and asked about the pain according to visual analogue scale (VAS and the level of disability according to World Health Organization previously of the epidural corticosteroid infiltration and, 1 and, 6 months after starting therapy. Independently of the initial VAS value, all patients decreased their pain score after one and six months of follow-up (pA lombociatalgia é condição clínica associada à dor intensa e alterações funcionais. O objetivo do presente estudo foi examinar a eficácia da infiltração de corticóide pela via epidural interlaminar no tratamento da dor da lombociatalgia. Foram avaliados, retrospectivamente, sessenta pacientes com lombociatalgia que foram submetidos à administração epidural interlaminar, em sequência, de 40 mg de metilprednisolona e 7 mL de bupivacaína a 0,25%. Os pacientes foram avaliados em relação à dor de acordo com a escala visual analógica (EVA e o grau de comprometimento funcional de acordo com a Organização Mundial de Saúde antes e, uma e, seis meses após o início do tratamento. Independentemente do valor inicial da EVA, todos os pacientes diminuíram o escore de dor após um e, seis meses de acompanhamento (p<0.05. Entretanto, apenas os pacientes com baixo grau de comprometimento funcional apresentaram melhora após o tratamento (p<0.05. Não foram observados efeitos colaterais após as injeções de corticóide epidural. Concluindo, a injeção epidural interlaminar de corticóide em associação com anestésico local pode

  17. Oral and inhaled corticosteroids: Differences in P-glycoprotein (ABCB1) mediated efflux

    Energy Technology Data Exchange (ETDEWEB)

    Crowe, Andrew, E-mail: a.p.crowe@curtin.edu.au; Tan, Ai May

    2012-05-01

    There is concern that P-glycoprotein mediated efflux contributes to steroid resistance. Therefore, this study examined bidirectional corticosteroid transport and induction capabilities for P-glycoprotein (P-gp) to understand which of the systemic and inhaled corticosteroids interacted with P-gp to the greatest extent. Hydrocortisone, prednisolone, prednisone, methylprednisolone, and dexamethasone represented systemically active drugs, while fluticasone propionate, beclomethasone dipropionate, ciclesonide and budesonide represented inhaled corticosteroids. Aldosterone and fludrocortisone represented mineralocorticoids. All drugs were detected using individually optimised HPLC protocols. Transport studies were conducted through Caco-2 monolayers. Hydrocortisone and aldosterone had efflux ratios below 1.5, while prednisone showed a P-gp mediated efflux ratio of only 1.8 compared to its active drug, prednisolone, with an efflux ratio of 4.5. Dexamethasone and beclomethasone had efflux ratios of 2.1 and 3.3 respectively, while this increased to 5.1 for methylprednisolone. Fluticasone showed an efflux ratio of 2.3. Protein expression studies suggested that all of the inhaled corticosteroids were able to induce P-gp expression, from 1.6 to 2 times control levels. Most of the systemic corticosteroids had higher passive permeability (> 20 × 10{sup −6} cm/s) compared to the inhaled corticosteroids (> 5 × 10{sup −6} cm/s), except for budesonide, with permeability similar to the systemic corticosteroids. Inhaled corticosteroids are not transported by P-gp to the same extent as systemic corticosteroids. However, they are able to induce P-gp production. Thus, inhaled corticosteroids may have greater interactions with other P-gp substrates, but P-gp itself is less likely to influence resistance to the drugs. -- Highlights: ► Inhaled corticosteroids are only weak substrates for P-gp, including budesonide. ► Inhaled corticosteroid potent P-gp inducers especially

  18. Isogeometric design optimisation

    NARCIS (Netherlands)

    Nagy, A.P.

    2011-01-01

    Design optimisation is of paramount importance in most engineering, e.g. aeronautical, automotive, or naval, disciplines. Its interdisciplinary character is manifested in the synthesis of geometric modelling, numerical analysis, mathematical programming, and computer sciences. The evolution of the f

  19. About Steroids (Inhaled and Oral Corticosteroids)

    Science.gov (United States)

    ... Medications Long-Term Control Medications About Steroids About Steroids Make an Appointment Ask a Question Refer Patient ... considerations when your dosage changes? What are corticosteroids (‘steroids’)? Corticosteroids (steroids) are medicines that are used to ...

  20. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest bene

  1. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest benef

  2. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest

  3. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest

  4. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest bene

  5. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest benef

  6. Corticosteroids compromise survival in glioblastoma.

    Science.gov (United States)

    Pitter, Kenneth L; Tamagno, Ilaria; Alikhanyan, Kristina; Hosni-Ahmed, Amira; Pattwell, Siobhan S; Donnola, Shannon; Dai, Charles; Ozawa, Tatsuya; Chang, Maria; Chan, Timothy A; Beal, Kathryn; Bishop, Andrew J; Barker, Christopher A; Jones, Terreia S; Hentschel, Bettina; Gorlia, Thierry; Schlegel, Uwe; Stupp, Roger; Weller, Michael; Holland, Eric C; Hambardzumyan, Dolores

    2016-05-01

    Glioblastoma is the most common and most aggressive primary brain tumour. Standard of care consists of surgical resection followed by radiotherapy and concomitant and maintenance temozolomide (temozolomide/radiotherapy→temozolomide). Corticosteroids are commonly used perioperatively to control cerebral oedema and are frequently continued throughout subsequent treatment, notably radiotherapy, for amelioration of side effects. The effects of corticosteroids such as dexamethasone on cell growth in glioma models and on patient survival have remained controversial. We performed a retrospective analysis of glioblastoma patient cohorts to determine the prognostic role of steroid administration. A disease-relevant mouse model of glioblastoma was used to characterize the effects of dexamethasone on tumour cell proliferation and death, and to identify gene signatures associated with these effects. A murine anti-VEGFA antibody was used in parallel as an alternative for oedema control. We applied the dexamethasone-induced gene signature to The Cancer Genome Atlas glioblastoma dataset to explore the association of dexamethasone exposure with outcome. Mouse experiments were used to validate the effects of dexamethasone on survival in vivo Retrospective clinical analyses identified corticosteroid use during radiotherapy as an independent indicator of shorter survival in three independent patient cohorts. A dexamethasone-associated gene expression signature correlated with shorter survival in The Cancer Genome Atlas patient dataset. In glioma-bearing mice, dexamethasone pretreatment decreased tumour cell proliferation without affecting tumour cell viability, but reduced survival when combined with radiotherapy. Conversely, anti-VEGFA antibody decreased proliferation and increased tumour cell death, but did not affect survival when combined with radiotherapy. Clinical and mouse experimental data suggest that corticosteroids may decrease the effectiveness of treatment and shorten

  7. Simulation versus Optimisation

    DEFF Research Database (Denmark)

    Lund, Henrik; Arler, Finn; Østergaard, Poul Alberg

    2017-01-01

    investment optimisation or optimal solutions approach. On the other hand the analytical simulation or alternatives assessment approach. Awareness of the dissimilar theoretical assumption behind the models clarifies differences between the models, explains dissimilarities in results, and provides...... a theoretical and methodological foundation for understanding and interpreting results from the two archetypes. Keywords: energy system analysis; investment optimisation models; simulations models; modelling theory;renewable energy......In recent years, several tools and models have been developed and used for the design and analysis of future national energy systems. Many of these models focus on the integration of various renewable energy resources and the transformation of existing fossil-based energy systems into future...

  8. Optimising AspectJ

    DEFF Research Database (Denmark)

    Avgustinov, Pavel; Christensen, Aske Simon; Hendren, Laurie

    2005-01-01

    AspectJ, an aspect-oriented extension of Java, is becoming increasingly popular. However, not much work has been directed at optimising compilers for AspectJ. Optimising AOP languages provides many new and interesting challenges for compiler writers, and this paper identifies and addresses three...... all of the techniques in this paper in abc, our AspectBench Compiler for AspectJ, and we demonstrate significant speedups with empirical results. Some of our techniques have already been integrated into the production AspectJ compiler, ajc 1.2.1....

  9. Use of inhaled corticosteroids in pediatric asthma

    DEFF Research Database (Denmark)

    Bisgaard, H

    1997-01-01

    Inhaled corticosteroids reduce asthma symptoms and exacerbations, improve lung function, and reduce airway inflammation and bronchial hyperreactivity more effectively than other treatments. However, inhaled corticosteroids may be unable to return lung function and bronchial hyperreactivity...... of the disease. Therefore, a change in treatment strategy toward earlier introduction of corticosteroids may impede airway remodeling, bronchial hyperreactivity, and airway damage. No other treatment has been found to affect the course of the disease. Systemic side-effects, particularly inhibition of growth...... in asthmatic children using inhaled corticosteroids, do not seem to be cause for concern. Growth retardation has not been reported when inhaled corticosteroid doses of

  10. A prospective randomized, double-blind, controlled clinical trial comparing epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus

    Directory of Open Access Journals (Sweden)

    Abhijan Maity

    2012-01-01

    Full Text Available Objective: To compare the efficacy of up to 3 epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus. Materials and Methods: In a randomized, double-blind controlled clinical trial, we administered up to 3 epidural injections of either 80 mg (2 mL of methylprednisolone acetate and 1 mg (1 mL of butorphanol diluted with 7 mL of isotonic saline or 80 mg (2 mL of methylprednisolone acetate diluted with 8 mL of isotonic saline by a lumbar interlaminar approach under fluoroscopic guidance to 120 patients (60 patients in each group with sciatica due to a herniated nucleus pulposus lasting for 4 weeks to 1 year. All patients had scores higher than 30 mm on visual analog scale (VAS. Information on the use of paracetamol, intensity of pain on a VAS ranging from 0 (no pain to 100 mm (worst pain possible, Schober′s test (cm, Straight Leg Raising test, neurologic examination assessing sensory deficits, motor deficits and reflex changes, and Oswestry Low Back Pain Disability Questionnaire were evaluated at 3 weeks, 6 weeks, and 3 months after the first injection. Results: There were no significant differences between the 2 groups with regard to baseline characteristics, withdrawals, and complication rate. Three weeks, 6 weeks, and 3 months after the first injection, all the outcome measures in the butorphanol plus corticosteroid group were significantly different from that of the corticosteroid group. Conclusions: Epidural butorphanol plus corticosteroid injections, as compared with corticosteroid alone injections, offered marked improvement in pain, reflex, motor and sensory deficits, and functional status and reduced the need for analgesics. Level of Evidence: Therapeutic Level I.

  11. Systemic corticosteroid hypersensitivity in children

    OpenAIRE

    Sousa, NG; Santa Marta, C; Morais-Almeida, M.

    2010-01-01

    We describe 5 cases of immediate-type reactions to systemic corticosteroids observed during the last 2 decades in boys aged 2, 4, 8, 9, and 10 years. Symptoms ranged from generalized urticaria and angioedema to anaphylactic shock immediately after administration. Oral betamethasone was implicated in 2 cases, oral prednisolone in 2 cases, and intravenous prednisolone in 1 case. The parents of patient 5 refused the skin tests. The remaining patients underwent skin prick tests with the following...

  12. Optimising Magnetostatic Assemblies

    DEFF Research Database (Denmark)

    Insinga, Andrea Roberto; Smith, Anders

    the optimal remanence distribution with respect to a linear objective functional. Additionally, it is shown here that the same formalism can be applied to the optimisation of the geometry of magnetic systems. Specifically, the border separating the permanent magnet from regions occupied by air or soft...

  13. Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat-tail tendon.

    Science.gov (United States)

    Haraldsson, B T; Aagaard, P; Crafoord-Larsen, D; Kjaer, M; Magnusson, S P

    2009-10-01

    Overload tendon injuries are frequent in recreational and elite sports. The optimal treatment strategy remains unknown, but local administration of corticosteroids is one common treatment option. The direct effects of the corticosteroid administration on the tissue are not fully understood. The present study examined the biomechanical effects of intratendinous corticosteroid injections on healthy rat-tail tendon collagen fascicles. A total of 24 Wistar male rats were divided into (A) a corticosteroid group where the animals were injected in the tail tendon with methylprednisolone acetate, 1.0 mL of 40 mg/mL mixed with 1.0 mL 9% saline (n=12), and (B) a control group that was injected with 9% saline (n=12). Three days after the injections, the animals were sacrificed and single individual collagen fascicles were collected and underwent displacement to failure. Corticosteroid administration significantly reduced tensile fascicle yield strength by 16% and Young's modulus by 14% compared with sham treatment (10.5+/-0.8 vs 12.4+/-0.5 MPa, P< or =0.05, and 537+/-27 vs 641+/-30 MPa, P<0.05, respectively), while the strain properties were unaffected. Peak stress was similar between the two groups. There was no difference in fascicle diameter between the two groups.

  14. Corticosteroids

    Science.gov (United States)

    ... a clinical trial of experimental treatments. Interactive Disease Tracker Use GI Buddy to keep a daily log ... also are immunosuppressive. That means they decrease the activity of the immune system, which experts believe may ...

  15. Corticosteroids

    Science.gov (United States)

    ... Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic Prevention Sexually Transmitted Skin Tobacco Treatments Injuries & ...

  16. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  17. Optimisation by hierarchical search

    Science.gov (United States)

    Zintchenko, Ilia; Hastings, Matthew; Troyer, Matthias

    2015-03-01

    Finding optimal values for a set of variables relative to a cost function gives rise to some of the hardest problems in physics, computer science and applied mathematics. Although often very simple in their formulation, these problems have a complex cost function landscape which prevents currently known algorithms from efficiently finding the global optimum. Countless techniques have been proposed to partially circumvent this problem, but an efficient method is yet to be found. We present a heuristic, general purpose approach to potentially improve the performance of conventional algorithms or special purpose hardware devices by optimising groups of variables in a hierarchical way. We apply this approach to problems in combinatorial optimisation, machine learning and other fields.

  18. Application of Factorial Designs and Simplex Optimisation in the Development of Flow Injection-Hydride Generation-Graphite Furnace Atomic Absorption Spectrometry Procedures as Demonstrated for the Determination of Trace Levels of Germanium

    DEFF Research Database (Denmark)

    Hilligsøe, Bo; Hansen, Elo Harald

    1997-01-01

    The optimisation of a volume-based FI-HG-GFAAS procedure is described for the trace determination of Ge, comprising in situ collection of the generated germane in the graphite furnace. The response function is the peak area readout (A*s). Based on a preliminary study, where factorial designs were...... at a sampling frequency of 22 h-1. The sensitivity, in terms of the characteristic mass, m0, was 26 pg/0.0044 A*s, with a detection limit of 0.21 mu-g/L (3 sigma). The precision (relative standard deviation) was 2.0% (n=10) at the 1 mu-g/L level....

  19. Corticosteroid contact allergy: an EECDRG multicentre study

    DEFF Research Database (Denmark)

    Dooms-Goossens, A; Andersen, Klaus Ejner; Brandäo, F M;

    1996-01-01

    This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet......., betamethasone-17-valerate 1% pet., clobetasol-17-propionate 1% pet., hydrocortisone-17-butyrate 1% eth., and tixocortol-21-pivalate 1% pet.; 189 (2.6%) gave a positive patchtest reaction (+, ++, + + +) to at least 1 of the corticosteroids. The data regarding the corticosteroid-sensitive patients, as well...

  20. Nonsurgical Management of Oral Mucocele by Intralesional Corticosteroid Therapy

    Directory of Open Access Journals (Sweden)

    Rupam Sinha

    2016-01-01

    Full Text Available Background. Oral mucocele is a common lesion resulting from an alteration of minor salivary glands due to mucus accumulation. Rapid appearance, specific location, history of trauma, bluish colour, and consistency help in the diagnosis. Conventional surgical removal is the treatment of choice but has several disadvantages like damage to adjacent ducts with further development of satellite lesions. Therefore, the present study was undertaken to evaluate the efficacy of intralesional corticosteroid injection (betamethasone as a nonsurgical treatment procedure in oral mucoceles. Material and Method. A total of 20 cases (males and females, 10–30 years of age with clinically diagnosed oral mucoceles were given 1 mL of betamethasone intralesionally. All the patients were examined after a period of 7, 14, and 21 days to evaluate the response of the lesion towards treatment and consequently given the 2nd, 3rd, 4th injections. If the lesion resolved after one or two injections, the treatment was discontinued. Results. Out of the 20 cases, 18 of them showed complete regression of the lesion whereas the remaining 2 cases showed decrease in size. All the patients received maximum of 4 consecutive shots in weekly interval. Conclusion. Intralesional corticosteroid therapy can be considered as the first choice in the treatment of oral mucoceles.

  1. Corticosteroids for fat embolism after multiple fractures

    Institute of Scientific and Technical Information of China (English)

    CHEN Huai-sheng; ZHANG Qing-mei; WEN Jun-min; WEN Shun-kang; YI Jing; ZHOU Zhi-qiang; WU Sheng-nan

    2007-01-01

    @@ Fat embolism is a common complication of multiple fractures. Corticosteroids are usually prescribed in prophylactic and treatment of fat embolism. A case of fat embolism followed multiple fractures was hospitalized, and we searched best evidences about corticosteroids for fat embolism so as to provide best therapeutics for the patient.

  2. Corticosteroids and the risk of atrial fibrillation

    NARCIS (Netherlands)

    van der Hooft, CS; Heeringa, J; Brusselle, GG; Hofman, A; Witteman, JCM; Kingma, JH; Sturkenboom, MCJM; Stricker, BHC

    2006-01-01

    Background: High-dose ( pulse) corticosteroid therapy has been associated with the development of atrial fibrillation. This association, however, is mainly based on case reports. Methods: To test the hypothesis that high-dose corticosteroid exposure increases the risk of new-onset atrial fibrillatio

  3. Risk of preterm delivery: a single course of antenatal corticosteroids.

    Science.gov (United States)

    2010-08-01

    For women at risk of delivery before 34 weeks of gestation, administration of betamethasone or dexamethasone for 24 or 36 hours reduces neonatal morbidity and mortality. In a double-blind randomised trial involving 1858 pregnant women, who received either a single course of corticosteroids or multiple courses every 14 days, no statistically significant difference in the rates of mortality and respiratory morbidity were observed during the 28 first days of life. Newborns had decreased height, weight and head circumference in the group treated every 14 days. No difference in outcome was noted at 2 years among 1047 infants whose mothers had received a single course of betamethasone or weekly treatment up to 32 weeks of gestation. Similarly, no difference in outcome was observed among 556 children whose mothers had received an initial course of betamethasone followed by regular injections of either betamethasone or placebo. However, 6 children (2.9%) exposed to repeated maternal treatment developed cerebral palsy, versus only one of the children (0.5%) exposed to a single course, indicating that repeat courses of antenatal corticosteroids might have a detrimental effect. In practice, it seems prudent to only use a single course of corticosteroids in this setting.

  4. Optimisation of Microstrip Antenna

    Directory of Open Access Journals (Sweden)

    H. El Hamchary

    1996-04-01

    Full Text Available When choosing the most appropriate microstrip antenna configuration for particular applications, the kind of excitation of the radiating element is an essential factor that requires careful considerations. For controlling the distribution of energy of the linear or planar array of elements and for coupling energy to the individual elements, a wide variety of feed mechanisms are available. In this paper, the coaxial antenna feeding is assumed and the best (optimised feeding is found. Then, antenna characteristics such as radiation pattern, return loss, input impedance, and VSWR are obtained.

  5. 肩袖及肱二头肌能量技术对肱二头肌长头肌腱炎的远期疗效观察%Long term effect of muscle energy technique compared to corticosteroid injection in treating tendinitis of long head of bi-ceps brachii

    Institute of Scientific and Technical Information of China (English)

    朱迪; 张大威; 章丽雅

    2016-01-01

    Objective:To observe the long term effect of muscle energy technique (MET)used in the treatment of tendinitis of long head of biceps brachii.Methods:Forty-two patients with tendinitis of long head of biceps brachii were randomly assigned into 2 groups (n = 21 each).The control group was treated with corticosteroid injection, and the observation group was given MET.The two groups were assessed with muscle strength test and visual ana-logue scale (VAS)before treatment and at the end of the treatment period (3 weeks),and assessed with Constant at 3rd month,6th month and 1st year during the follow-up period after the treatment.Results:At the end of treatment (3 weeks),the strength of the biceps was significantly higher than before treatment (P <0.01),more significantly in the observation group than in the control group (P <0.01).The VAS scores in the two groups were significantly decreased after treatment as compared with those before treatment (P < 0.01),more significantly in the control group than in the observation group (P <0.01).At 3rd month,6th month,and 1st year during the follow-up peri-od after the treatment,the Constant scores in two groups were higher than pretreatment,and those in the observa-tion group were significantly higher than those in the control group (P <0.01).Conclusion:The short-term analge-sic efficacy of corticosteroid injection in the tendinitis of long head of biceps brachii is better than MET,but the long-term effect of MET in treating tendinitis of long head of biceps brachii is affirmative,and was obviously better than corticosteroid injection.%目的:应用肌肉能量技术(MET)对肩袖及肱二头肌进行干预,观察其对肱二头肌长头肌腱炎的远期疗效。方法:选取肱二头肌长头肌腱炎患者42例,随机分为观察组和对照组各21例,对观察组患者肩袖及肱二头肌应用MET 治疗,对照组进行鞘内注射封闭治疗,共治疗3周。分别于治疗前后进行疼痛视觉模拟

  6. Topical corticosteroid addiction and phobia

    Directory of Open Access Journals (Sweden)

    Aparajita Ghosh

    2014-01-01

    Full Text Available Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.

  7. A Global Optimisation Toolbox for Massively Parallel Engineering Optimisation

    CERN Document Server

    Biscani, Francesco; Yam, Chit Hong

    2010-01-01

    A software platform for global optimisation, called PaGMO, has been developed within the Advanced Concepts Team (ACT) at the European Space Agency, and was recently released as an open-source project. PaGMO is built to tackle high-dimensional global optimisation problems, and it has been successfully used to find solutions to real-life engineering problems among which the preliminary design of interplanetary spacecraft trajectories - both chemical (including multiple flybys and deep-space maneuvers) and low-thrust (limited, at the moment, to single phase trajectories), the inverse design of nano-structured radiators and the design of non-reactive controllers for planetary rovers. Featuring an arsenal of global and local optimisation algorithms (including genetic algorithms, differential evolution, simulated annealing, particle swarm optimisation, compass search, improved harmony search, and various interfaces to libraries for local optimisation such as SNOPT, IPOPT, GSL and NLopt), PaGMO is at its core a C++ ...

  8. Simple Combinatorial Optimisation Cost Games

    NARCIS (Netherlands)

    van Velzen, S.

    2005-01-01

    In this paper we introduce the class of simple combinatorial optimisation cost games, which are games associated to {0, 1}-matrices.A coalitional value of a combinatorial optimisation game is determined by solving an integer program associated with this matrix and the characteristic vector of the

  9. Topology optimised wavelength dependent splitters

    DEFF Research Database (Denmark)

    Hede, K. K.; Burgos Leon, J.; Frandsen, Lars Hagedorn

    A photonic crystal wavelength dependent splitter has been constructed by utilising topology optimisation1. The splitter has been fabricated in a silicon-on-insulator material (Fig. 1). The topology optimised wavelength dependent splitter demonstrates promising 3D FDTD simulation results....... This complex photonic crystal structure is very sensitive against small fabrication variations from the expected topology optimised design. A wavelength dependent splitter is an important basic building block for high-performance nanophotonic circuits. 1J. S. Jensen and O. Sigmund, App. Phys. Lett. 84, 2022...

  10. Engineering Optimisation by Cuckoo Search

    CERN Document Server

    Yang, Xin-She

    2010-01-01

    A new metaheuristic optimisation algorithm, called Cuckoo Search (CS), was developed recently by Yang and Deb (2009). This paper presents a more extensive comparison study using some standard test functions and newly designed stochastic test functions. We then apply the CS algorithm to solve engineering design optimisation problems, including the design of springs and welded beam structures. The optimal solutions obtained by CS are far better than the best solutions obtained by an efficient particle swarm optimiser. We will discuss the unique search features used in CS and the implications for further research.

  11. Topology optimised wavelength dependent splitters

    DEFF Research Database (Denmark)

    Hede, K. K.; Burgos Leon, J.; Frandsen, Lars Hagedorn;

    A photonic crystal wavelength dependent splitter has been constructed by utilising topology optimisation1. The splitter has been fabricated in a silicon-on-insulator material (Fig. 1). The topology optimised wavelength dependent splitter demonstrates promising 3D FDTD simulation results....... This complex photonic crystal structure is very sensitive against small fabrication variations from the expected topology optimised design. A wavelength dependent splitter is an important basic building block for high-performance nanophotonic circuits. 1J. S. Jensen and O. Sigmund, App. Phys. Lett. 84, 2022...

  12. Optimisation of Oil Production in Two – Phase Flow Reservoir Using Simultaneous Method and Interior Point Optimiser

    DEFF Research Database (Denmark)

    2012-01-01

    in the reservoir. A promising decrease of these remained resources can be provided by smart wells applying water injections to sustain satisfactory pressure level in the reservoir throughout the whole process of oil production. Basically to enhance secondary recovery of the remaining oil after drilling, water...... fields, or closed loop optimisation, can be used for optimising the reservoir performance in terms of net present value of oil recovery or another economic objective. In order to solve an optimal control problem we use a direct collocation method where we translate a continuous problem into a discrete...... for large scale nonlinear optimisation was applied. Because of its versatile compatibility with programming technologies, a C++ programming language in Microsoft Visual Studio integrated development environment was used for modelling the optimal control problem. Thanks to object oriented features...

  13. Optimisation of the Laser Cutting Process

    DEFF Research Database (Denmark)

    Dragsted, Birgitte; Olsen, Flemmming Ove

    1996-01-01

    The problem in optimising the laser cutting process is outlined. Basic optimisation criteria and principles for adapting an optimisation method, the simplex method, are presented. The results of implementing a response function in the optimisation are discussed with respect to the quality as well...

  14. Isogeometric Analysis and Shape Optimisation

    DEFF Research Database (Denmark)

    Gravesen, Jens; Evgrafov, Anton; Gersborg, Allan Roulund

    obtained and also some of the problems we have encountered. One of these problems is that the geometry of the shape is given by the boundary alone. And, it is the parametrisation of the boundary which is changed by the optimisation procedure. But isogeometric analysis requires a parametrisation......One of the attractive features of isogeometric analysis is the exact representation of the geometry. The geometry is furthermore given by a relative low number of control points and this makes isogeometric analysis an ideal basis for shape optimisation. I will describe some of the results we have...... of the whole domain. So in every optimisation cycle we need to extend a parametrisation of the boundary of a domain to the whole domain. It has to be fast in order not to slow the optimisation down but it also has to be robust and give a parametrisation of high quality. These are conflicting requirements so we...

  15. Turbulence optimisation in stellarator experiments

    Energy Technology Data Exchange (ETDEWEB)

    Proll, Josefine H.E. [Max-Planck/Princeton Center for Plasma Physics (Germany); Max-Planck-Institut fuer Plasmaphysik, Wendelsteinstr. 1, 17491 Greifswald (Germany); Faber, Benjamin J. [HSX Plasma Laboratory, University of Wisconsin-Madison, Madison, WI 53706 (United States); Helander, Per; Xanthopoulos, Pavlos [Max-Planck/Princeton Center for Plasma Physics (Germany); Lazerson, Samuel A.; Mynick, Harry E. [Plasma Physics Laboratory, Princeton University, P.O. Box 451 Princeton, New Jersey 08543-0451 (United States)

    2015-05-01

    Stellarators, the twisted siblings of the axisymmetric fusion experiments called tokamaks, have historically suffered from confining the heat of the plasma insufficiently compared with tokamaks and were therefore considered to be less promising candidates for a fusion reactor. This has changed, however, with the advent of stellarators in which the laminar transport is reduced to levels below that of tokamaks by shaping the magnetic field accordingly. As in tokamaks, the turbulent transport remains as the now dominant transport channel. Recent analytical theory suggests that the large configuration space of stellarators allows for an additional optimisation of the magnetic field to also reduce the turbulent transport. In this talk, the idea behind the turbulence optimisation is explained. We also present how an optimised equilibrium is obtained and how it might differ from the equilibrium field of an already existing device, and we compare experimental turbulence measurements in different configurations of the HSX stellarator in order to test the optimisation procedure.

  16. COMPARITIVE STUDY OF LOCAL STEROID INJECTION VERSUS AUTOLOGOUS BLOOD INJECTION THERAPY FOR THE MANAGEMENT OF LATERAL EPICONDYLITI S

    Directory of Open Access Journals (Sweden)

    Partap

    2015-03-01

    Full Text Available OBJECTIVES : Local corticosteroid infiltration is a common practice of treatment for lateral epicondylitis. In recent studies no statistically significant or clinically relevant results in favour of corticosteroid injections were found. The injection of autologous blood has been reported to be effective for both intermediate and long - term outcomes. It is hypothesized that blood contains growth factors, which induce the healing cascade. METHODS : A total of 50 patients were included in this prospective randomized study. Patients were divided in 2 groups of 25 patients each. Group I received 2 ml local corticosteroid +1 ml 2% lignocaine, Group II received 2 ml autologous blood drawn from ipsilateral upper limb vein +1 ml 2% lignocaine, and at the lateral epicondyle. Outcome was measured using a pain score (VAS . Follow - up was continued for tota l of six months. RESULTS : The corticosteroid injection group showed a statistically significant decrease in pain compared with autologous blood injection group at six weeks follow up. At final six - month follow - up, autologous blood injection group showed st atistically significant decrease in pain compared with corticosteroid injection group. CONCLUSIONS : Autologous blood injection is efficient compared with corticosteroid injection, with less side - effects and minimum recurrence rate in long term.

  17. Optimisation of load control

    Energy Technology Data Exchange (ETDEWEB)

    Koponen, P. [VTT Energy, Espoo (Finland)

    1998-08-01

    Electricity cannot be stored in large quantities. That is why the electricity supply and consumption are always almost equal in large power supply systems. If this balance were disturbed beyond stability, the system or a part of it would collapse until a new stable equilibrium is reached. The balance between supply and consumption is mainly maintained by controlling the power production, but also the electricity consumption or, in other words, the load is controlled. Controlling the load of the power supply system is important, if easily controllable power production capacity is limited. Temporary shortage of capacity causes high peaks in the energy price in the electricity market. Load control either reduces the electricity consumption during peak consumption and peak price or moves electricity consumption to some other time. The project Optimisation of Load Control is a part of the EDISON research program for distribution automation. The following areas were studied: Optimization of space heating and ventilation, when electricity price is time variable, load control model in power purchase optimization, optimization of direct load control sequences, interaction between load control optimization and power purchase optimization, literature on load control, optimization methods and field tests and response models of direct load control and the effects of the electricity market deregulation on load control. An overview of the main results is given in this chapter

  18. Osteoporotic Characteristics Persist in the Spine of Ovariectomized Sheep after Withdrawal of Corticosteroid Administration

    Directory of Open Access Journals (Sweden)

    Mohammad-Reza Zarrinkalam

    2012-01-01

    Full Text Available A validated ovine model of osteoporosis achieves severe bone loss in a relatively short period. This study investigated if osteoporotic features persist in this model after cessation of corticosteroid administration. Methods. Osteoporosis was induced in nine ewes by chronic corticosteroid injection, ovariectomy, and low calcium diet. Six ewes were used as controls. Bone mineral density (BMD of the lumbar spine (LS and body weight were assessed at regular intervals. After five months, corticosteroid treatment was withdrawn systematically over one month. Three months later, all animals were euthanised, and the LS was collected for histomorphometric analysis. Results. BMD in the LS of osteoporotic sheep was 25% lower than control sheep. Body weight of osteoporotic sheep was reduced in the first month of the corticosteroid withdrawal period but returned to baseline level thereafter. Trabecular bone volume of LS in osteoporotic sheep was 27% lower than controls and showed a heterogeneous structure. Conclusions. Osteoporotic characteristics remain in the vertebra after ceasing corticosteroid administration providing an opportunity to evaluate potential systemic or local treatments in vivo under realistic physiological conditions. The microstructural arrangement of vertebral trabecular bone in sheep is similar to humans demonstrating further relevance of this model for preclinical investigations.

  19. Osteoporotic characteristics persist in the spine of ovariectomized sheep after withdrawal of corticosteroid administration.

    Science.gov (United States)

    Zarrinkalam, Mohammad-Reza; Schultz, Christopher G; Parkinson, Ian H; Moore, Robert J

    2012-01-01

    A validated ovine model of osteoporosis achieves severe bone loss in a relatively short period. This study investigated if osteoporotic features persist in this model after cessation of corticosteroid administration. Methods. Osteoporosis was induced in nine ewes by chronic corticosteroid injection, ovariectomy, and low calcium diet. Six ewes were used as controls. Bone mineral density (BMD) of the lumbar spine (LS) and body weight were assessed at regular intervals. After five months, corticosteroid treatment was withdrawn systematically over one month. Three months later, all animals were euthanised, and the LS was collected for histomorphometric analysis. Results. BMD in the LS of osteoporotic sheep was 25% lower than control sheep. Body weight of osteoporotic sheep was reduced in the first month of the corticosteroid withdrawal period but returned to baseline level thereafter. Trabecular bone volume of LS in osteoporotic sheep was 27% lower than controls and showed a heterogeneous structure. Conclusions. Osteoporotic characteristics remain in the vertebra after ceasing corticosteroid administration providing an opportunity to evaluate potential systemic or local treatments in vivo under realistic physiological conditions. The microstructural arrangement of vertebral trabecular bone in sheep is similar to humans demonstrating further relevance of this model for preclinical investigations.

  20. Psychiatric adverse effects of pediatric corticosteroid use.

    Science.gov (United States)

    Drozdowicz, Linda B; Bostwick, J Michael

    2014-06-01

    Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions

  1. Use of intranasal corticosteroids in adenotonsillar hypertrophy.

    Science.gov (United States)

    Sakarya, E U; Bayar Muluk, N; Sakalar, E G; Senturk, M; Aricigil, M; Bafaqeeh, S A; Cingi, C

    2017-05-01

    This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy. The related literature was searched using PubMed and Proquest Central databases. Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system. Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

  2. Effects of Antenatal Corticosteroids in Preterm Delivery

    Directory of Open Access Journals (Sweden)

    Kuo-Gon Wang

    2004-12-01

    Full Text Available Antenatal corticosteroid administration is one of the most effective methods to improve perinatal outcomes. It reduces the incidence of respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia and necrotizing enterocolitis in preterm neonates. Antenatal corticosteroids are also effective in treating maternal hemolysis, elevated liver enzymes and low platelet count syndrome. However, complications in neonates and mothers may occur when antenatal corticosteroids are given, including infection, sepsis and maternal pulmonary edema. The National Institutes of Health Consensus Development Conference recommends treatment regimens of either two 12 mg doses of betamethasone given intramuscularly 24 hours apart or four 6 mg doses of dexamethasone given intramuscularly 12 hours apart between 24 and 34 weeks of gestation in pregnancies at risk for preterm delivery. The benefits are most apparent when the corticosteroids are administered between 24 hours and 7 days before delivery. In principle, antenatal steroid therapy should not be routinely repeated in patients with preterm labor. For preterm premature rupture of membranes at less than 30–32 weeks of gestation, antenatal corticosteroids are also suggested as long as there is no evidence of infection.

  3. The treatment of sports injuries by local injection.

    OpenAIRE

    1981-01-01

    Local injections of corticosteroids are frequently employed in the management of soft-tissue injuries. Side effects and contraindications of this treatment are discussed with reference to relevant literature. Indications for steroid therapy are described.

  4. [Corticosteroids in the treatment of infectious diseases].

    Science.gov (United States)

    Kronig, I; Schibler, M; Rougemont, M; Emonet, S

    2013-04-24

    The addition of a corticosteroid has become a common practice for the treatment of some infectious diseases, such as meningitis, septic shock, moderate to severe Pneumocystis jirovecii pneumonia. The belief that steroids may have a beneficial effect in the early stage of pro-inflammatory infections explains the renewed interest for these treatments. This review of recent literature helps determine the use of steroids in the treatment of infectious diseases as formal guidance, questionable or rather contraindicated. When there is a clear scientific indication for the use of corticosteroids regardless of the current infection, the latter is never a formal contraindication.

  5. Spiral CT and optimization of the modalities of the iodinated intravenous contrast material: Experimental studies in human pathology; Tomodensitometrie spiralee et optimisation des protocoles d'injection du contraste iode intra-veineux: etudes experimentales en pathologie humaine

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, V

    1998-06-19

    Spiral (or helical) CT represents the most recent improvement in the field of computed assisted tomography (CAT scan). The capabilities of this new imaging modality are much superior to these of conventional CT scanning; then result from the rapid acquisition and from the volumetric nature of the derived data set. The short time of data acquisition had made mandatory the revision of protocols for intravenous administration of iodinated contrast material. By the means of several studies, carried out on pathologic and healthy patients, we have attempted to improve knowledge in factors influencing CT attenuation values after injection of contrast material, in the aim of improving contrast administration performed during spiral CT scanning. Anatomical landmarks that we have studied till now have been liver, the pancreas, the kidney and the cervical spine. In addition, a paired based methodology has been used. The volumetric set of data derived from spiral CT scanning leads to optimal post-processing tasks, the most interesting being related to cine-display and multiplanar reformatting; both modalities have been evaluated, about the pancreas and the musculo-skeletal system respectively. Conversely, this new modality, as for other imaging modalities, is responsible for additional costs derived from restless increase in the number of images to be dealt with and from the occurrence of new tasks (in post-processing particularly). The place of spiral CT in diagnostic strategies among other modern imaging modalities should be assessed, especially with respect to Magnetic Resonance Imaging (MRI). (author)

  6. TEM turbulence optimisation in stellarators

    CERN Document Server

    Proll, J H E; Xanthopoulos, P; Lazerson, S A; Faber, B J

    2015-01-01

    With the advent of neoclassically optimised stellarators, optimising stellarators for turbulent transport is an important next step. The reduction of ion-temperature-gradient-driven turbulence has been achieved via shaping of the magnetic field, and the reduction of trapped-electron mode (TEM) turbulence is adressed in the present paper. Recent analytical and numerical findings suggest TEMs are stabilised when a large fraction of trapped particles experiences favourable bounce-averaged curvature. This is the case for example in Wendelstein 7-X [C.D. Beidler $\\textit{et al}$ Fusion Technology $\\bf{17}$, 148 (1990)] and other Helias-type stellarators. Using this knowledge, a proxy function was designed to estimate the TEM dynamics, allowing optimal configurations for TEM stability to be determined with the STELLOPT [D.A. Spong $\\textit{et al}$ Nucl. Fusion $\\bf{41}$, 711 (2001)] code without extensive turbulence simulations. A first proof-of-principle optimised equilibrium stemming from the TEM-dominated stella...

  7. [Intra-articular injections].

    Science.gov (United States)

    Chapelle, Ch

    2015-09-01

    It is not unusual for a specialist or general practitioner to be presented with a pathology which necessitates the use of an intra-articular injection of corticosteroids, hyaluronic acid or a local anaesthetic. It would seem to be interesting to update and to precise the techniques and methods of intraarticular injections which have appeared in recent international publications, when we know that 30 % of the injections given into the knee and so called "dry" are incorrect and, therefore, inefficient. The indication of an articular injection depends, firstly, on the diagnosis which should be done with great care; after which should be an objective analysis complete with secondary effects linked to both the injection and the product used. The conditions of asepsis, the choice of needles and quantities of the injection and even the ways of the injections should be reviewed in detail. The last studies clearly question the secondary effects of the cartilage degradations of the cortisone given as an intra-articular injection and shows its efficiency on the pain and inflammatory phenomonen in osteoarthritis. Studies on hyaluronic acid are often contradictory going from a modest result to an important pain relief but it is necessary to be aware that the objective criteria are difficult to interpret. The use of local anaesthetics in intra-articular is limited by the few indications in view of the major risk of aggravating the pre-existing lesions by the disappearing signs of pain.

  8. Intra-Articular Corticosteroids in Addition to Exercise for Reducing Pain Sensitivity in Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Soriano-Maldonado, Alberto; Klokker, Louise; Bartholdy, Cecilie

    2016-01-01

    participants with clinical and radiographic knee OA that were randomized to one intra-articular injection on the knee with either 1 ml of 40 mg/ml methylprednisolone (corticosteroid) dissolved in 4 ml lidocaine (10 mg/ml) or 1 ml isotonic saline (placebo) mixed with 4 ml lidocaine (10 mg/ml). Two weeks after....... The mean group difference in changes from baseline at week 14 was 0.6 kPa (95% CI: -1.7 to 2.8; P = 0.626) for PPT and 384 mm×sec (95% CI: -2980 to 3750; P = 0.821) for TS. CONCLUSIONS: These results suggest that adding intra-articular corticosteroid injection 2 weeks prior to an exercise program does...

  9. Systemic corticosteroids for acute gout (Review)

    NARCIS (Netherlands)

    Janssens, H.J.; Lucassen, P.L.B.J.; Laar, F.A. van de; Janssen, M.; Lisdonk, E.H. van de

    2008-01-01

    BACKGROUND: Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives. OBJECTIVES: To assess the

  10. Inhaled corticosteroids do not affect behaviour

    NARCIS (Netherlands)

    de Vries, T. W.; van Roon, E. N.; Duiverman, E. J.

    2008-01-01

    Aim: To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders. Methods: Questionnaires were given to three group

  11. Systemic corticosteroids for acute gout (Review)

    NARCIS (Netherlands)

    Janssens, H.J.; Lucassen, P.L.B.J.; Laar, F.A. van de; Janssen, M.; Lisdonk, E.H. van de

    2008-01-01

    BACKGROUND: Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives. OBJECTIVES: To assess the

  12. Corticosteroids for acute adult bacterial meningitis

    NARCIS (Netherlands)

    D. van de Beek

    2009-01-01

    Bacterial meningitis in adults is a severe disease, with high fatality and morbidity rates. Experimental studies showed that the inflammatory response in the subarachnoid space is associated with unfavorable outcome. In these experiments, corticosteroids, and in particular dexamethasone, were able t

  13. Stability of corticosteroids under anaerobic conditions. C6 and C9 fluorine-containing corticosteroids

    NARCIS (Netherlands)

    Dekker, D.; Buijs, D.J.

    1980-01-01

    The decomposition of corticosteroids due to a fluorine atom at C6 and/or C9 is investigated. Chromatographic properties, the isolation and the structure elucidation of decomposition products are given.

  14. Stability of corticosteroids under anaerobic conditions. C6 and C9 fluorine-containing corticosteroids

    NARCIS (Netherlands)

    Dekker, D.; Buijs, D.J.

    1980-01-01

    The decomposition of corticosteroids due to a fluorine atom at C6 and/or C9 is investigated. Chromatographic properties, the isolation and the structure elucidation of decomposition products are given.

  15. Measuring the Corticosteroid Responsiveness Endophenotype in Asthma

    Science.gov (United States)

    Clemmer, George L.; Wu, Ann Chen; Rosner, Bernard; McGeachie, Michael J.; Litonjua, Augusto A.; Tantisira, Kelan G.; Weiss, Scott T.

    2015-01-01

    Background Inhaled corticosteroids are the most commonly used controller therapies for asthma, producing treatment responses in six clinical phenotypes; lung function, bronchodilator response, airway responsiveness, symptoms, need for oral steroids and frequency of emergency department visits and hospitalizations. We hypothesize that treatment response in all of these phenotypes is modulated by a single, quantative corticosteroid responsiveness endophenotype. Objective To develop a composite phenotype that combines multiple clinical phenotypes to measure corticosteroid responsiveness with high accuracy, high stability across populations, and high robustness to missing data. Methods We employed principal component analysis (PCA) to determine a composite corticosteroid responsiveness phenotype that we tested in four replication populations. We evaluated the relative accuracy with which the composite and clinical phenotypes measure the endophenotype using treatment effect area under the receiver operating characteristic curve (AUC). Results In the study population, the composite phenotype measured the endophenotype with an AUC of 0.74, significantly exceeding the AUCs of the six individual clinical phenotypes, which ranged from 0.56 (p-value <.001) to 0.67 (p-value 0.015). In four replication populations with a total of 22 clinical phenotypes available, the composite phenotype AUC ranged from 0.69 to 0.73, significantly exceeded the AUCs of 14 phenotypes, and was not significantly exceeded by any single phenotype. Conclusion The composite phenotype measured the endophenotype with higher accuracy, higher stability across populations, and higher robustness to missing data than any clinical phenotype. This should provide the capability to model corticosteroid pharmacologic response and resistance with increased accuracy and reproducibility. PMID:25951964

  16. Topical corticosteroids: clinical pharmacology and therapeutic use.

    Science.gov (United States)

    Miller, J A; Munro, D D

    1980-02-01

    The development of topical corticosteroids has enabled many dermatoses to be more effectively treated than previously, but there is also no doubt that misuse of these preparations can lead to troublesome local effects and potentially serious systemic problems. The most effective assay for comparing different compounds has been their vasoconstrictive activity, and this on the whole correlates well with clinical effect. To be effective, corticosteroid must be absorbed and the importance of concentration, occlusion, the type of vehicle, added penetrants such as urea and the anatomical site, on the amount of absorption and therefore on clinical activity has been demonstrated. Ointments have been shown to be more effective than creams but because of the considerable choice of potencies now available most dermatologists tend to prescribe the different formulations according to the wishes of the patient. For the same reason, dilution of the commercially marketed preparations is now not generally recommended. The main therapeutic activity of topical corticosteroids is their nonspecific anti-inflammatory effect, thought to be primarily a result of their action on the chemical mediators of inflammation. They have also been shown to be antimitotic which may well be relevant not only to the treatment of scaling dermatoses but also to their dermal thinning effect resulting from inhibition of fibroblasts. Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be very effective in flexural eruptions and secondarily infected dermatoses. As a general rule, the use of topical corticosteroids in outpatients, unless badly misused, is not associated with any significant risk of adrenal axis suppression, but care must be exercised as to the amount prescribed, especially if large areas of the body are to be treated with highly potent preparations. Certain groups such as young children and patients with liver failure, and certain anatomical sites such

  17. Effects of corticosteroid on the expressions of neuropeptide and cytokine mRNA and on tenocyte viability in lateral epicondylitis

    Directory of Open Access Journals (Sweden)

    Han Soo

    2012-10-01

    Full Text Available Abstract Background The purpose of this study was to determine the reaction mechanism of corticosteroid by analyzing the expression patterns of neuropeptides (substance P (SP, calcitonin gene related peptide (CGRP and of cytokines (interleukin (IL-1α, tumor growth factor (TGF-β after corticosteroid treatment in lateral epicondylitis. In addition, we also investigated whether corticosteroid influenced tenocyte viability. Methods The corticosteroid triamcinolone acetonide (TAA was applied to cultured tenocytes of lateral epicondylitis, and the changes in the mRNA expressions of neuropeptides and cytokines and tenocyte viabilities were analyzed at seven time points. Quantitative real-time polymerase chain reaction and an MTT assay were used. Results The expression of SP mRNA was maximally inhibited by TAA at 24 hours but recovered at 72 hours, and the expressions of CGRP mRNA and IL-1α mRNA were inhibited at 24 and 3 hours, respectively. The expression of TGF-β mRNA was not significant. Tenocyte viability was significantly reduced by TAA at 24 hours. Conclusions We postulate that the reaction mechanism predominantly responsible for symptomatic relief after a corticosteroid injection involves the inhibitions of neuropeptides and cytokines, such as, CGRP and IL-1α. However the tenocyte viability was compromised by a corticosteroid.

  18. Asthma and Therapeutics: Inhaled Corticosteroids, Corticosteroid Osteoporosis, and the Risk of Fracture in Chronic Asthma

    Directory of Open Access Journals (Sweden)

    Toogood John H

    2005-03-01

    Full Text Available Abstract Current guidelines for the diagnosis and treatment of osteoporosis do not address the risks to bone density and the likelihood of fracture that may be associated with inhaled corticosteroid treatment for asthma. This review outlines an approach to the use of bone densitometry in clinical practice for the diagnosis, prevention, and treatment of osteoporosis in asthmatic patients receiving inhaled corticosteroid therapy.

  19. Increasing awareness of corticosteroid hypersensitivity reactions is important

    DEFF Research Database (Denmark)

    Knarborg, Malene; Bendstrup, Elisabeth; Hilberg, Ole

    2013-01-01

    the tolerability to other corticosteroid preparations and thus identify a safe treatment alternative. We report a case of corticosteroid hypersensitivity in a 65-year-old woman with a history of difficult-to-treat asthma and systemic corticosteroid allergy admitted with increasing dyspnea and dry cough...

  20. Cogeneration technologies, optimisation and implementation

    CERN Document Server

    Frangopoulos, Christos A

    2017-01-01

    Cogeneration refers to the use of a power station to deliver two or more useful forms of energy, for example, to generate electricity and heat at the same time. This book provides an integrated treatment of cogeneration, including a tour of the available technologies and their features, and how these systems can be analysed and optimised.

  1. Optimisation of solar synoptic observations

    Science.gov (United States)

    Klvaña, Miroslav; Sobotka, Michal; Švanda, Michal

    2012-09-01

    The development of instrumental and computer technologies is connected with steadily increasing needs for archiving of large data volumes. The current trend to meet this requirement includes the data compression and growth of storage capacities. This approach, however, has technical and practical limits. A further reduction of the archived data volume can be achieved by means of an optimisation of the archiving that consists in data selection without losing the useful information. We describe a method of optimised archiving of solar images, based on the selection of images that contain a new information. The new information content is evaluated by means of the analysis of changes detected in the images. We present characteristics of different kinds of image changes and divide them into fictitious changes with a disturbing effect and real changes that provide a new information. In block diagrams describing the selection and archiving, we demonstrate the influence of clouds, the recording of images during an active event on the Sun, including a period before the event onset, and the archiving of long-term history of solar activity. The described optimisation technique is not suitable for helioseismology, because it does not conserve the uniform time step in the archived sequence and removes the information about solar oscillations. In case of long-term synoptic observations, the optimised archiving can save a large amount of storage capacities. The actual capacity saving will depend on the setting of the change-detection sensitivity and on the capability to exclude the fictitious changes.

  2. For Time-Continuous Optimisation

    DEFF Research Database (Denmark)

    Heinrich, Mary Katherine; Ayres, Phil

    2016-01-01

    Strategies for optimisation in design normatively assume an artefact end-point, disallowing continuous architecture that engages living systems, dynamic behaviour, and complex systems. In our Flora Robotica investigations of symbiotic plant-robot bio-hybrids, we re- quire computational tools...

  3. For Time-Continuous Optimisation

    DEFF Research Database (Denmark)

    Heinrich, Mary Katherine; Ayres, Phil

    2016-01-01

    Strategies for optimisation in design normatively assume an artefact end-point, disallowing continuous architecture that engages living systems, dynamic behaviour, and complex systems. In our Flora Robotica investigations of symbiotic plant-robot bio-hybrids, we re- quire computational tools...

  4. Helpful tips for performing musculoskeletal injections.

    Science.gov (United States)

    Metz, John P

    2010-01-01

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.

  5. Musculoskeletal injections: a review of the evidence.

    Science.gov (United States)

    Stephens, Mark B; Beutler, Anthony I; O'Connor, Francis G

    2008-10-15

    Injections are valuable procedures for managing musculoskeletal conditions commonly encountered by family physicians. Corticosteroid injections into articular, periarticular, or soft tissue structures relieve pain, reduce inflammation, and improve mobility. Injections can provide diagnostic information and are commonly used for postoperative pain control. Local anesthetics may be injected with corticosteroids to provide additional, rapid pain relief. Steroid injection is the preferred and definitive treatment for de Quervain tenosynovitis and trochanteric bursitis. Steroid injections can also be helpful in controlling pain during physical rehabilitation from rotator cuff syndrome and lateral epicondylitis. Intra-articular steroid injection provides pain relief in rheumatoid arthritis and osteoarthritis. There is little systematic evidence to guide medication selection for therapeutic injections. The medication used and the frequency of injection should be guided by the goal of the injection (i.e., diagnostic or therapeutic), the underlying musculoskeletal diagnosis, and clinical experience. Complications from steroid injections are rare, but physicians should understand the potential risks and counsel patients appropriately. Patients with diabetes who receive periarticular or soft tissue steroid injections should closely monitor their blood glucose for two weeks following injection.

  6. LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

    Directory of Open Access Journals (Sweden)

    Syam Sunder B

    2017-01-01

    Full Text Available BACKGROUND Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed plantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs, rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP injection, nitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT and surgical procedures. Recently, research has focused on regenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through collagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of autologous whole blood or Platelet-Rich Plasma (PRP. Platelets can be isolated using simple cell-separating systems. The degranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration processes. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial growth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with autologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy of autologous blood injection in plantar fasciitis by comparing it with the local

  7. Use of inhaled corticosteroids in pediatric asthma

    DEFF Research Database (Denmark)

    Bisgaard, H

    1997-01-01

    Inhaled corticosteroids reduce asthma symptoms and exacerbations, improve lung function, and reduce airway inflammation and bronchial hyperreactivity more effectively than other treatments. However, inhaled corticosteroids may be unable to return lung function and bronchial hyperreactivity...... to normal when introduced for moderately severe asthma. This finding highlights the need to improve treatment strategy in pediatric asthma. The natural progression of persistent asthma may lead to loss of lung function and chronic bronchial hyperreactivity for children and adults. There is evidence...... to suggest that asthma acts via a chronic inflammatory process that causes remodeling of the airways with mucosal thickening and smooth muscle hypertrophy. An optimal treatment strategy would be one aimed at reducing the ongoing airway inflammation. Inhaled steroids ameliorate the inflammation, whereas...

  8. Asthma and Adherence to Inhaled Corticosteroids

    DEFF Research Database (Denmark)

    Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means...... was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, ... prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma...

  9. Endogenous synthesis of corticosteroids in the hippocampus.

    Directory of Open Access Journals (Sweden)

    Shimpei Higo

    Full Text Available BACKGROUND: Brain synthesis of steroids including sex-steroids is attracting much attention. The endogenous synthesis of corticosteroids in the hippocampus, however, has been doubted because of the inability to detect deoxycorticosterone (DOC synthase, cytochrome P450(c21. METHODOLOGY/PRINCIPAL FINDINGS: The expression of P450(c21 was demonstrated using mRNA analysis and immmunogold electron microscopic analysis in the adult male rat hippocampus. DOC production from progesterone (PROG was demonstrated by metabolism analysis of (3H-steroids. All the enzymes required for corticosteroid synthesis including P450(c21, P450(2D4, P450(11β1 and 3β-hydroxysteroid dehydrogenase (3β-HSD were localized in the hippocampal principal neurons as shown via in situ hybridization and immunoelectron microscopic analysis. Accurate corticosteroid concentrations in rat hippocampus were determined by liquid chromatography-tandem mass spectrometry. In adrenalectomized rats, net hippocampus-synthesized corticosterone (CORT and DOC were determined to 6.9 and 5.8 nM, respectively. Enhanced spinogenesis was observed in the hippocampus following application of low nanomolar (10 nM doses of CORT for 1 h. CONCLUSIONS/SIGNIFICANCE: These results imply the complete pathway of corticosteroid synthesis of 'pregnenolone →PROG→DOC→CORT' in the hippocampal neurons. Both P450(c21 and P450(2D4 can catalyze conversion of PROG to DOC. The low nanomolar level of CORT synthesized in hippocampal neurons may play a role in modulation of synaptic plasticity, in contrast to the stress effects by micromolar CORT from adrenal glands.

  10. Dapsone versus corticosteroids in lichen planus

    Directory of Open Access Journals (Sweden)

    Chopra Adarsh

    1999-01-01

    Full Text Available Seventy five patients with Lichen Planus (LP were enrolled from out-patient department for screening the therapeutic effect of dapsone. Patients were divided into two groups of 50 and 25. In regimen - 1 (RI 25 patients were given local corticosteroids and oral chlorpheniramine maleate. In regimen - 2 (R2 50 patients were given oral dapsone and chlorpheniramine maleate and topical coconut oil. It was found that total efficacy of R2 was 18% higher than R1.

  11. Optimising Code Generation with haggies

    OpenAIRE

    Reiter, Thomas

    2009-01-01

    This article describes haggies, a program for the generation of optimised programs for the efficient numerical evaluation of mathematical expressions. It uses a multivariate Horner-scheme and Common Subexpression Elimination to reduce the overall number of operations. The package can serve as a back-end for virtually any general purpose computer algebra program. Built-in type inference that allows to deal with non-standard data types in strongly typed languages and a very flexible, pattern-ba...

  12. [Prenatal corticosteroids: short-term and long-term effects of multiple courses. Literature review in 2013].

    Science.gov (United States)

    Fuchs, F; Audibert, F; Senat, M-V

    2014-03-01

    Prenatal corticosteroids administration is one of the major advances in obstetrics and neonatology for the prevention of preterm-birth related complications. However, concerns have been raised about its safety regarding neonatal growth and children development. Therefore, some obstetricians have restricted the use of corticosteroids to precisely defined indications. It remains some uncertainty regarding the choice of antenatal corticosteroids, the interval between injections, the timing of effectiveness and the maximum number of courses per pregnancy that is acceptable without causing complications among children. Thus, we performed a current literature review in 2013 regarding short- and long-term efficacy and safety in order to give clear recommendations to practitioners. Copyright © 2014. Published by Elsevier Masson SAS.

  13. Robust optimisation of railway crossing geometry

    Science.gov (United States)

    Wan, Chang; Markine, Valeri; Dollevoet, Rolf

    2016-05-01

    This paper presents a methodology for improving the crossing (frog) geometry through the robust optimisation approach, wherein the variability of the design parameters within a prescribed tolerance is included in the optimisation problem. Here, the crossing geometry is defined by parameterising the B-spline represented cross-sectional shape and the longitudinal height profile of the nose rail. The dynamic performance of the crossing is evaluated considering the variation of wheel profiles and track alignment. A multipoint approximation method (MAM) is applied in solving the optimisation problem of minimising the contact pressure during the wheel-rail contact and constraining the location of wheel transition at the crossing. To clarify the difference between the robust optimisation and the normal deterministic optimisation approaches, the optimisation problems are solved in both approaches. The results show that the deterministic optimum fails under slight change of the design variables; the robust optimum, however, has improved and robust performance.

  14. Optimising magnetic sentinel lymph node biopsy in an in vivo porcine model

    NARCIS (Netherlands)

    Ahmed, M.; Anninga, Bauke; Pouw, Joost Jacob; Vreemann, S.; Peek, M.; van Hemelrijck, Mieke; Pinder, Sara E.; ten Haken, Bernard; Pankhurst, Quentin A.; Douek, Michael

    2015-01-01

    The magnetic technique for sentinel lymph node biopsy (SLNB) has been evaluated in several clinical trials. An in vivo porcine model was developed to optimise the magnetic technique by evaluating the effect of differing volume, concentration and time of injection of magnetic tracer. A total of 60

  15. An Optimisation Approach for Room Acoustics Design

    DEFF Research Database (Denmark)

    Holm-Jørgensen, Kristian; Kirkegaard, Poul Henning; Andersen, Lars

    2005-01-01

    This paper discuss on a conceptual level the value of optimisation techniques in architectural acoustics room design from a practical point of view. It is chosen to optimise one objective room acoustics design criterium estimated from the sound field inside the room. The sound field is modeled...... using the boundary element method where absorption is incorporated. An example is given where the geometry of a room is defined by four design modes. The room geometry is optimised to get a uniform sound pressure....

  16. Enhancing nuclear translocation: perspectives in inhaled corticosteroid therapy.

    Science.gov (United States)

    Hakim, Amir; Usmani, Omar S

    2015-01-01

    Corticosteroids are widely used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). In contrast to their use in mild-to-moderate asthma, they are less efficacious in improving lung function and controlling the underlying inflammation in COPD. In most clinical trials, corticosteroids have shown little benefit in COPD, but have shown a greater clinical effect in combination with long-acting bronchodilators. Impaired corticosteroid activation of the glucocorticoid receptor (GR) has been reported in corticosteroid-insensitive individuals. Reversal of corticosteroid-insensitivity by enhancing GR nuclear translocation is a potential therapeutic target. Preclinical studies suggest members of the nuclear receptor superfamily may facilitate glucocorticoid receptor nuclear translocation. Unravelling the mechanisms that govern GR nuclear translocation may identify novel therapeutic targets for reversing corticosteroid-insensitivity.

  17. Do autologous blood and PRP injections effectively treat tennis elbow?

    Science.gov (United States)

    Widstrom, Luke; Slattengren, Andrew

    2016-09-01

    Both approaches reduce pain, but the improvement with platelet-rich plasma (PRP) is not clinically meaningful. Autologous blood injections (ABIs) are more effective than corticosteroid injections for reducing pain and disability in patients with tennis elbow in both the short and long term.

  18. Glycemic management after antenatal corticosteroid therapy

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2014-01-01

    Full Text Available Antenatal corticosteroids (ACS are recommended for use in antenatal mothers at risk of preterm delivery before 34 weeks. One common side-effect of these drugs is their propensity to cause hyperglycemia. A PubMed search was made using terms ′steroid,′ ′dexamethasone,′ ′betamethasone′ with diabetes/glucose. Relevant articles were extracted. In addition, important cross-reference articles were reviewed. This review, based upon this literature search, discusses the available evidence on effects on glycemic status as well as management strategies in women with pre-existing diabetes, gestational diabetes mellitus, as well as normoglycemic women after ACS use in pregnancy.

  19. Corticosteroids: clinical pharmacology and therapeutic use.

    Science.gov (United States)

    Swartz, S L; Dluhy, R G

    1978-09-01

    The widespread use of corticosteroids in clinical practice emphasises the need for a thorough understanding of their metabolic effects. In general, the actions of corticosteroids on carbohydrate, protein, and lipid metabolism result in increased hepatic capacity for gluconeogenesis and enhanced catabolic actions upon muscle, skin, lymphoid, adipose and connective tissues. Because of the morbidity associated with steroid therapy, the clinician must carefully consider in each case the gains that can reasonably be expected from corticosteroid therapy versus the inevitable undesirable side effects of prolonged therapy. Thus, it is important to remember that the enhanced anti-inflammatory activity of the various synthetic analogues of cortisol is not dissociated from the expected catabolic actions of glucocorticoid hormones. Replacement therapy with physiological doses of cortisol in primary or secondary adrenal insufficiency is intended to simulate the normal daily secretion of cortisol. Short term, high dose suppressive glucocorticoid therapy is indicated in the treatment of medical emergencies such as necrotising vasculitis, status asthmaticus and anaphylactic shock. With improvement of the underlying disorder, the steroid dosage can be rapidly tapered and then discontinued over a 2 to 3 day period. Long term, high dose suppressive therapy is often commonly used to treat certain diseases (see sections 4.7.2 and 4.7.3). In this setting, suppression of the hypothalamic-pituitary-adrenal axis may persist for as long as 9 to 12 months following steroid withdrawal if steroid doses are administered in the supraphysiological range for longer than 2 weeks. In general, higher doses, longer duration of usage, and frequent daily administration are all correlated with the severity of pituitary ACTH suppression. When steroid therapy is to be withdrawn, gradual tapering of the dosage is necessary; the steroid dosage should also be given as a single morning dose if possible. Rapid

  20. Optimisation combinatoire Theorie et algorithmes

    CERN Document Server

    Korte, Bernhard; Fonlupt, Jean

    2010-01-01

    Ce livre est la traduction fran aise de la quatri me et derni re dition de Combinatorial Optimization: Theory and Algorithms crit par deux minents sp cialistes du domaine: Bernhard Korte et Jens Vygen de l'universit de Bonn en Allemagne. Il met l accent sur les aspects th oriques de l'optimisation combinatoire ainsi que sur les algorithmes efficaces et exacts de r solution de probl mes. Il se distingue en cela des approches heuristiques plus simples et souvent d crites par ailleurs. L ouvrage contient de nombreuses d monstrations, concises et l gantes, de r sultats difficiles. Destin aux tudia

  1. Optimisation of the LHCb detector

    CERN Document Server

    Hierck, R

    2003-01-01

    This thesis describes a comparison of the LHCb classic and LHCb light concept from a tracking perspective. The comparison includes the detector occupancies, the various pattern recognition algorithms and the reconstruction performance. The final optimised LHCb setup is used to study the physics performance of LHCb for the Bs->DsK and Bs->DsPi decay channels. This includes both the event selection and a study of the sensitivity for the Bs oscillation frequency, delta m_s, the Bs lifetime difference, DGamma_s, and the CP parameter gamma-2delta gamma.

  2. Optimisation of the LHCb detector

    CERN Document Server

    Hierck, R H

    2003-01-01

    This thesis describes a comparison of the LHCb classic and LHCb light concept from a tracking perspective. The comparison includes the detector occupancies, the various pattern recognition algorithms and the reconstruction performance. The final optimised LHCb setup is used to study the physics performance of LHCb for the Bs->DsK and Bs->DsPi decay channels. This includes both the event selection and a study of the sensitivity for the Bs oscillation frequency, delta m_s, the Bs lifetime difference, DGamma_s, and the CP parameter gamma-2delta gamma.

  3. Perioperative corticosteroid management for patients with inflammatory bowel disease.

    Science.gov (United States)

    Hicks, Caitlin W; Wick, Elizabeth C; Salvatori, Roberto; Ha, Christina Y

    2015-01-01

    Guidelines on the appropriate use of perioperative steroids in patients with inflammatory bowel disease (IBD) are lacking. As a result, corticosteroid supplementation during and after colorectal surgery procedures has been shown to be highly variable. A clearer understanding of the indications for perioperative corticosteroid administration relative to preoperative corticosteroid dosing and duration of therapy is essential. In this review, we outline the basic tenets of the hypothalamic-pituitary-adrenal (HPA) axis and its normal response to stress, describe how corticosteroid use is thought to affect this system, and provide an overview of the currently available data on perioperative corticosteroid supplementation including the limited evidence pertaining to patients with inflammatory bowel disease. Based on currently existing data, we define "adrenal suppression," and propose a patient-based approach to perioperative corticosteroid management in the inflammatory bowel disease population based on an individual's historical use of corticosteroids, the type of surgery they are undergoing, and HPA axis testing when applicable. Patients without adrenal suppression (corticosteroid supplementation in the perioperative period; patients with adrenal suppression (>20 mg prednisone per day) should be treated with additional perioperative corticosteroid coverage above their baseline home regimen; and patients with unclear HPA axis function (>5 and <20 mg prednisone per day) should undergo preoperative HPA axis testing to determine the best management practices. The proposed management algorithm attempts to balance the risks of adrenal insufficiency and immunosuppression.

  4. Optimising resource management in neurorehabilitation.

    Science.gov (United States)

    Wood, Richard M; Griffiths, Jeff D; Williams, Janet E; Brouwers, Jakko

    2014-01-01

    To date, little research has been published regarding the effective and efficient management of resources (beds and staff) in neurorehabilitation, despite being an expensive service in limited supply. To demonstrate how mathematical modelling can be used to optimise service delivery, by way of a case study at a major 21 bed neurorehabilitation unit in the UK. An automated computer program for assigning weekly treatment sessions is developed. Queue modelling is used to construct a mathematical model of the hospital in terms of referral submissions to a waiting list, admission and treatment, and ultimately discharge. This is used to analyse the impact of hypothetical strategic decisions on a variety of performance measures and costs. The project culminates in a hybridised model of these two approaches, since a relationship is found between the number of therapy hours received each week (scheduling output) and length of stay (queuing model input). The introduction of the treatment scheduling program has substantially improved timetable quality (meaning a better and fairer service to patients) and has reduced employee time expended in its creation by approximately six hours each week (freeing up time for clinical work). The queuing model has been used to assess the effect of potential strategies, such as increasing the number of beds or employing more therapists. The use of mathematical modelling has not only optimised resources in the short term, but has allowed the optimality of longer term strategic decisions to be assessed.

  5. Detection of contact hypersensitivity to corticosteroids in allergic contact dermatitis patients who do not respond to topical corticosteroids.

    Science.gov (United States)

    Gönül, Müzeyyen; Gül, Ulker

    2005-08-01

    The delayed hypersensitivity development against topical corticosteroids which are used in allergic contact dermatitis (ACD) treatment is an important clinical problem. In our study, 41 ACD patients who did not show any response to topical corticosteroid treatment were patch tested with corticosteroid series and the commercial preparations of corticosteroids and their vehicles. In corticosteroid series, there were budesonide, bethametasone-17-valerate, triamcinolone acetonide, tixocortol pivalate, alclomethasone-17-21-dipropionate, clobetasole-17-propionate, dexamethasone-21-phosphate disodium and hydrocortisone-17-butyrate. We detected positive reaction to corticosteroids in 9 of our cases (22%) (5 single and 4 multiple). The sensitivity was mostly produced by tixocortol pivalate (6 patients). This was followed by triamcinolone acetonide (2 patients) budesonide (2 patients), alclomethasone dipropionate (2 patients), dexamethasone 21 phosphate disodium (2 patients) and betamethasone-17-valerate (1 patient). As a result, it should not be forgotten that the corticosteroids used to treat ACD patients may cause ACD themselves. In ACD patients who did not respond to corticosteroid treatment, routinely applying patch test with corticosteroids should be helpful in directing the treatment.

  6. Surgery versus ultrasound-guided steroid injections for trigger finger disease

    DEFF Research Database (Denmark)

    Hansen, Rehne L; Lange, Jeppe

    2013-01-01

    -centre, randomised controlled trial with a one-year follow-up. Patients are randomly assigned to either ultrasound-guided corticosteroid injection (n = 83) or to open surgical release of A1-pulley (n = 83). Follow-up is conducted at 12 weeks and one year after treatment. The affected finger will be assessed using......INTRODUCTION: Trigger fingers have been reported in the literature for over a century; yet, the lack of trials comparing open surgery to corticosteroid injection is pronounced. At the initiation of the present study in 2010, no randomized controlled trials could be found comparing open surgery...... to corticosteroid injection. In the present randomized controlled trial, we plan to compare the efficacy of a single ultrasound-guided corticosteroid injection with conventional open surgery in terms of ability to correct the trigger finger. MATERIAL AND METHODS: The study is performed as an open-label single...

  7. Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

    Directory of Open Access Journals (Sweden)

    Sarah J Atkinson

    Full Text Available The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE, 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high. Subjects receiving corticosteroids during the initial 7 days of admission (n = 252 were compared to subjects who did not receive corticosteroids (n = 244. Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004 and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012. Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

  8. Dose optimisation in single plane interstitial brachytherapy

    DEFF Research Database (Denmark)

    Tanderup, Kari; Hellebust, Taran Paulsen; Honoré, Henriette Benedicte;

    2006-01-01

    BACKGROUND AND PURPOSE: Brachytherapy dose distributions can be optimised       by modulation of source dwell times. In this study dose optimisation in       single planar interstitial implants was evaluated in order to quantify the       potential benefit in patients. MATERIAL AND METHODS: In 14...

  9. Self-optimising control of sewer systems

    DEFF Research Database (Denmark)

    Mauricio Iglesias, Miguel; Montero-Castro, Ignacio; Mollerup, Ane Loft;

    The design of sewer system control is a complex task given the large size of the sewer networks, the transient dynamics of the water flows and the stochastic nature of rainfall. This contribution presents a generic methodology for the design of a self-optimising controller in sewer systems...... to design an optimising control strategy for a subcathcment area in Copenhagen....

  10. An Optimisation Approach for Room Acoustics Design

    DEFF Research Database (Denmark)

    Holm-Jørgensen, Kristian; Kirkegaard, Poul Henning; Andersen, Lars

    2005-01-01

    This paper discuss on a conceptual level the value of optimisation techniques in architectural acoustics room design from a practical point of view. It is chosen to optimise one objective room acoustics design criterium estimated from the sound field inside the room. The sound field is modeled...

  11. Haemodynamic optimisation in lower limb arterial surgery

    DEFF Research Database (Denmark)

    Bisgaard, J; Gilsaa, T; Rønholm, E;

    2012-01-01

    index was optimised by administering 250 ml aliquots of colloid intraoperatively and during the first 6 h post-operatively. Following surgery, fluid optimisation was supplemented with dobutamine, if necessary, targeting an oxygen delivery index level ≥ 600 ml/min(/) m(2) in the intervention group...

  12. Evolutionary programming for neutron instrument optimisation

    Science.gov (United States)

    Bentley, Phillip M.; Pappas, Catherine; Habicht, Klaus; Lelièvre-Berna, Eddy

    2006-11-01

    Virtual instruments based on Monte-Carlo techniques are now integral part of novel instrumentation development and the existing codes (McSTAS and Vitess) are extensively used to define and optimise novel instrumental concepts. Neutron spectrometers, however, involve a large number of parameters and their optimisation is often a complex and tedious procedure. Artificial intelligence algorithms are proving increasingly useful in such situations. Here, we present an automatic, reliable and scalable numerical optimisation concept based on the canonical genetic algorithm (GA). The algorithm was used to optimise the 3D magnetic field profile of the NSE spectrometer SPAN, at the HMI. We discuss the potential of the GA which combined with the existing Monte-Carlo codes (Vitess, McSTAS, etc.) leads to a very powerful tool for automated global optimisation of a general neutron scattering instrument, avoiding local optimum configurations.

  13. Evolutionary programming for neutron instrument optimisation

    Energy Technology Data Exchange (ETDEWEB)

    Bentley, Phillip M. [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany)]. E-mail: phillip.bentley@hmi.de; Pappas, Catherine [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany); Habicht, Klaus [Hahn-Meitner Institut, Glienicker Strasse 100, D-14109 Berlin (Germany); Lelievre-Berna, Eddy [Institut Laue-Langevin, 6 rue Jules Horowitz, BP 156, 38042 Grenoble Cedex 9 (France)

    2006-11-15

    Virtual instruments based on Monte-Carlo techniques are now integral part of novel instrumentation development and the existing codes (McSTAS and Vitess) are extensively used to define and optimise novel instrumental concepts. Neutron spectrometers, however, involve a large number of parameters and their optimisation is often a complex and tedious procedure. Artificial intelligence algorithms are proving increasingly useful in such situations. Here, we present an automatic, reliable and scalable numerical optimisation concept based on the canonical genetic algorithm (GA). The algorithm was used to optimise the 3D magnetic field profile of the NSE spectrometer SPAN, at the HMI. We discuss the potential of the GA which combined with the existing Monte-Carlo codes (Vitess, McSTAS, etc.) leads to a very powerful tool for automated global optimisation of a general neutron scattering instrument, avoiding local optimum configurations.

  14. MACROSCOPIC ANALYSES OF THE EFFECTS OF HYALURONATES AND CORTICOSTEROIDS ON INDUCED OSTEOARTHRITIS IN RABBITS’ KNEES

    Science.gov (United States)

    Albano, Mauro Batista; Vidigal, Leandro; de Oliveira, Marcello Zaia; Namba, Mario Massatomo; da Silva, João Luiz Vieira; de Assis Pereira Filho, Francisco; Barbosa, Marcio Alves; da Silva, Elias Marcelo Batista

    2015-01-01

    Objective: To evaluate the effects of intra-articular injections of corticosteroids, native hyaluronic acid and branched-chain hyaluronic acid in experimentally-induced osteoarthrosis. Methods: 44 rabbits underwent anterior cruciate ligament resection and were then divided into four groups of eleven. Group 1: one intra-articular injection of saline solution per week, for three weeks; Group 2: three injections (one per week) of native hyaluronic acid; Group 3: three injections (one per week) of branched-chain hyaluronic acid; Group 4: two injections of betamethasone with an interval of three weeks. The cartilage of the tibial plateaus was evaluated macroscopically twelve weeks after surgery. Changes to the joint surface were graded as follows: Grade 0: smooth joint surface without relief changes; Grade 1: rough surface without any depressions; Grade 2: similar to grade 1, but with depressions on the joint surface; and Grade 3: subchondral bone exposure. The statistical analysis consisted of the use of Student's t test, chi-square test and analysis of variance (ANOVA). The significance level used was 5%. Results: A statistical difference was found between the control group and the three study groups 2, 3, 4 in relation to the development and severity of arthrosis. However, there was no difference between the groups regarding the drugs studied. Conclusion: A similar degree of attenuation of the osteoarthrosis process in the rabbits’ knees was found with the use of intra-articular injections of low-molecular-weight and high-molecular-weight glycosaminoglycans, and the corticosteroid betamethasone, compared with placebo. PMID:27022552

  15. Mould filling simulations during powder injection moulding

    NARCIS (Netherlands)

    Bilovol, V.V.

    2003-01-01

    Powder injection moulding (PIM) is a versatile technology capable of producing complex and near net shape parts. Significant help in optimisation of the PIM process can be obtained from the numerical simulation. To obtain realistic numerical results it is necessary to fulfil certain conditions. The

  16. Corticosteroids: friends or foes of teleost fish reproduction?

    OpenAIRE

    2009-01-01

    Reproduction in vertebrates is controlled by the Hypothalamus-Pituitary-Gonad axis and the main hormone actions have been extensively described. Still, despite the scattered information in fish, accumulating evidence strongly indicates that corticosteroids play essential roles in reproductive mechanisms. An integrative approach is important for understanding these implications. Animal husbandry and physiological studies at molecular to organismal levels have revealed that these corticosteroid...

  17. Risk of miscarriage among users of corticosteroid hormones

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Nielsen, Rikke B; Nørgaard, Mette Lone

    2013-01-01

    The purpose of this nested case-control study in Denmark was to study the association between use of corticosteroids and risk of miscarriage.......The purpose of this nested case-control study in Denmark was to study the association between use of corticosteroids and risk of miscarriage....

  18. Unintended effects of inhaled corticosteroids : disease or drugs?

    NARCIS (Netherlands)

    Vries, F. de

    2007-01-01

    Patients with asthma or COPD are often treated with inhaled corticosteroids. These drugs reduce the inflammation in the lungs and patients suffer fewer exacerbations. In the late nineties, a tendency to treat patients in general with higher doses of inhaled corticosteroids was accompanied with an in

  19. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis

    DEFF Research Database (Denmark)

    Juel-Berg, Nanna; Darling, Peter; Bolvig, Julie

    2017-01-01

    Background: Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007. Objective...

  20. Corticosteroids for all adult patients with community-acquired pneumonia?

    OpenAIRE

    Ger Rijkers; Simone Spoorenberg; Stefan Vestjens; Werner Albrich

    2015-01-01

    Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.

  1. Ovine fetal thymus response to lipopolysaccharide-induced chorioamnionitis and antenatal corticosteroids.

    Directory of Open Access Journals (Sweden)

    Elke Kuypers

    Full Text Available RATIONALE: Chorioamnionitis is associated with preterm delivery and involution of the fetal thymus. Women at risk of preterm delivery receive antenatal corticosteroids which accelerate fetal lung maturation and improve neonatal outcome. However, the effects of antenatal corticosteroids on the fetal thymus in the settings of chorioamnionitis are largely unknown. We hypothesized that intra-amniotic exposure to lipopolysaccharide (LPS causes involution of the fetal thymus resulting in persistent effects on thymic structure and cell populations. We also hypothesized that antenatal corticosteroids may modulate the effects of LPS on thymic development. METHODS: Time-mated ewes with singleton fetuses received an intra-amniotic injection of LPS 7 or 14 days before preterm delivery at 120 days gestational age (term = 150 days. LPS and corticosteroid treatment groups received intra-amniotic LPS either preceding or following maternal intra-muscular betamethasone. Gestation matched controls received intra-amniotic and maternal intra-muscular saline. The fetal intra-thoracic thymus was evaluated. RESULTS: Intra-amniotic LPS decreased the cortico-medullary (C/M ratio of the thymus and increased Toll-like receptor (TLR 4 mRNA and CD3 expression indicating involution and activation of the fetal thymus. Increased TLR4 and CD3 expression persisted for 14 days but Foxp3 expression decreased suggesting a change in regulatory T-cells. Sonic hedgehog and bone morphogenetic protein 4 mRNA, which are negative regulators of T-cell development, decreased in response to intra-amniotic LPS. Betamethasone treatment before LPS exposure attenuated some of the LPS-induced thymic responses but increased cleaved caspase-3 expression and decreased the C/M ratio. Betamethasone treatment after LPS exposure did not prevent the LPS-induced thymic changes. CONCLUSION: Intra-amniotic exposure to LPS activated the fetal thymus which was accompanied by structural changes. Treatment

  2. Factors impacting the combination of topical corticosteroid therapies for psoriasis: perspectives from the international psoriasis council

    NARCIS (Netherlands)

    Kerkhof, P.C. van de; Kragballe, K.; Segaert, S.; Lebwohl, M.

    2011-01-01

    Corticosteroids are the mainstay of topical therapies for the treatment of mild to moderate psoriasis. Selection of vehicle, concentrations of corticosteroid and coadministered medications, and frequency of administration are critical factors that enhance bioavailability of topical corticosteroids.

  3. Proliferative and necrotizing otitis externa in a kitten: successful treatment with intralesional and topical corticosteroid therapy

    Science.gov (United States)

    MOMOTA, Yutaka; YASUDA, Junya; IKEZAWA, Mitsutaka; SASAKI, Jun; KATAYAMA, Masaaki; TANI, Kenji; MIYABE, Masahiro; ONOZAWA, Eri; AZAKAMI, Daigo; ISHIOKA, Katsumi; SAKO, Toshinori

    2016-01-01

    Proliferative and necrotising otitis externa (PNOE) is a very rare disease affecting the ear canals and concave pinnae of kittens. This report describes a 5-month-old cat with PNOE. Histopathological examination confirmed the diagnosis. Treatment was initiated with local injection of methylprednisolone acetate into the lesions. The cat was subsequently treated with clobetasol propionate cream, a potent topical glucocorticoid ointment. The cat showed marked improvement. While topical treatment with tacrolimus, an immunosuppressive agent, is reported to be an effective therapy, to the best of our knowledge, this is the first report to treat PNOE with local corticosteroid therapy. PMID:27570137

  4. Ultrasound-guided injection for plantar fasciitis: A brief review

    Directory of Open Access Journals (Sweden)

    A S Nair

    2016-01-01

    Full Text Available Plantar fasciitis (PF is a distressing condition experienced by many patients. Although self-limiting, it tends to become a chronic ailment if the precipitating factors are not addressed. One of the modality of treating PF is intra-lesional corticosteroid injection. This was done using palpation technique earlier but nowadays many specialists use ultrasound (US imaging as a guide to give injection accurately instead of inadvertently damaging the plantar fascia or injecting into surrounding soft tissue, both of which can have serious implications. We did a literature search in Medline, Scopus, and Embase databases to find out articles describing US-guided corticosteroid injection for treating PF and whether guided injection was effective than injection given by palpation.

  5. Corticosteroids In Infections Of Central Nervous System

    Directory of Open Access Journals (Sweden)

    Meena AK

    2003-01-01

    Full Text Available Infections of central nervous system are still a major problem. Despite the introduction of newer antimicrobial agents, mortality and long-term sequelace associated with these infections is unacceptably high. Based on the evidence that proinflammtory cytokines have a role in pathophysiology of bacterial and tuberculous meningitis, corticosteroids with a potent anti-inflammatory and immunomodulating effect have been tested and found to be of use in experimental and clinical studies, Review of the available literature suggests steroid administration just prior to antimicrobial therapy is effective in decreasing audiologic and neurologic sequelae in childern with H. influenzae nenigitis. Steroid use for bacterial meningitis in adults is found to be beneficial in case of S. pneumoniae. The value of adjunctive steroid therapy for other bacterial causes of meningitis remains unproven. Corticocorticoids are found to be of no benefit in viral meningitis, Role of steroids in HIV positive patients needs to be studied.

  6. Optimising costs in WLCG operations

    CERN Document Server

    Pradillo, Mar; Flix, Josep; Forti, Alessandra; Sciabà, Andrea

    2015-01-01

    The Worldwide LHC Computing Grid project (WLCG) provides the computing and storage resources required by the LHC collaborations to store, process and analyse the 50 Petabytes of data annually generated by the LHC. The WLCG operations are coordinated by a distributed team of managers and experts and performed by people at all participating sites and from all the experiments. Several improvements in the WLCG infrastructure have been implemented during the first long LHC shutdown to prepare for the increasing needs of the experiments during Run2 and beyond. However, constraints in funding will affect not only the computing resources but also the available effort for operations. This paper presents the results of a detailed investigation on the allocation of the effort in the different areas of WLCG operations, identifies the most important sources of inefficiency and proposes viable strategies for optimising the operational cost, taking into account the current trends in the evolution of the computing infrastruc...

  7. Optimising Comprehensibility in Interlingual Translation

    DEFF Research Database (Denmark)

    Nisbeth Jensen, Matilde

    2015-01-01

    . It is argued that Plain Language writing is a type of intralingual translation as it involves rewriting or translating a complex monolingual text into comprehensible language. Based on Plain Language literature, a comprehensibility framework is elaborated, which is subsequently exemplified through...... the functional text type of Patient Information Leaflet. Finally, the usefulness of applying the principles of Plain Language and intralingual translation for optimising comprehensibility in interlingual translation is discussed....... information on medication and tax information. Such texts are often written by experts and received by lay people, and, in today’s globalised world, they are often translated as well. In these functional texts, the receiver is not a mere recipient of information, but s/he needs to be able to act upon it...

  8. Corticosteroid therapy of zoster-associated pain

    Directory of Open Access Journals (Sweden)

    Cvjetković Dejan M.

    2004-01-01

    Full Text Available Introduction Lack of exact clinical studies on effects of corticosteroids in therapy and prevention of herpes zoster-related pain, elicited many controversies in the past. The aim of our study was to estimate effects of prednisone on frequency, intensity and duration of postherpetic neuralgia. Material and methods 68 immunocompetent herpes zoster patients, 8-90 years of age (37 females and 31 males, mean age 55,7 years were enrolled for study; 30 patients were treated with acyclovir (5x800 mg daily for a 7-day period and prednisone (initial daily dose 60 mg, tapering over 14 days, and the control group of 38 patients with acyclovir only. Patients were clinically followed up for 3 months after complete resolution of skin lesions. Chi-square test was used in statistical data analysis. Results The difference regarding incidence of postherpetic neuralgia in acyclovir/prednisone group and acyclovir group (although slightly less in the former one was not significant. Duration of postherpetic neuralgia over 3 months was similar in both groups. Mild postherpetic pain was more common in the acyclovir/prednisone group (44.4% than in the acyclovir group (28.6%; however, statistical validation requires more patients to be studied. Discussion Results of our study didn’t confirm efficiency of prednisone regarding occurrence and characteristics of postherpetic neuralgia. Failure of prednisone therapy may be partly contributed to advanced age of patients and delayed onset of therapy. Conclusion Use of corticosteroids in zoster patients gives neither reliable protection from appearance of postherpetic neuralgia, nor shortens its duration. Further investigations are necessary to estimate their effects on postherpetic pain.

  9. Do not rush to return to sports after trigger finger injection.

    Science.gov (United States)

    Oh, Jeehae; Jo, Leechan; Lee, Jong In

    2015-04-01

    Trigger finger, or digital stenosing tenosynovitis, is a common hand problem. A widely accepted treatment is steroid injection into the flexor tendon sheath. This can cause rupture of the flexor tendon. However, to the best of our knowledge, there is no report on tendon rupture after a single corticosteroid injection. Moreover, there are no guidelines for patients with tendinopathy who want to return to sports after corticosteroid injection. Clinicians who perform local steroid injections for tendinopathy treatment should be aware of the possible dangers of tendon rupture and should confirm that steroids are not administrated into the tendon. Patients should also be warned about returning to sports prematurely and should be encouraged to gradually resume sports after the injection to prevent further damage. Herein, we report an unusual case of flexor digitorum profundus rupture after a single corticosteroid injection in a 57-yr-old male golfer and we also present a review of the literature.

  10. Optimization of solid phase extraction clean up and validation of quantitative determination of corticosteroids in urine by liquid chromatography-tandem mass spectrometry

    DEFF Research Database (Denmark)

    Andersen, Jens Hinge; Hansen, Lene Gram; Pedersen, Mikael

    2008-01-01

    A solid phase extraction (SPE) method for extraction and clean up of 9 synthetic corticosteroids was optimized for quantification by reversed-phase high-performance liquid chromatography/negative electrospray ionisation mass spectrometry. Clean up was accomplished using a mixed mode polymeric...... strong anion exchange SPE column. The final method was validated according to EU regulations for determination of residues of veterinarian drugs in products of animal origin. Initial results showed a large difference in ion suppression between samples of porcine and bovine urine. The aim of optimisation...

  11. Medroxyprogesterone Injection

    Science.gov (United States)

    Medroxyprogesterone intramuscular (into a muscle) injection and medroxyprogesterone subcutaneous (under the skin) injection are used to prevent pregnancy. Medroxyprogesterone subcutaneous injection is also used to treat endometriosis (a condition in which ...

  12. Pentamidine Injection

    Science.gov (United States)

    Pentamidine injection is used to treat pneumonia caused by a fungus called Pneumocystis carinii. It is in ... Pentamidine injection comes as powder to be mixed with liquid to be injected intramuscularly (into a muscle) ...

  13. Uso antenatal do corticosteroide e hemorragia peri-intraventricular Antenatal corticosteroids and intraventricular hemorrhage

    Directory of Open Access Journals (Sweden)

    Luis Eduardo de F. Vinagre

    2010-09-01

    Full Text Available OBJETIVO: Realizar uma revisão bibliográfica sobre o uso antenatal do corticosteroide na prevenção da hemorragia peri-intraventricular. FONTES DE DADOS: Levantamento bibliográfico por meio do Pubmed e SciELO abrangendo os últimos 20 anos. Foram utilizadas as palavras chaves no idioma inglês: "cerebral hemorrhage", "steroids" e "newborn, infant". SÍNTESES DE DADOS: A hemorragia peri-intraventricular é uma importante patologia nos prematuros, sobretudo nos menores de 34 semanas, devido a suas graves sequelas neurológicas. Uma vez ocorrido o sangramento, não há tratamento específico. Desta forma, a prevenção torna-se o maior objetivo das pesquisas. O resultado da meta-análise de estudos randomizados demonstrou que o corticosteroide antenatal reduz a mortalidade e a incidência da doença de membrana hialina e da hemorragia peri-intraventricular. O efeito protetor na redução do risco da hemorragia peri-intraventricular não está completamente esclarecido. Além de acelerar a maturidade pulmonar, o corticosteroide antenatal estimula a maturação da microvasculatura da matriz germinativa, promove o espessamento da membrana basal, acelera a formação proteica nas junções firmes e estabiliza o fluxo sanguíneo cerebral. Também melhora as condições de nascimento dos fetos pré-termo. CONCLUSÕES: O uso antenatal do corticosteroide associado à implementação de melhores práticas de atendimento ao prematuro tem sido responsável pela evidente redução dos índices dessa doença. Apesar de comprovada eficácia e segurança, não é amplamente utilizado. Medidas devem ser tomadas para estimular seu uso como prática rotineira no atendimento de gestantes com risco de parto prematuro.OBJECTIVE: To conduct a literature review on the use of antenatal corticosteroids for the prevention of peri-intraventricular hemorrhage. DATA SOURCE: Bibliography search in Pubmed and SciELO databases covering the past 20 years using the following

  14. 11-Deoxycortisol is a corticosteroid hormone in the lamprey

    Science.gov (United States)

    Close, D.A.; Yun, S.-S.; McCormick, S.D.; Wildbill, A.J.; Li, W.

    2010-01-01

    Corticosteroid hormones are critical for controlling metabolism, hydromineral balance, and the stress response in vertebrates. Although corticosteroid hormones have been well characterized in most vertebrate groups, the identity of the earliest vertebrate corticosteroid hormone has remained elusive. Here we provide evidence that 11-deoxycortisol is the corticosteroid hormone in the lamprey, a member of the agnathans that evolved more than 500 million years ago. We used RIA, HPLC, and mass spectrometry analysis to determine that 11-deoxycortisol is the active corticosteroid present in lamprey plasma. We also characterized an 11-deoxycortisol receptor extracted from sea lamprey gill cytosol. The receptor was highly specific for 11-deoxycortisol and exhibited corticosteroid binding characteristics, including DNA binding. Furthermore, we observed that 11-deoxycortisol was regulated by the hypothalamus-pituitary axis and responded to acute stress. 11-Deoxycortisol implants reduced sex steroid concentrations and upregulated gill Na+, K+-ATPase, an enzyme critical for ion balance. We show here that 11-deoxycortisol functioned as both a glucocorticoid and a mineralocorticoid in the lamprey. Our findings indicate that a complex and highly specific corticosteroid signaling pathway evolved at least 500 million years ago with the arrival of the earliest vertebrate.

  15. Corticosteroids in chronic obstructive pulmonary disease. Clinical benefits and risks.

    Science.gov (United States)

    McEvoy, C E; Niewoehner, D E

    2000-12-01

    The use of systemic and inhaled corticosteroids for COPD has increased appreciably over the past 20 years. Clearer indications for corticosteroid therapy in COPD are beginning to emerge as the results from large clinical trials become available. Systemic corticosteroids are only modestly effective for acute COPD exacerbations, increase the risk for hyperglycemia, and should be given for no more than 2 weeks. The efficacy of long-term systemic corticosteroid therapy has not been adequately evaluated in this patient population. If longer term use of systemic steroids in COPD should be found to be useful, this conclusion would have to be weighed against the risk for serious adverse effects. High doses of inhaled corticosteroids cause a small sustained increase of the FEV1 in patients with mild and moderately severe COPD, but they do not slow the rate of FEV1 decline. Based on analyses of secondary outcome, inhaled corticosteroids may improve the respiratory symptoms and decrease the number and severity of COPD exacerbations in patients with more advanced disease. Low doses of inhaled corticosteroids appear to be safe, but there is growing awareness that higher doses may not be so benign.

  16. Serum pharmacodynamic biomarkers for chronic corticosteroid treatment of children

    Science.gov (United States)

    Hathout, Yetrib; Conklin, Laurie S.; Seol, Haeri; Gordish-Dressman, Heather; Brown, Kristy J.; Morgenroth, Lauren P.; Nagaraju, Kanneboyina; Heier, Christopher R.; Damsker, Jesse M.; van den Anker, John N.; Henricson, Erik; Clemens, Paula R.; Mah, Jean K.; McDonald, Craig; Hoffman, Eric P.

    2016-01-01

    Corticosteroids are extensively used in pediatrics, yet the burden of side effects is significant. Availability of a simple, fast, and reliable biochemical read out of steroidal drug pharmacodynamics could enable a rapid and objective assessment of safety and efficacy of corticosteroids and aid development of corticosteroid replacement drugs. To identify potential corticosteroid responsive biomarkers we performed proteome profiling of serum samples from DMD and IBD patients with and without corticosteroid treatment using SOMAscan aptamer panel testing 1,129 proteins in FGG). These are candidate biomarkers for anti-inflammatory efficacy of corticosteroids. Known safety concerns were validated, including elevated non-fasting insulin (insulin resistance), and elevated angiotensinogen (salt retention). These were extended by new candidates for metabolism disturbances (leptin, afamin), stunting of growth (growth hormone binding protein), and connective tissue remodeling (MMP3). Significant suppression of multiple adrenal steroid hormones was also seen in treated children (reductions of 17-hydroxyprogesterone, corticosterone, 11-deoxycortisol and testosterone). A panel of new pharmacodynamic biomarkers for corticosteroids in children was defined. Future studies will need to bridge specific biomarkers to mechanism of drug action, and specific clinical outcomes. PMID:27530235

  17. Systematic delay-driven power optimisation and power-driven delay optimisation of combinational circuits

    OpenAIRE

    Mehrotra, Rashmi

    2013-01-01

    With the proliferation of mobile wireless communication and embedded systems, the energy efficiency becomes a major design constraint. The dissipated energy is often referred as the product of power dissipation and the input-output delay. Most of electronic design automation techniques focus on optimising only one of these parameters either power or delay. Industry standard design flows integrate systematic methods of optimising either area or timing while for power consumption optimisation o...

  18. [Postnatal corticosteroids in preterm infants with immature lung disease].

    Science.gov (United States)

    Hinriksdottir, Erna; Brynjarsson, Hrolfur; Thorkelsson, Thordur

    2016-05-01

    Corticosteroids have been used in preterm infants with immature lungs to decrease their need for supplemental oxygen and mechanical ventilation. Whether the benefits of the treatment outweigh possible adverse effects remains controversial. The main objective of the study was to evaluate the effects of intravenous and inhalation corticosteroids on preterm infants' need for supplemental oxygen and mechanical ventilation and potential adverse effects. This was a retrospective cohort study on preterm infants at the Neonatal Intensive Care Unit of Children's Hospital Iceland, born between 2000-2014 and treated with intravenous (n=28) or inhalation (n=30) corticosteroids for immature lung disease. For each infant receiving steriods one infant who did not receive steriods was selected as control, matched on gestational age. There was a significant decrease in the need for supplemental oxygen following intravenous and inhalation corticosteroids administration, and a significant decrease in the need for mechanical ventilation following intravenous corticosteroids administration, but not in controls. Infants receiving intravenous corticosteroids gained significantly less weight than controls during treatment, but no significant difference in weight between groups was found at 35 weeks postmenstrual age, or in other possible adverse effects such as the prevalence of cerebral palsy. Intravenous and inhalation corticosteroids decrease the need for supplemental oxygen in preterm infants with immature lung disease and intravenous steriods facilitate earlier weaning from mechanical ventilation, without significant adverse effects. Therefore, it seems justifiable in selected cases to use corticosteroids in treatment of preterm infants with severe immature lung disease. Corticosteroids, preterm infants, chronic lung disease, mechanical ventilation. Correspondence: Thorður Thorkelsson, thordth@landspitali.is.

  19. PCP prophylaxis with use of corticosteroids by neurologists.

    Science.gov (United States)

    Kelly, Dearbhla M; Cronin, Simon

    2014-04-01

    Pneumocystis jirovecii pneumonia (PCP) is increasingly reported in patients without HIV. Corticosteroids are a major risk factor, with up to 90% of patients receiving corticosteroid treatment prior to the development of PCP. In view of this, many specialties now prescribe PCP prophylaxis to patients receiving prolonged or high-dose glucocorticoid regimens. Neurologists frequently prescribe corticosteroids but may not be as aware of the risk for PCP. Here, we review the evidence for routine PCP prophylaxis among regular glucocorticoid users and ask what guidance there is on the subject for neurologists.

  20. Benchmarks for dynamic multi-objective optimisation

    CSIR Research Space (South Africa)

    Helbig, M

    2013-06-01

    Full Text Available When algorithms solve dynamic multi-objective optimisation problems (DMOOPs), benchmark functions should be used to determine whether the algorithm can overcome specific difficulties that can occur in real-world problems. However, for dynamic multi...

  1. Topology optimisation for natural convection problems

    CERN Document Server

    Alexandersen, Joe; Andreasen, Casper Schousboe; Sigmund, Ole

    2014-01-01

    This paper demonstrates the application of the density-based topology optimisation approach for the design of heat sinks and micropumps based on natural convection effects. The problems are modelled under the assumptions of steady-state laminar flow using the incompressible Navier-Stokes equations coupled to the convection-diffusion equation through the Boussinesq approximation. In order to facilitate topology optimisation, the Brinkman approach is taken to penalise velocities inside the solid domain and the effective thermal conductivity is interpolated in order to accommodate differences in thermal conductivity of the solid and fluid phases. The governing equations are discretised using stabilised finite elements and topology optimisation is performed for two different problems using discrete adjoint sensitivity analysis. The study shows that topology optimisation is a viable approach for designing heat sink geometries cooled by natural convection and micropumps powered by natural convection.

  2. Topology Optimisation for Coupled Convection Problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe

    This thesis deals with topology optimisation for coupled convection problems. The aim is to extend and apply topology optimisation to steady-state conjugate heat transfer problems, where the heat conduction equation governs the heat transfer in a solid and is coupled to thermal transport...... in a surrounding uid, governed by a convection-diffusion equation, where the convective velocity field is found from solving the isothermal incompressible steady-state Navier-Stokes equations. Topology optimisation is also applied to steady-state natural convection problems. The modelling is done using stabilised...... finite elements, the formulation and implementation of which was done partly during a special course as prepatory work for this thesis. The formulation is extended with a Brinkman friction term in order to facilitate the topology optimisation of fluid flow and convective cooling problems. The derived...

  3. An optimisation method for complex product design

    Science.gov (United States)

    Li, Ni; Yi, Wenqing; Bi, Zhuming; Kong, Haipeng; Gong, Guanghong

    2013-11-01

    Designing a complex product such as an aircraft usually requires both qualitative and quantitative data and reasoning. To assist the design process, a critical issue is how to represent qualitative data and utilise it in the optimisation. In this study, a new method is proposed for the optimal design of complex products: to make the full use of available data, information and knowledge, qualitative reasoning is integrated into the optimisation process. The transformation and fusion of qualitative and qualitative data are achieved via the fuzzy sets theory and a cloud model. To shorten the design process, parallel computing is implemented to solve the formulated optimisation problems. A parallel adaptive hybrid algorithm (PAHA) has been proposed. The performance of the new algorithm has been verified by a comparison with the results from PAHA and two other existing algorithms. Further, PAHA has been applied to determine the shape parameters of an aircraft model for aerodynamic optimisation purpose.

  4. On the determination of reducing corticosteroids

    Directory of Open Access Journals (Sweden)

    Luiz Augusto de Abreu

    1955-12-01

    Full Text Available 1. The authors preconize the use of Folin-Ciocalteu's reagent in the colorimetric determination of reducing cortcosteroids. 2. The reaction follows Beer's law in the range 0-50 μg of 11-desoxycorticosterone. 3. Determinations made in human urine and adrenal glands of rats and guinea pigs are comparable with results obtained by other methods.Os autores preconizam o reagente de Folin-Ciocalteu na determinação colorimétrica dos corticosteroides redutores. A reação segue a lei de Beer na faixa de 0 a 50 μg de 11-desoxycorticosterona. A excreção urinária de corticosteroides redutores, em 24 horas, de indivíduos normais variou de 0.83 mg a 2.72 mg com a média de 1.69 mg, sem hidrólise prévia pela β glicuronidase. A intensidade da reação permite efetuar a dosagem em quantidades de urina sensìvelmente menores às usadas por outros métodos baseados nas propriedades redutoras dos corticosteróides. Os resultados, obtidos com suprarrenais de ratos, variaram de 16.3 mg a 50.8 mg de corticosteróides redutores por 100 g de glândula, com uma média de 32.5 mg, fazendo-se as determinações com as duas glândulas em cada animal. A taxa média observada nas suprarrenais de cobaias foi 22.9 mg de corticosteróides redutores por 100 g de glândula, com uma variação individual de 12.6 a 33.2 mg, fazendo-se as determinações sòmente com uma glândula. Os resultados obtidos são comparáveis aos descritos na literatura.

  5. User perspectives in public transport timetable optimisation

    DEFF Research Database (Denmark)

    Jensen, Jens Parbo; Nielsen, Otto Anker; Prato, Carlo Giacomo

    2014-01-01

    The present paper deals with timetable optimisation from the perspective of minimising the waiting time experienced by passengers when transferring either to or from a bus. Due to its inherent complexity, this bi-level minimisation problem is extremely difficult to solve mathematically, since...... on the large-scale public transport network in Denmark. The timetable optimisation approach yielded a yearly reduction in weighted waiting time equivalent to approximately 45 million Danish kroner (9 million USD)....

  6. Analysing bone regeneration using topological optimisation

    Directory of Open Access Journals (Sweden)

    Diego Alexander Garzón Alvarado

    2010-04-01

    Full Text Available The present article's object is to present the mathematical foundations of topological optimisation aimed at carrying out a study of bone regeneration. Bone structure can be economically adopted to different mechanical demands responding to topological optimisation models (having "minimum" mass and "high" resistance. Such analysis is essential for formulating physical therapy in patients needing partial or total strengthening of a particular bone's tissue structure. A mathematical model is formulated, as are the methods for resolving it.

  7. Optimising costs in WLCG operations

    Science.gov (United States)

    Alandes Pradillo, María; Dimou, Maria; Flix, Josep; Forti, Alessandra; Sciabà, Andrea

    2015-12-01

    The Worldwide LHC Computing Grid project (WLCG) provides the computing and storage resources required by the LHC collaborations to store, process and analyse the 50 Petabytes of data annually generated by the LHC. The WLCG operations are coordinated by a distributed team of managers and experts and performed by people at all participating sites and from all the experiments. Several improvements in the WLCG infrastructure have been implemented during the first long LHC shutdown to prepare for the increasing needs of the experiments during Run2 and beyond. However, constraints in funding will affect not only the computing resources but also the available effort for operations. This paper presents the results of a detailed investigation on the allocation of the effort in the different areas of WLCG operations, identifies the most important sources of inefficiency and proposes viable strategies for optimising the operational cost, taking into account the current trends in the evolution of the computing infrastructure and the computing models of the experiments.

  8. Fluticasone furoate: A new intranasal corticosteroid

    Directory of Open Access Journals (Sweden)

    R Kumar

    2012-01-01

    Full Text Available Intranasal corticosteroids are recommended as one of the first-line therapies for the treatment of allergic rhinitis (AR, especially when associated with nasal congestion and recurrent symptoms. Fluticasone furoate is a novel enhanced-affinity glucocorticoid for the treatment of AR approved by the Food and Drug Administration in 2007 and recently introduced in India. Fluticasone furoate nasal spray is indicated for the treatment of the symptoms of seasonal and perennial AR in patients aged two years and older. This review summarizes the clinical data on fluticasone furoate nasal spray and discusses its role in the management of AR. Important attributes of fluticasone furoate include low systemic bioavailability (<0.5%, 24-h symptom relief with once-daily dosing, comprehensive coverage of both nasal and ocular symptoms, safety and tolerability with daily use, and availability in a side-actuated device that makes medication delivery simple and consistent. With these properties, fluticasone furoate nasal spray has the potential to enhance patient satisfaction and compliance, thus making it a good choice amongst available intranasal steroids.

  9. Early interventions in asthma with inhaled corticosteroids.

    Science.gov (United States)

    Laitinen, L A; Altraja, A; Karjalainen, E M; Laitinen, A

    2000-02-01

    We have earlier shown epithelial damage in the airway mucosa in patients with asthma. Later other structural changes have been recognized in asthma, such as deposition of collagen and tenascin in the subepithelial basement membrane and changes in the laminin subchain composition. These processes are modified by an inflammatory process in the airways. Both the United States National Institutes of Health and the British Thoracic Society guidelines on the management of asthma emphasize the need for early use of anti-inflammatory drugs. Many clinical studies that used airway biopsy specimens have shown a decrease in airway inflammatory cell numbers after inhaled corticosteroid therapy. However, there is very little information on the effects of asthma medication on the structural components of the airways. Both the synthesis and degradation of many extracellular matrix components may be affected by the disease process and the drugs resulting in altered remodeling and gene expression in the airways. Because there are only a few studies that try to identify early changes in asthma, it is not known whether the anti-inflammatory treatment of asthma proposed by the guidelines is started early enough.

  10. Modulation of the proteolytic cascade systems by high dose corticosteroids.

    Science.gov (United States)

    Aasen, A O; Ruud, T E; Pillgram-Larsen, J; Röise, O; Stadaas, J

    1985-01-01

    The effects of high-dose corticosteroids (HDC) on activities within the proteolytic cascade systems were studied in vitro and in vivo using chromogenic peptide substrate assays. In in vitro experiments 20 mg methylprednisolone sodium succinate (Solu-Medrol) per ml plasma significantly inhibited activation of plasma prekallikrein, prothrombin and plasminogen and reduced functional plasma kallikrein inhibition, antithrombin and antiplasmin activities. The effects of HDC on activities within these proteolytic cascade systems were further evaluated in experimental acute pancreatitis in pigs. Acute pancreatitis was induced by injection of Na-taurocholate into the pancreatic duct. Seven test animals received methylprednisolone sodium succinate 30 mg per kg intravenously for 30 minutes before the induction of pancreatitis as pretreatment. Eight animals remained untreated. Trypsin (TRY), plasma prekallikrein (PKK), plasma kallikrein (KK) and functional plasma kallikrein inhibition capacity (KKI) were studied in the peritoneal exudate. Cardiac output (CO) and mean arterial pressure (MAP) were monitored regularly before and during a 6 hour observation period. During untreated pancreatitis a reduction of PKK levels of about 40% were found, paralleled by an increased KK activity and a reduction of KKI capacity. Several of the animals experienced high TRY activities. The mortality rate was 63% (5 out of 8 animals). In the pretreated groups, all animals survived the observation period. CO and MAP were significantly less reduced than the untreated group at 6 hours. HDC was also found to reduce significantly plasma kallikrein activities in the peritoneal exudate compared with untreated animals. No changes in TRY activities were found in pretreated animals. Furthermore, plasma prekallikrein and functional plasma kallikrein inhibition values in the exudate were elevated significantly in HDC treated animals compared with untreated animals.

  11. Radiolytic degradation scheme for 60Co-irradiated corticosteroids

    Energy Technology Data Exchange (ETDEWEB)

    Kane, M.P.; Tsuji, K.

    1983-01-01

    The cobalt 60 radiolytic degradation products have been identified in the following corticosteroids: cortisone, cortisone acetate, hydrocortisone, hydrocortisone acetate, hydrocortisone sodium succinate, isoflupredone acetate, methylprednisolone, methylprednisolone acetate, prednisolone, prednisolone acetate, and prednisone. Two major types of degradation processes have been identified: loss of the corticoid side chain on the D-ring to produce the C-17 ketone and conversion of the C-11 alcohol, if present, to the C-11 ketone. Minor degradation products derived from other changes affecting the side chain are also identified in several corticosteroids. These compounds are frequently associated in corticosteroids as process impurities or degradation compounds. No new radiolytic compounds unique to 60Co-irradiation have been found. The majority of corticosteroids have been shown to be stable to 60Co-irradiation. The rates of radiolytic degradation ranged from 0.2 to 1.4%/Mrad.

  12. Corticosteroids: Friends or foes of teleost fish reproduction?

    Science.gov (United States)

    Milla, S; Wang, N; Mandiki, S N M; Kestemont, P

    2009-07-01

    Reproduction in vertebrates is controlled by the Hypothalamus-Pituitary-Gonad axis and the main hormone actions have been extensively described. Still, despite the scattered information in fish, accumulating evidence strongly indicates that corticosteroids play essential roles in reproductive mechanisms. An integrative approach is important for understanding these implications. Animal husbandry and physiological studies at molecular to organismal levels have revealed that these corticosteroids are regulators of fish reproductive processes. But their involvements appear strongly contrasted. Indeed, for both sexes, corticosteroids present either deleterious or positive effects on fish reproduction. In this review, the authors will attempt to gather and clarify the available information about these physiological involvements. The authors will also suggest future ways to prospect corticosteroid roles in fish reproduction.

  13. Oxidant-induced corticosteroid unresponsiveness in human bronchial epithelial cells

    NARCIS (Netherlands)

    Heijink, Irene; van Oosterhout, Antoon; Kliphuis, Nathalie; Jonker, Marnix; Hoffmann, Roland; Telenga, Eef; Klooster, Karin; Slebos, Dirk-Jan; ten Hacken, Nick; Postma, Dirkje; van den Berge, Maarten

    2014-01-01

    Background We hypothesised that increased oxidative stress, as present in the airways of asthma and chronic obstructive pulmonary disease (COPD) patients, induces epithelial damage and reduces epithelial responsiveness to suppressive effects of corticosteroids on proinflammatory cytokine production

  14. Chlorhexidine monotherapy with adjunctive topical corticosteroids for acanthamoeba keratitis

    Directory of Open Access Journals (Sweden)

    Firoozeh Rahimi

    2015-01-01

    Conclusion: Chlorhexidine is effective for monotherapy in AK and could be a good choice for initiating treatment. After the initial response to anti-Acanthamoeba agents, corticosteroids can be used as adjunctive therapy depending on the clinical condition.

  15. Oxidant-induced corticosteroid unresponsiveness in human bronchial epithelial cells

    NARCIS (Netherlands)

    Heijink, Irene; van Oosterhout, Antoon; Kliphuis, Nathalie; Jonker, Marnix; Hoffmann, Roland; Telenga, Eef; Klooster, Karin; Slebos, Dirk-Jan; ten Hacken, Nick; Postma, Dirkje; van den Berge, Maarten

    2014-01-01

    Background We hypothesised that increased oxidative stress, as present in the airways of asthma and chronic obstructive pulmonary disease (COPD) patients, induces epithelial damage and reduces epithelial responsiveness to suppressive effects of corticosteroids on proinflammatory cytokine production

  16. Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

    NARCIS (Netherlands)

    Hoonhorst, Susan J. M.; ten Hacken, Nicolaas; Loi, Adele T. Lo Tam; Koenderman, Leo; Lammers, Jan Willem J.; Telenga, Eef D.; Boezen, Hendrika; van den Berge, Maarten; Postma, Dirkje S.

    2014-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive t

  17. Acute corticosteroid-induced rhabdomyolysis in a golf player

    African Journals Online (AJOL)

    management. The baseline creatine ... The diagnosis of acute steroid-induced rhabdomyolysis was based ... and muscle weakness was first reported by Cushing in 1932.2 ... Corticosteroid-induced myopathy is a disease that mainly causes.

  18. [Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].

    Science.gov (United States)

    Möhnle, P; Briegel, J

    2012-04-01

    Despite a number of clinical trials there is still controversy about the role of corticosteroid therapy in acute respiratory distress syndrome (ARDS). In addition recent meta-analyses differed markedly in the conclusions. This review is intended to provide a short practical guide for the clinician. Based on the available literature, high-dose and pre-emptive administration of corticosteroids is hazardous and not indicated. A low-dose corticosteroid regime given for 4 weeks may potentially be helpful and can be considered in acute or unresolved ARDS in less than 14 days after onset of ARDS, if a close infection surveillance program is available, if neuromuscular blockade can be avoided and if a stepwise dose reduction of corticosteroids is performed. The total daily dose at the beginning of treatment should not exceed 2 mg/kg body weight (BW) methylprednisolone.

  19. Safety of bronchodilators and corticosteroids for asthma during pregnancy

    DEFF Research Database (Denmark)

    Gregersen, Thorbjørn Lomholt; Ulrik, Charlotte Suppli

    2013-01-01

    the safety of add-on long-acting β2-agonists to inhaled corticosteroids. Inhaled corticosteroids are generally found to be safe, although further research is needed to investigate both the efficacy and safety of high dose therapy with inhaled corticosteroids. Studies have reported associations between......Asthma is a common medical condition complicating pregnancy with potentially serious effects on pregnancy outcome. The aim of this review is to provide an update on efficacy and safety of asthma medications, primarily bronchodilators and corticosteroids, used during pregnancy with focus...... stating otherwise appear to have, perhaps critical, methodological limitations. The safety of long-acting β2-agonists remains to be further investigated, and the few available studies have methodological limitations and, therefore, provide no definite answers, although a very recent study supports...

  20. Prednisone and Other Corticosteroids: Balance the Risks and Benefits

    Science.gov (United States)

    ... least amount of risk: Try lower doses or intermittent dosing. Newer forms of corticosteroids come in varying ... ways to minimize side effects. Eat a healthy diet and participate in activities that help you maintain ...

  1. The effects of corticosteroids and nonsteroidal anti-inflammatory ...

    African Journals Online (AJOL)

    conversion of arachidonic acid to prostaglandins by COX. Corticosteroids reduce the .... Zezos P, Kouklakis G, Saibil F. Inflammatory bowel disease and thromboembolism. World J ... The cardiovascular toxicity of selective and nonselective ...

  2. The role of ultrasound guided peri-tendinous injection in the treatment of non-calcific tendinopathy

    Directory of Open Access Journals (Sweden)

    Gamal Niazi

    2015-03-01

    Conclusion: Ultrasound is a non invasive imaging technique that allows real time guidance for interventional therapy of non-calcific tendinopathy improving the result of peri-tendinous corticosteroid injection.

  3. Effects of corticosteroids and splenectomy on the immune clearance and destruction of erythrocytes.

    Science.gov (United States)

    Atkinson, J P; Schreiber, A D; Frank, M M

    1973-06-01

    Corticosteroids and splenectomy constitute two important therapeutic modalities in the treatment of autoimmune hemolytic anemia. Each of these may affect both the rate of synthesis of autoantibody and the clearance of antibody sensitized cells. The latter possibility has been examined in an experimental model which allows evaluation of the role of antibody and complement in the immune clearance of erythrocytes in molecular terms. The in vivo clearance of (51)Cr-labeled guinea pig erythrocytes sensitized with purified rabbit IgG or IgM antibody to produce a known number of complement-fixing sites per cell was studied. Corticosteroid therapy increased the survival of both IgG and IgM sensitized erythrocytes by decreasing sequestration in the reticuloendothelial system (RES). 5 days of therapy prior to injection of antibody coated cells were required for a maximal effect. It appeared that the RES of cortisone-treated animals had a lowered sensitivity to erythrocytes coated with antibody and complement and the cells were removed as though they were coated with fewer complement sites/cell. The general pattern and kinetics of clearance and the localization of sequestered cells were not modified by corticosteroids. As the number of IgG C1-fixing sites was increased, the difference betwen cortisone treated and control animals was less marked. Splenectomy led to an increased survival of IgG-coated cells and a sixfold increase in IgG C1-fixing sites was necessary in order to obtain similar rates of clearance in splenectomized and control animals. The liver was responsible for this much less efficient clearance of cells in splenectomized animals: the clearance pattern was typical of that noted for IgG. No effect at all was noted on the clearance of IgM sensitized cells in splenectomized animals. These experiments clearly demonstrate that both corticosteroid therapy and splenectomy act to decrease the in vivo clearance of IgG-sensitized cells: only corticosteroids alter the

  4. Systemic sclerosis with portal hypertensive ascites responded to corticosteroid treatment

    Institute of Scientific and Technical Information of China (English)

    LENG Xiao-mei; SUN Xue-feng; ZHANG Xuan; ZHANG Wen; LI Meng-tao; ZENG Xiao-feng

    2012-01-01

    We describe a case of systemic sclerosis (SSc) complicated with portal hypertensive ascites which did not improve with diuretics and ascitic drainage.When corticosteroid added,her ascites diminished dramatically.Though portal hypertension can be imputed to other causes,such as polycystic liver in this case,it can occur in limited SSc with positive anti-centromere antibody and respond to corticosteroid treatment.

  5. Patch testing with corticosteroid mixes in Europe. A multicentre study of the EECDRG

    DEFF Research Database (Denmark)

    Isaksson, M; Andersen, Klaus Ejner; Brandão, F M;

    2000-01-01

    This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents...... allergy to corticosteroid markers was missed....

  6. Intratympanic corticosteroid for sudden hearing loss: does it really work?

    Science.gov (United States)

    Barreto, Monique Antunes de Souza Chelminski; Ledesma, Aleluia Lima Losno; de Oliveira, Carlos Augusto Costa Pires; Bahmad, Fayez

    2016-01-01

    Sudden deafness is characterized by an abrupt hearing loss of at least 30dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Intratympanic corticosteroid for sudden hearing loss: does it really work?

    Directory of Open Access Journals (Sweden)

    Monique Antunes de Souza Chelminski Barreto

    Full Text Available ABSTRACT INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

  8. Misuse of topical corticosteroids: A clinical study of adverse effects

    Directory of Open Access Journals (Sweden)

    Vivek Kumar Dey

    2014-01-01

    Full Text Available Background: Misuse of topical corticosteroids is a widespread phenomenon among young people in India, especially women. The practice is associated with significant adverse effects and poor awareness of these effects among the general public. Aim: This study was conducted to examine the misuse and adverse effects of topical corticosteroids among the people in Bastar region in Chhattisgarh state of India. Materials and Methods: Data collected from patients presenting with at least one of the adverse effects of topical corticosteroids as the chief complaint, from November 2010 to October 2011. Results: Out of the 6723 new patients, 379 (5.63% had presented with misuse and adverse effects of topical corticosteroids, of whom 78.89% were females. More than 65% of the patients were in the age group 10-29 years. The main reason for using the topical corticosteroids was to lighten skin colour and treat melasma and suntan. Acne (37.99% and telangiectasia (18.99% were the most common adverse effects noted. Conclusions: Misuse of topical corticosteroids has a huge impact on dermatological practice, leading to a significant proportion of visits to the dermatologist. This hydra-headed problem needs multi-dimensional interventions, involving educational, legal and managerial approaches with cooperation from different sectors of society.

  9. Optimisation of post mortem cardiac computed tomography compared to optical coherence tomography and histopathology - Technical note

    DEFF Research Database (Denmark)

    Precht, Helle; Leth, Peter Mygind; Thygesen, Jesper

    2014-01-01

    Introduction: Coronary atherosclerosis is a leading cause of mortality. New technological developments in computed tomography (CT), including dual energy, iterative reconstructions and high definition scanning, could significantly improve the non-invasive identification of atherosclerosis plaques....... Here, a new method for optimising cardiac coronary CT with optical coherence tomography (OCT) and histopathology is presented. Materials and methods: Twenty human hearts obtained from autopsies were used. A contrast agent that solidifies after cooling was injected into the coronary arteries. CT...

  10. Optimisation Modelling of Efficiency of Enterprise Restructuring

    Directory of Open Access Journals (Sweden)

    Yefimova Hanna V.

    2014-03-01

    Full Text Available The article considers issues of optimisation of the use of resources directed at restructuring of a shipbuilding enterprise, which is the main prerequisite of its efficiency. Restructuring is considered as a process of complex and interconnected change in the structure of assets, liabilities, enterprise functions, initiated by dynamic environment, which is based on the strategic concept of its development and directed at increase of efficiency of its activity, which is expressed in the growth of cost. The task of making a decision to restructure a shipbuilding enterprise and selection of a specific restructuring project refers to optimisation tasks of prospective planning. Enterprise resources that are allocated for restructuring serve as constraints of the mathematical model. Main criteria of optimisation are maximisation of pure discounted income or minimisation of expenditures on restructuring measures. The formed optimisation model is designed for assessment of volumes of attraction of own and borrowed funds for restructuring. Imitation model ensures development of cash flows. The task solution is achieved on the basis of the complex of interrelated optimisation and imitation models and procedures on formation, selection and co-ordination of managerial decisions.

  11. Optimisation of Investment Resources at Small Enterprises

    Directory of Open Access Journals (Sweden)

    Shvets Iryna B.

    2014-03-01

    Full Text Available The goal of the article lies in the study of the process of optimisation of the structure of investment resources, development of criteria and stages of optimisation of volumes of investment resources for small enterprises by types of economic activity. The article characterises the process of transformation of investment resources into assets and liabilities of the balances of small enterprises and conducts calculation of the structure of sources of formation of investment resources in Ukraine at small enterprises by types of economic activity in 2011. On the basis of the conducted analysis of the structure of investment resources of small enterprises the article forms main groups of criteria of optimisation in the context of individual small enterprises by types of economic activity. The article offers an algorithm and step-by-step scheme of optimisation of investment resources at small enterprises in the form of a multi-stage process of management of investment resources in the context of increase of their mobility and rate of transformation of existing resources into investments. The prospect of further studies in this direction is development of a structural and logic scheme of optimisation of volumes of investment resources at small enterprises.

  12. Optimising treatment for COPD--new strategies for combination therapy.

    Science.gov (United States)

    Welte, T

    2009-08-01

    Chronic obstructive pulmonary disease (COPD) is a multi-component disease characterised by airflow limitation and airway inflammation. Exacerbations of COPD have a considerable impact on the quality of life, daily activities and general well-being of patients and are a great burden on the health system. Thus, the aims of COPD management include not only relieving symptoms and preventing disease progression but also preventing and treating exacerbations. Attention towards the day-to-day burden of the disease is also required in light of evidence that suggests COPD may be variable throughout the day with morning being the time when symptoms are most severe and patients' ability to perform regular morning activities the most problematic. While available therapies improve clinical symptoms and decrease airway inflammation, they do not unequivocally slow long-term progression or address all disease components. With the burden of COPD continuing to increase, research into new and improved treatment strategies to optimise pharmacotherapy is ongoing - in particular, combination therapies, with a view to their complementary modes of action enabling multiple components of the disease to be addressed. Evidence from recent clinical trials indicates that triple therapy, combining an anticholinergic with an inhaled corticosteroid and a long-acting beta(2)-agonist, may provide clinical benefits additional to those associated with each treatment alone in patients with more severe COPD. This article reviews the evidence for treatment strategies used in COPD with a focus on combination therapies and introduces the 3-month CLIMB study (Evaluation of Efficacy and Safety of Symbicort as an Add-on Treatment to Spiriva in Patients With Severe COPD) which investigated the potential treatment benefits of combining tiotropium with budesonide/formoterol in patients with COPD with regard to lung function, exacerbations, symptoms and morning activities.

  13. Doripenem Injection

    Science.gov (United States)

    ... injection is in a class of medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such ... if you are allergic to doripenem injection; other carbapenem antibiotics such as imipenem/cilastatin (Primaxin) or meropenem ( ...

  14. Methotrexate Injection

    Science.gov (United States)

    Methotrexate injection is used alone or in combination with other medications to treat gestational trophoblastic tumors (a ... in bones) after surgery to remove the tumor. Methotrexate injection is also used to treat severe psoriasis ( ...

  15. Bendamustine Injection

    Science.gov (United States)

    Bendamustine injection is used to treat chronic lymphocytic leukemia (CLL; a type of cancer of the white ... injection. You should use birth control to prevent pregnancy in yourself or your partner during your treatment ...

  16. Caspofungin Injection

    Science.gov (United States)

    Caspofungin injection is used in adults and children 3 months of age and older to treat yeast ... people with a weakened ability to fight infection. Caspofungin injection is in a class of antifungal medications ...

  17. Temozolomide Injection

    Science.gov (United States)

    Temozolomide is used to treat certain types of brain tumors. Temozolomide is in a class of medications called alkylating ... Temozolomide injection comes as a powder to be added to fluid and injected over 90 minutes intravenously ( ...

  18. Pembrolizumab Injection

    Science.gov (United States)

    Pembrolizumab injection is used to treat melanoma (a type of skin cancer) that cannot be treated with ... who have a specific type of melanoma tumor. Pembrolizumab injection is also used to treat a certain ...

  19. Lacosamide Injection

    Science.gov (United States)

    ... injection is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in ... older (about 1 in 500 people) who took anticonvulsants like lacosamide injection to treat various conditions during ...

  20. Midazolam Injection

    Science.gov (United States)

    ... injection is in a class of medications called benzodiazepines. It works by slowing activity in the brain ... breast-feeding.talk to your doctor about the risks and benefits of receiving midazolam injection if you ...

  1. Doxycycline Injection

    Science.gov (United States)

    Doxycycline injection is used to treat or prevent bacterial infections, including pneumonia and other respiratory tract infections. ... certain skin, genital, intestine, and urinary system infections. Doxycycline injection may be used to treat or prevent ...

  2. Paclitaxel Injection

    Science.gov (United States)

    ... with other medications. Paclitaxel injection manufactured with polyoxyethylated castor oil is used to treat ovarian cancer (cancer that ... cancer, and lung cancer. Paclitaxel injection with polyoxyethylated castor oil is also used to treat Kaposi's sarcoma (a ...

  3. Etanercept Injection

    Science.gov (United States)

    ... will be using the prefilled syringe or automatic injection device, tell your doctor if you or the person who will be injecting the medication for you are allergic to rubber or latex.tell your doctor and pharmacist what ...

  4. Cyclosporine Injection

    Science.gov (United States)

    Cyclosporine injection is used with other medications to prevent transplant rejection (attack of the transplanted organ by ... who have received kidney, liver, and heart transplants. Cyclosporine injection should only be used to treat people ...

  5. Estrogen Injection

    Science.gov (United States)

    The estradiol cypionate and estradiol valerate forms of estrogen injection are used to treat hot flushes (hot ... should consider a different treatment. These forms of estrogen injection are also sometimes used to treat the ...

  6. Cefotaxime Injection

    Science.gov (United States)

    Cefotaxime injection is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory ... skin, blood, bone, joint, and urinary tract infections. Cefotaxime injection may also be used before surgery, and ...

  7. Multicriteria Optimisation in Logistics Forwarder Activities

    Directory of Open Access Journals (Sweden)

    Tanja Poletan Jugović

    2007-05-01

    Full Text Available Logistics forwarder, as organizer and planner of coordinationand integration of all the transport and logistics chains elements,uses adequate ways and methods in the process of planningand decision-making. One of these methods, analysed inthis paper, which could be used in optimisation of transportand logistics processes and activities of logistics forwarder, isthe multicriteria optimisation method. Using that method, inthis paper is suggested model of multicriteria optimisation of logisticsforwarder activities. The suggested model of optimisationis justified in keeping with method principles of multicriteriaoptimization, which is included in operation researchmethods and it represents the process of multicriteria optimizationof variants. Among many different processes of multicriteriaoptimization, PROMETHEE (Preference Ranking OrganizationMethod for Enrichment Evaluations and Promcalc& Gaia V. 3.2., computer program of multicriteria programming,which is based on the mentioned process, were used.

  8. Topology Optimisation for Coupled Convection Problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe; Andreasen, Casper Schousboe; Aage, Niels

    conduction governs in the solid parts of the design domain and couples to convection-dominated heat transfer to a surrounding fluid. Both loosely coupled and tightly coupled problems are considered. The loosely coupled problems are convection-diffusion problems, based on an advective velocity field from......The work focuses on applying topology optimisation to forced and natural convection problems in fluid dynamics and conjugate (fluid-structure) heat transfer. To the authors' knowledge, topology optimisation has not yet been applied to natural convection flow problems in the published literature...... and the current work is thus seen as contributing new results to the field. In the literature, most works on the topology optimisation of weakly coupled convection-diffusion problems focus on the temperature distribution of the fluid, but a selection of notable exceptions also focusing on the temperature...

  9. Analysis of Strength on Thick Plate Part using Genetic Algorithm Optimisation Method

    Directory of Open Access Journals (Sweden)

    Azlan S.M.

    2016-01-01

    Full Text Available This study focuses on the optimisation of the injection moulding parameters to maximise the strength ofmoulded parts using a simulation software. The moulded parts were injected with Acrylonitrile- Butadiene-Styrene (ABS whereas mould temperature, melt temperature, packing pressure and packing time were selected as variable process parameters. The polynomial model obtained using Design of Experiment (DOE was integrated with the Response Surface Methodology (RSM and Centre Composite Design (CCD. The RSM was supported with Genetic Algorithm (GA to anticipate the optimum value of processing parameters with the highest strength. It was found that strength of the parts can be improved 2.2% using the methodology reported herein.

  10. Ustekinumab Injection

    Science.gov (United States)

    ... Do not inject into an area where the skin is tender, bruised, red, or hard or where you have scars or stretch marks.Your doctor or pharmacist will ... injection.you should know that ustekinumab injection may decrease your ability ... new or changing skin lesions, minor infections (such as open cuts or ...

  11. Ranitidine Injection

    Science.gov (United States)

    Ranitidine injection comes as a solution (liquid) to be mixed with another fluid and injected intravenously (into a vein) over 5 to 20 minutes. Ranitidine may also be injected into a muscle. It is usually given every 6 to 8 hours, but may also be given ...

  12. Quasi-stable injection channels in a wakefield accelerator

    Science.gov (United States)

    Wiltshire-Turkay, Mara; Farmer, John P.; Pukhov, Alexander

    2016-05-01

    The influence of initial position on the acceleration of externally injected electrons in a plasma wakefield is investigated. Test-particle simulations show previously unobserved complex structure in the parameter space, with quasi-stable injection channels forming for particles injected in narrow regions away from the wake centre. Particles injected into these channels remain in the wake for a considerable time after dephasing and as a result achieve significantly higher energy than their neighbours. The result is relevant to both the planning and optimisation of experiments making use of external injection.

  13. [Process optimisation: from theory to practical implementation].

    Science.gov (United States)

    Töpfer, Armin

    2010-01-01

    Today process optimisation is an indispensable approach to mastering the current challenges of modern health care management. The objective is to design business processes free of defects and free of waste as well as their monitoring and controlling with meaningful test statistics. Based on the identification of essential key performance indicators, key success factors and value cash generators two basic approaches to process optimisation, which are well-established and widely used in the industry, are now being implemented in the health care sector as well: Lean Management and Six Sigma.

  14. Simulating stem growth using topological optimisation

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Narváez

    2010-04-01

    Full Text Available Engineers are currently resorting to observations of nature for making new designs. Studying the functioning of bodies of plants and animals has required them to be modelled and simulated; however, some models born from engineering problems could be used for such purposes. This article shows how topological optimisation (a mathematical model for optimising designing structural elements can be used for modeling and simulating the way a stem grows in terms of carrying out its funtion of providing support for the leaves and a plant's other upper organs.

  15. Bat Algorithm for Multi-objective Optimisation

    CERN Document Server

    Yang, Xin-She

    2012-01-01

    Engineering optimization is typically multiobjective and multidisciplinary with complex constraints, and the solution of such complex problems requires efficient optimization algorithms. Recently, Xin-She Yang proposed a bat-inspired algorithm for solving nonlinear, global optimisation problems. In this paper, we extend this algorithm to solve multiobjective optimisation problems. The proposed multiobjective bat algorithm (MOBA) is first validated against a subset of test functions, and then applied to solve multiobjective design problems such as welded beam design. Simulation results suggest that the proposed algorithm works efficiently.

  16. Topology Optimisation of Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Thike Aye Min

    2016-01-01

    Full Text Available Wireless sensor networks are widely used in a variety of fields including industrial environments. In case of a clustered network the location of cluster head affects the reliability of the network operation. Finding of the optimum location of the cluster head, therefore, is critical for the design of a network. This paper discusses the optimisation approach, based on the brute force algorithm, in the context of topology optimisation of a cluster structure centralised wireless sensor network. Two examples are given to verify the approach that demonstrate the implementation of the brute force algorithm to find an optimum location of the cluster head.

  17. Ultrasound-guided Intraarticular Hip Injection for Osteoarthritis Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Erik S Anderson

    2013-09-01

    Full Text Available Ultrasound-guided intraarticular hip corticosteroid injections may be useful for emergency care providers treating patients with painful exacerbations of osteoarthritis of the hip. Corticosteroid injection is widely recommended as a first-line treatment for painful osteoarthritis of the hip. Bedside ultrasound is readily available in most emergency departments; however, using ultrasound to guide therapeutic hip injections has not yet been described in emergency practice. Herein, we present the first description of a successful emergency physician-performed ultrasound-guided hip injection of local anesthetic and corticosteroid for pain control in a patient with an acute exacerbation of osteoarthritis. [West J Emerg Med. 2013;14(5:505–508.

  18. Treatment of chronic rhinosinusitis with pressure-pulsed corticosteroid inhalation.

    Science.gov (United States)

    Goektas, Oender; Lau, Larissa; Olze, Heidi

    2013-08-01

    Chronic rhinosinusitis may cause olfactory dysfunction and affects quality of life in patients. In a prospective study we investigated the effect of topical application of corticosteroids through pressure-pulsed inhalation as treatment option of chronic rhinosinusitis with olfactory disorder. Patients with sinonasal olfactory disorder according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) were allocated to the new nasal inhalation therapy or a systemic corticosteroid therapy, each receiving a corticosteroid course of 12 days. 18 patients received topical corticosteroid pressure-pulsed inhalation (AMSA, Schumacher, Dausenau) and 15 systemic corticosteroid. Olfactory function was measured before and after treatment using the Threshold Discrimination Identification score (TDI score) and visual analogue scales. Lund Mackay score (LMS) was measured before starting treatment. Olfactory function (OF) increased from 17.5 ± 6.4 to 21 ± 7.9 TDI points (p treatment after 2 months. In the follow-up period of 6 months, the mean TDI score dropped to 20.0 ± 9.2 points (p = 0.01). There was no correlation between LMS and TDI. Treatment of chronic rhinosinusitis with pressure-pulsed inhalation was demonstrated to be effective. Multicenter investigations with large participant numbers are needed.

  19. High dose corticosteroids in severe leptospirosis: a systematic review.

    Science.gov (United States)

    Rodrigo, Chaturaka; Lakshitha de Silva, Nipun; Goonaratne, Ravindi; Samarasekara, Keshinie; Wijesinghe, Indika; Parththipan, B; Rajapakse, Senaka

    2014-12-01

    The role of corticosteroids in the treatment of severe leptospirosis is unclear. The rationale for their use is that, in severe leptospirosis, there is a severe immunological response that is harmful to the host resulting in multi-organ dysfunction, which is potentially offset by the nonspecific immunosuppression of high dose steroids. We conducted a systematic review of studies that have assessed the use of high dose corticosteroids in patients with severe leptospirosis by searching MEDLINE and Scopus SciVerse without any language or time restrictions. We identified five studies, including one open randomized clinical trial, which had assessed the use of high dose steroids in severe leptospirosis. Four studies demonstrated a benefit of corticosteroids in treating severe disease with pulmonary involvement when administered early in the course of the disease, but these studies had several methodological constraints as highlighted in the text. Only the randomized controlled trial study showed that corticosteroids are ineffective and may increase the risk of nosocomial infections. There is no robust evidence to suggest that high dose corticosteroids are effective in severe leptospirosis, and a well-designed randomized clinical trial is needed to resolve this.

  20. T lymphocyte insensitivity to corticosteroids in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Kaur Manminder

    2012-03-01

    Full Text Available Abstract Background There are increased numbers of activated lymphocytes in the lungs of chronic obstructive pulmonary disease (COPD patients. The clinical benefits of corticosteroids in COPD patients are limited. Our hypothesis is that lymphocytes play a role in this corticosteroid insensitivity. Objectives To investigate the effects of the corticosteroid dexamethasone on lung lymphocyte cytokine production from patients with COPD compared to controls. Methods Cultured airway lymphocytes obtained by bronchoscopy from healthy non-smokers (HNS, smokers (S and COPD patients were stimulated with phytohaemagglutinin (PHA & phorbol myristate acetate (PMA, +/- dexamethasone. Supernatants were assayed for interleukin (IL-2 and interferon (IFNγ. Immunofluoresence was used to analyse changes in CD8 glucocorticoid receptor (GRα and GRβ expression. Results The inhibition of PHA/PMA stimulated IFNγ production by dexamethasone was reduced in COPD patients compared to HNS (p p Conclusions IFNγ production from COPD airway lymphocytes is corticosteroid insensitive. This phenomenon may be important in the poor clinical response often observed with corticosteroids.

  1. Optimisation of interventional cardiology procedures; Optimisation des procedures en cardiologie interventionnelle

    Energy Technology Data Exchange (ETDEWEB)

    Bar, Olivier [SELARL, Cardiologie Interventionnelle Imagerie Cardiaque - CIIC, 8, place de la Cathedrale - 37042 Tours (France)

    2011-07-15

    Radiation-guided procedures in interventional cardiology include diagnostic and/or therapeutic procedures, primarily coronary catheterization and coronary angioplasty. Application of the principles of radiation protection and the use of optimised procedures are contributing to dose reduction while maintaining the radiological image quality necessary for performance of the procedures. The mandatory training in patient radiation protection and technical training in the use of radiology devices mean that implementing continuous optimisation of procedures is possible in practice. This optimisation approach is the basis of patient radiation protection; when associated with the wearing of protective equipment it also contributes to the radiation protection of the cardiologists. (author)

  2. Extending Particle Swarm Optimisers with Self-Organized Criticality

    DEFF Research Database (Denmark)

    Løvbjerg, Morten; Krink, Thiemo

    2002-01-01

    Particle swarm optimisers (PSOs) show potential in function optimisation, but still have room for improvement. Self-organized criticality (SOC) can help control the PSO and add diversity. Extending the PSO with SOC seems promising reaching faster convergence and better solutions.......Particle swarm optimisers (PSOs) show potential in function optimisation, but still have room for improvement. Self-organized criticality (SOC) can help control the PSO and add diversity. Extending the PSO with SOC seems promising reaching faster convergence and better solutions....

  3. Evidence and recommendation. Is intratympanic corticosteroid treatment of sudden hearing loss effective?

    Directory of Open Access Journals (Sweden)

    José Luis PARDAL-REFOYO

    2016-03-01

    Full Text Available Introduction and objective: It is considered that treatment with systemic corticosteroid (SC orally is preferred in sudden deafness and intratympanic injection of corticosteroid (ITC can be used as an alternative. PICO question: In an adult with no improvement sudden deafness or partial hearing improvement [patient], does treatment with intratympanic corticoid [intervention] compared with conventional treatment [compared] improve hearing? [result]. Material and Methods: Literature search in PubMed, Scopus and Cochrane meta-analysis of published data including descriptors: deafness, hearing loss, steroids, corticoids, intratympanic. Selected studies in adult humans, in Spanish or English that included meta-analysis. Results: Level of evidence: Evidence is high for the use of ITC as rescue therapy in patients undergoing SC without response or partial response. The evidence is moderate for the use of ITC as initial therapy given the poor quality of published studies. What is more, the evidence is high against the use of ITC as initial therapy. Conclusions: Recommendation: The recommendation is strongly in favor of ITC as rescue therapy in patients with little or no response to SC treatment. The recommendation is weak against ITC perform as first-line treatment.

  4. Treatment of coccidioidomycosis-associated eosinophilic pneumonia with corticosteroids

    Directory of Open Access Journals (Sweden)

    Raz Y

    2012-03-01

    Full Text Available Pulmonary coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. The clinical spectrum of this disease ranges from an asymptomatic presentation to severe disease with ARDS and hypoxemic respiratory failure. Despite evidence supporting the use of corticosteroids for severe pulmonary disease in other fungal infections, there is currently no established role for this therapy in coccidioidomycosis infections. Peripheral eosinophilia is a common feature of coccidioidomycosis; however, pulmonary eosinophilia is rarely reported. In the setting of pulmonary eosinophilia of other etiologies, corticosteroid therapy has been demonstrated to have a role in reducing the inflammatory response and leading to a more rapid resolution of hypoxemic respiratory failure. We report a case of a patient with primary pulmonary coccidioidomycosis complicated by severe pulmonary eosinophilia that demonstrated rapid improvement after the initiation of corticosteroid therapy.

  5. Combination DMARD therapy including corticosteroids in early rheumatoid arthritis.

    Science.gov (United States)

    Möttönen, T T; Hannonen, P J; Boers, M

    1999-01-01

    A number of reports indicating the growing acceptance of simultaneous therapy with multiple disease-modifying anti-rheumatic drugs (DMARDs), as well as the use of more aggressive treatment measures in the early phases of disease to combat rheumatoid arthritis (RA), have appeared during the last decade. However, only a few randomized controlled clinical trials have been conducted on the use of DMARD combinations in early RA. We review these trials in this article. In two separate one-year studies combination therapy with sulphasalazine (SSZ) and methotrexate (MTX) seemed to offer no benefits compared to either drug used as monotherapy. On the other hand, the DMARD combinations so far proven to be superior to single DMARDs have initially also included a corticosteroid component. In the COBRA study (Combinatietherapie Bij Reumatoide Artritis) the combination of SSZ (2 gm/day), MTX (7.5 mg/week for 40 weeks), and prednisolone (Prd) (initially 60 mg/day, tapered in 6 weekly steps to 7.5 mg/day and stopped after 28 weeks) compared to SSZ alone (2 gm/day) resulted in significantly better clinical outcomes at week 28. Although the difference in clinical response between the treatment arms was lost at week 58, the progression of joint damage remained statistically significantly slower at week 80 in the patients initially assigned to the combination therapy. Furthermore, in the FIN-RACo trial (Finnish Rheumatoid Arthritis Combination Therapy Trial), therapy using a "tailored-steps" strategy with SSZ (1-2 gm/day), MTX (7.5-1.5 mg/week), hydroxychloroquine (300 mg/day), and Prd (up to 10 mg/day) yielded a significantly increased remission rate and less peripheral joint damage at two years than the single DMARD treatment strategy (initially SSZ 2 gm/day), with or without Prd. Adverse effects in both study arms were comparable. Two additional preliminary reports (in abstract form) suggest that intensive local therapy in the form of intra-articular injections added to single or

  6. Clinical observation on the efficacy of local injection of anesthetic and corticosteroid combined with rehabilitation training in treatment of patients with external humeral epicondylitis%局部注射麻醉药及皮质类固醇复合康复训练治疗肱骨外上髁炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    李德刚; 李彦平; 罗克金

    2016-01-01

    目的:观察局部注射麻醉药及皮质类固醇复合康复训练治疗肱骨外上髁炎的临床效果。方法选择40例疼痛时间在1~4周的肱骨外上髁炎患者,随机分成局部注射组(B 组,n =20)和局部注射复合康复训练组(BR 组,n=20)。B 组仅接受肱骨外上髁0.5%利多卡因+甲强龙20 mg 注射治疗(1次/周,共2周)治疗。BR 组接受肱骨外上髁同样药物注射治疗(1次/周,共2周)复合康复训练(3次/天,5分钟/次,共2周)治疗。观察两组治疗后第1、2、4、8周的局部疼痛感、局部压痛、屈肘负重的疼痛视觉模拟评分。观察两组治疗后4周和8周时疼痛症状复发率。结果两组治疗后第1周和第2周时疼痛程度较治疗前显著降低( P 0.05)。治疗后第4周和第8周时 BR 组疼痛程度明显低于 B 组( P 0. 05). The intensity of pain in patients of group BR in 4 and 8 weeks after treatment was significantly lower than that of patients in group B( P < 0. 05). The recurrence rates of LA,LPP,and EFWBP at 4 and 8 weeks after the treatment in group BR were significantly lower than those in group B( P < 0. 05). Conclusion Local injection of anesthethetic combined with rehabilitation training is effective in controlling the local pain,improving the movement and keeping a long - term stable therapeutic effect in patients with external hu-meral epicondylitis.

  7. Corticosteroids in the treatment of dengue shock syndrome

    Directory of Open Access Journals (Sweden)

    Rajapakse S

    2014-05-01

    Full Text Available Senaka Rajapakse,1 Chaturaka Rodrigo,1 Sachith Maduranga,1 Anoja Chamarie Rajapakse21Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; 2Kings Mill Hospital, Sherwood Forest NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, UKAbstract: Dengue infection causes significant morbidity and mortality in over 100 countries worldwide, and its incidence is on the rise. The pathophysiological basis for the development of severe dengue, characterized by plasma leakage and the “shock syndrome” are poorly understood. No specific treatment or vaccine is available, and careful monitoring and judicious administration of fluids forms the mainstay of management at present. It is postulated that vascular endothelial dysfunction, induced by cytokine and chemical mediators, is an important mechanism of plasma leakage. Although corticosteroids are potent modulators of the immune system, their role in pharmacological doses in modulating the purported immunological effects that take place in severe dengue has been a subject of controversy. The key evidence related to the role of corticosteroids for various manifestations of dengue are reviewed here. In summary, there is currently no high-quality evidence supporting the beneficial effects of corticosteroids for treatment of shock, prevention of serious complications, or increasing platelet counts. Non-randomized trials of corticosteroids given as rescue medication for severe shock have shown possible benefit. Nonetheless, the evidence base is small, and good-quality trials are lacking. We reiterate the need for well-designed and adequately powered randomized controlled trials of corticosteroids for the treatment of dengue shock.Keywords: dengue, dengue shock, shock, corticosteroids, vascular leak, thrombocytopenia

  8. Lower corticosteroid skin blanching response is associated with severe COPD.

    Directory of Open Access Journals (Sweden)

    Susan J M Hoonhorst

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive to steroids in COPD than in asthma. The underlying mechanisms are yet unclear. This study aimed to assess whether skin corticosteroid insensitivity is associated with COPD and COPD severity using the corticosteroid skin blanching test. METHODS: COPD patients GOLD stage I-IV (n = 27, 24, 22, and 16 respectively and healthy never-smokers and smokers (n = 28 and 56 respectively were included. Corticosteroid sensitivity was assessed by the corticosteroid skin blanching test. Budesonide was applied in 8 logarithmically increasing concentrations (0-100 μg/ml on subject's forearm. Assessment of blanching was performed after 7 hours using a 7-point scale (normal skin to intense blanching. All subjects performed spirometry and body plethysmography. RESULTS: Both GOLD III and GOLD IV COPD patients showed significantly lower skin blanching responses than healthy never-smokers and smokers, GOLD I, and GOLD II patients. Their area under the dose-response curve values of the skin blanching response were 586 and 243 vs. 1560, 1154, 1380, and 1309 respectively, p<0.05. Lower FEV1 levels and higher RV/TLC ratios were significantly associated with lower skin blanching responses (p = 0.001 and p = 0.004 respectively. GOLD stage I, II, III and IV patients had similar age and packyears. CONCLUSIONS: In this study, severe and very severe COPD patients had lower skin corticosteroid sensitivity than mild and moderate COPD patients and non-COPD controls with comparable age and packyears. Our findings together suggest that the reduced skin blanching response fits with a subgroup of COPD patients that has an early-onset COPD phenotype.

  9. The effects of oral and topical corticosteroid in rabbit corneas.

    Science.gov (United States)

    Araki-Sasaki, Kaoru; Katsuta, Osamu; Mano, Hidetoshi; Nagano, Takashi; Nakamura, Masatsugu

    2016-09-05

    To determine the most effective route of administration of corticosteroids in the treatment of ocular surface disease, by characterizing the difference between oral prednisolone and topical dexamethasone administration using an animal model. Pharmacokinetic analyses determined the corticosteroid concentrations in the normal ocular tissues of rabbits after oral or topical administration of corticosteroids using LC-MS/MS. In wound healing analyses, the area of the epithelial defect created by keratectomy using a 6-mm trephine was calculated with an image analyzer using an orally or topically steroid-administrated animal model. The average size of basal epithelial cells, the frequency of mitotic basal epithelial cells, the number of squamous cells, and the number of hypertrophic stromal fibroblasts were determined in the enucleated corneal tissues after wound closure. By slit lamp examination, no remarkable differences were observed between orally and topically administered groups. Pharmacokinetic analyses showed that the distribution of dexamethasone after topical administration was superior to that after oral administration in the cornea. In contrast, both concentrations of corticosteroid applied topically and orally were similar with regards to AUCs (area under the concentration-time curve) in the conjunctiva. Although the healing rate was slower in the topical group, all corneas were almost healed within 96 h in the wound healing analysis. According to the histological analyses of epithelial cells, the average basal cell size was larger, the frequency of mitotic basal cells was greater, and the number of squamous epithelial cell layers was lower in the topically administered group although all of these differences were with no statistical significance. However, the number of hypertrophic stromal fibroblasts in the topically administered group was significantly lower than that in the orally administered group. There are different distributions and effects between

  10. Particle Swarm Optimisation with Spatial Particle Extension

    DEFF Research Database (Denmark)

    Krink, Thiemo; Vesterstrøm, Jakob Svaneborg; Riget, Jacques

    2002-01-01

    In this paper, we introduce spatial extension to particles in the PSO model in order to overcome premature convergence in iterative optimisation. The standard PSO and the new model (SEPSO) are compared w.r.t. performance on well-studied benchmark problems. We show that the SEPSO indeed managed...

  11. Topology optimisation of natural convection problems

    DEFF Research Database (Denmark)

    Alexandersen, Joe; Aage, Niels; Andreasen, Casper Schousboe

    2014-01-01

    This paper demonstrates the application of the density-based topology optimisation approach for the design of heat sinks and micropumps based on natural convection effects. The problems are modelled under the assumptions of steady-state laminar flow using the incompressible Navier-Stokes equation...

  12. Thermodynamic optimisation of a heat exchanger

    NARCIS (Netherlands)

    Cornelissen, R.L.; Hirs, G.G.

    1999-01-01

    The objective of this paper is to show that for the optimal design of an energy system, where there is a trade-off between exergy saving during operation and exergy use during construction of the energy system, exergy analysis and life cycle analysis should be combined. An exergy optimisation of a h

  13. Optimised Design of Transparent Optical Domains

    DEFF Research Database (Denmark)

    Hanik, N.; Caspar, C.; Schmidt, F.;

    2000-01-01

    Three different design concepts for transparent, dispersion compensated, optical WDM transmission links are optimised numerically and experimentally for 10 Gbit/s data rate per channel. It is shown that robust transparent domains of 1,500 km in diameter can be realised using simple design rutes....

  14. Subcutaneous Injections

    DEFF Research Database (Denmark)

    Thomsen, Maria

    This thesis is about visualization and characterization of the tissue-device interaction during subcutaneous injection. The tissue pressure build-up during subcutaneous injections was measured in humans. The insulin pen FlexTouchr (Novo Nordisk A/S) was used for the measurements and the pressure...... build-up was evaluated indirectly from the changes in the flow rate between subcutaneous injections and air injections. This method enabled the tissue counter pressure to be evaluated without a formal clinical study approval. The measurements were coupled to a model for the pressure evolution...

  15. Perioperative corticosteroids for preventing complications following facial plastic surgery

    Directory of Open Access Journals (Sweden)

    Edina Mariko Koga da Silva

    Full Text Available BACKGROUND:Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling and ecchymosis (bruising, which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis.OBJECTIVES:To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults.METHODS:Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations; Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS. There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. ata collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data.MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema and bruising (ecchymosis. Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only

  16. Fluoroscopy-guided application of corticosteroids for local control of manubriosternal joint pain in patients with spondyloarthropathies.

    Science.gov (United States)

    Golder, Werner; Karberg, Kirsten; Sieper, Joachim

    2004-12-01

    Symptomatic manubriosternal arthritis, occasionally encountered with spondyloarthropathies, may not be adequately controlled by systemic therapy. Local corticosteroid injections make a potential contribution to symptomatic management. Three patients with acute inflammation of the joint as documented by MRI and fluoroscopy-guided therapy are presented. Topical treatment with triamcinolone acetonide (40 mg) was well tolerated and induced rapid and complete relief of pain for between 3 weeks and 3 months. In spite of the clinical improvement, the signs of inflammation in MRI did not decrease. Local steroid application seems to be an underused therapeutic modality in managing rheumatic involvement of the anterior chest wall.

  17. EFFECTS OF CORTICOSTEROIDS ON BRONCHODILATOR ACTION IN CHRONIC OBSTRUCTIVE LUNG-DISEASE

    NARCIS (Netherlands)

    WEMPE, JB; POSTMA, DS; BREEDERVELD, N; KORT, E; VANDERMARK, TW; KOETER, GH

    1992-01-01

    Background Short term treatment corticosteroids does not usually reduce airflow limitation and airway responsiveness in patients with chronic obstructive lung disease. We investigated whether corticosteroids modulate the effects of inhaled salbutamol and ipratropium bromide. Methods Ten non-allergic

  18. Corticosteroid effects on glutamatergic transmission and fear memory

    NARCIS (Netherlands)

    Xiong, Hui

    2016-01-01

    In our daily life we are regularly exposed to situations which we experience as stressful. In response to these events our body increases the release of corticosteroid hormones from the adrenal glands. These hormones promote behavioural adaptation to stressful experiences by enhancing the storage of

  19. Corticosteroid therapy in Henoch-Schönlein gastritis

    Directory of Open Access Journals (Sweden)

    Pavlović Momčilo

    2007-01-01

    Full Text Available Introduction. Henoch-Schönlein purpura (HSP is the most common vascular disease of childhood. It is a multisystem disease most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, but other organs may be affected, too. Gastrointestinal involvement occurs in approximately 65-90% of patients, ranging from mild symptoms such as abdominal pain, nausea, and vomiting, to more severe manifestations such as gastrointestinal bleeding and intussusception. In most cases, HSP spontaneously resolves without treatment. The use of corticosteroids is controversial and usually reserved for severe systemic manifestations. Some authors suggest that the abdominal pain and gastrointestinal hemorrhage of HSP may respond to steroids, with some suggesting that there is a benefit in their use and describing a regimen. Case outline. This is a case report of HSP in a fourteen year-old boy with abdominal pain and hematemesis. Upper endoscopy showed an edematous and erythematous change in the body of the stomach and purpuric lesions in the duodenum, while multiple erosions were found in the antral area. Parenteral corticosteroid therapy with gastric acid secretion inhibitor administration led to regression of gastrointestinal symptoms on the seventh day, with relapses on the fourth and sixth day. Peroral administration of corticosteroids and gradual decrease of daily doses started on the eighth day of abdominal symptoms. New purpuric skin rashes appeared during six weeks. Conclusion. Corticosteroid therapy with gastric acid secretion inhibitors showed a positive effect in our patient with a severe form of HSP accompanied by abdominal pain and gastrointestinal hemorrhage. .

  20. The interplay between rapid and slow corticosteroid actions in brain

    NARCIS (Netherlands)

    Joëls, M.; Pasricha, N.; Karst, H.

    2013-01-01

    Stress causes the release of many transmitters and hormones, including corticosteroids. These molecules enter the brain and exert their effects through the mineralo- and glucocorticoid receptor. The former receptor plays an important role in neuronal stability. However, it also mediates rapid non-ge

  1. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation.

    Science.gov (United States)

    Bashoura, L; Gupta, S; Jain, A; Couriel, D R; Komanduri, K V; Eapen, G A; Safdar, A; Broglio, K R; Adachi, R; Dickey, B F

    2008-01-01

    Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940 microg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3-6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.

  2. Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Debbie-Ann Shirley

    2016-07-01

    Full Text Available Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment.Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58% were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery.Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.

  3. Risks of pneumonia in patients with asthma taking inhaled corticosteroids

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Soren; Carlsson, Lars-Göran

    2011-01-01

    Rationale: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS. Objectives: To evaluate the risks...

  4. Treatment with inhaled corticosteroids in asthma is too often discontinued

    NARCIS (Netherlands)

    Breekveldt-Postma, Nancy S.; Koerselman, Jeroen; Erkens, Joelle A.; van der Molen, Thys; Lammers, Jan-Willem J.; Herings, Ron M. C.

    2008-01-01

    Purpose To study persistence with inhaled corticosteroids (ICS) and its determinants in asthma-patients. Methods From the PHARMO database, asthma-patients (age <35 years) with a first dispensing for ICS in 1999-2002 and >= 2 dispensings in the first year were included. Persistence during the first y

  5. Inhaled corticosteroids in chronic obstructive pulmonary disease : a review

    NARCIS (Netherlands)

    Telenga, Eef D.; Kerstjens, Huib A. M.; Postma, Dirkje S.; ten Hacken, Nick H.; van den Berge, Maarten

    2010-01-01

    Importance of the field: Chronic obstructive pulmonary disease (COPD) is a disease characterized by chronic airflow obstruction and a progressive lung function decline. Although widely used, the efficacy of inhaled corticosteroids (ICS) in the treatment of COPD remains a matter of debate. Areas cove

  6. [Inhaled corticosteroids in patients with COPD: maintain current guidelines

    NARCIS (Netherlands)

    Heijdra, Y.F.

    2007-01-01

    The use of inhaled corticosteroids (ICS) is one of the most controversial issues in COPD treatment. There is evidence that ICS with or without long-acting beta-2-adrenergics (LABA) reduce exacerbation rates and improve the health status of severe COPD patients. The effects on FEV1 are limited and th

  7. Drug interactions between inhaled corticosteroids and enzymatic inhibitors

    OpenAIRE

    Daveluy, Amélie; Raignoux, Cécile; Miremont-Salamé, Ghada; Girodet, Pierre-Olivier; Moore, Nicholas; Haramburu, Françoise; Molimard, Mathieu

    2009-01-01

    Drug interactions between inhaled corticosteroids and enzymatic inhibitors phone: +33-557-571561 (Daveluy, Amelie) (Daveluy, Amelie) Centre Regional de Pharmacovigilance, Hopital Pellegrin - 33076 - Bordeaux Cedex - FRANCE (Daveluy, Amelie) Unite 657, INSERM - Bordeaux - FRANCE (Daveluy, Amelie) Departement de Pharmacologie, CHU de Bordeaux - Bordeaux - FRANCE (Daveluy, Amelie) Centre Regional de Pharmacovigilance, Hopital Pellegrin - 33076...

  8. Vibrational spectra of corticosteroid hormones in the terahertz range

    Science.gov (United States)

    Cherkasova, O. P.; Nazarov, M. M.; Sapozhnikov, D. A.; Man'kova, A. A.; Fedulova, E. V.; Volodin, V. A.; Minaeva, V. A.; Minaev, B. F.; Baryshnikov, G. V.

    2010-11-01

    The terahertz time-domain and Raman spectra of corticosteroid hormones in the region of low-frequency infrared vibrations have been measured. On the ground of quantum chemical calculations of the frequencies and normal modes the assignments of vibrational bands in the THz-spectra are performed.

  9. Corticosteroid receptor dynamics : analysis by advanced fluorescence microscopy

    NARCIS (Netherlands)

    Groeneweg, Femke Lokke

    2014-01-01

    In this thesis I aimed to explore further finesses in the cellular dynamics of the two corticosteroid receptors, the MR and the GR, in both their membrane-associated and their nuclear subpopulations. Amongst others I quantified the dynamics of the receptors at the membrane (only MR) and at the chrom

  10. Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

    Science.gov (United States)

    Shirley, Debbie-Ann; Moonah, Shannon

    2016-01-01

    Background Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment. Methodology and Principal Findings Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery. Conclusions and Significance Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease. PMID:27467600

  11. Grizzly bear corticosteroid binding globulin: Cloning and serum protein expression.

    Science.gov (United States)

    Chow, Brian A; Hamilton, Jason; Alsop, Derek; Cattet, Marc R L; Stenhouse, Gordon; Vijayan, Mathilakath M

    2010-06-01

    Serum corticosteroid levels are routinely measured as markers of stress in wild animals. However, corticosteroid levels rise rapidly in response to the acute stress of capture and restraint for sampling, limiting its use as an indicator of chronic stress. We hypothesized that serum corticosteroid binding globulin (CBG), the primary transport protein for corticosteroids in circulation, may be a better marker of the stress status prior to capture in grizzly bears (Ursus arctos). To test this, a full-length CBG cDNA was cloned and sequenced from grizzly bear testis and polyclonal antibodies were generated for detection of this protein in bear sera. The deduced nucleotide and protein sequences were 1218 bp and 405 amino acids, respectively. Multiple sequence alignments showed that grizzly bear CBG (gbCBG) was 90% and 83% identical to the dog CBG nucleotide and amino acid sequences, respectively. The affinity purified rabbit gbCBG antiserum detected grizzly bear but not human CBG. There were no sex differences in serum total cortisol concentration, while CBG expression was significantly higher in adult females compared to males. Serum cortisol levels were significantly higher in bears captured by leg-hold snare compared to those captured by remote drug delivery from helicopter. However, serum CBG expression between these two groups did not differ significantly. Overall, serum CBG levels may be a better marker of chronic stress, especially because this protein is not modulated by the stress of capture and restraint in grizzly bears.

  12. Injection MD

    CERN Document Server

    Bartmann, W; Bracco, C; Drosdal, L; Gianfelice, E; Goddard, B; Kain, V; Papaphilippou, Y; Vanbavinckhove, G

    2012-01-01

    This note summarizes the results obtained at injection during the 2nd MD block and the floating MD block in July. Highlights are presented for injection in the LHC with the Q20 SPS optics, influence of the supercycle and injection with 25 ns bunch spacing. Beams were successfully injected into the LHC using the Q20 optics [1, 3]. Small corrections were needed to steer the beam in the transfer lines. Dispersion measurements were conducted for both beams. The horizontal normalized dispersion in TI2 was a factor 2 smaller for Q20 with respect to Q26, for TI8 on the other hand the opposite was observed. The results for injection loss dependency on super cycle composition show only a small increase in losses for beam 2. The losses observed must therefore mainly come from other sources such as shot-by-shot stability or quality of scraping. For the injection with 25 ns bunch spacing bunches were injected for both beams. For B1 up to the maximum of 288 bunches. For B2 on the other only up to 144 bunches were injected...

  13. Subcutaneous Injections

    DEFF Research Database (Denmark)

    Thomsen, Maria

    This thesis is about visualization and characterization of the tissue-device interaction during subcutaneous injection. The tissue pressure build-up during subcutaneous injections was measured in humans. The insulin pen FlexTouchr (Novo Nordisk A/S) was used for the measurements and the pressure...... build-up was evaluated indirectly from the changes in the flow rate between subcutaneous injections and air injections. This method enabled the tissue counter pressure to be evaluated without a formal clinical study approval. The measurements were coupled to a model for the pressure evolution...... in subcutaneous tissue, based on mass conservation and flow in a porous medium. From the measurements the flow permeability and bulk modulus of the tissue were determined. In the adipose tissue the drug forms a bolus from where it is absorbed by the blood capillaries. The spatial distribution of the injected...

  14. Prevalence of and factors influencing sensitization to corticosteroids in a Danish patch test population

    DEFF Research Database (Denmark)

    Vind-Kezunovic, Dina; Johansen, Jeanne Duus; Carlsen, Berit Christina

    2011-01-01

    Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability.......Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability....

  15. Safety and Efficacy of Corticosteroids for the Treatment of Septic Shock: A Systematic Review and Meta-Analysis

    National Research Council Canada - National Science Library

    Wendy I. Sligl; Danny A. Milner; Sugantha Sundar; Wendy Mphatswe; Sumit R. Majumdar

    2009-01-01

    .... Adjunctive treatment with corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of corticosteroid therapy among patients with septic shock. Methods...

  16. Public transport optimisation emphasising passengers’ travel behaviour

    DEFF Research Database (Denmark)

    Jensen, Jens Parbo

    to enhance the operations of public transport while explicitly emphasising passengers’ travel behaviour and preferences. Similar to economic theory, interactions between supply and demand are omnipresent in the context of public transport operations. In public transport, the demand is represented...... the published performance measures and what passengers actually experience, a large academic contribution of the current PhD study is the explicit consideration of passengers’ travel behaviour in optimisation studies and in the performance assessment. Besides the explicit passenger focus in transit planning...... at as the motivator for delay-robust railway timetables. Interestingly, passenger oriented optimisation studies considering robustness in railway planning typically limit their emphasis on passengers to the consideration of transfer maintenance. Clearly, passengers’ travel behaviour is more complex and multifaceted...

  17. Topology optimised planar photonic crystal building blocks

    DEFF Research Database (Denmark)

    Frandsen, Lars Hagedorn; Hede, K. K.; Borel, Peter Ingo

    A photonic crystal waveguide (PhCW) 1x4 splitter has been constructed from PhCW 60° bends1 and Y-splitters2 that have been designed individually by utilising topology optimisation3. The splitter has been fabricated in a silicon-on-insulator material (Fig. 1) and exhibits a broadband splitting...... for the TE-polarisation with an average excess loss of 1.55±0.54 dB for a 110 nm bandwidth. The 1x4 splitter demonstrates that individual topology-optimised parts can be used as building blocks to realise high-performance nanophotonic circuits. 1L. H. Frandsen et al., Opt. Express 12, 5916-5921 (2004) 2P. I...

  18. Self-optimising control of sewer systems

    DEFF Research Database (Denmark)

    Mauricio Iglesias, Miguel; Montero-Castro, I.; Mollerup, Ane Loft

    2013-01-01

    Self-optimising control is a useful concept to select optimal controlled variables from a set of candidate measurements in a systematic manner. In this study, use self-optimizing control tools and apply them to the specific features of sewer systems, e.g. the continuously transient dynamics......, the availability of a large number of measurements, the stochastic and unforeseeable character of the disturbances (rainfall). Using a subcatchment area in the Copenhagen sewer system as a case study we demonstrate, step by step, the formulation of the self-optimising control problem. The final result...... is an improved control structure aimed at optimizing the losses for a given control objective, here the minimization of the combined sewer overflows despite rainfall variations....

  19. Improved Squeaky Wheel Optimisation for Driver Scheduling

    CERN Document Server

    Aickelin, Uwe; Li, Jingpeng

    2008-01-01

    This paper presents a technique called Improved Squeaky Wheel Optimisation for driver scheduling problems. It improves the original Squeaky Wheel Optimisations effectiveness and execution speed by incorporating two additional steps of Selection and Mutation which implement evolution within a single solution. In the ISWO, a cycle of Analysis-Selection-Mutation-Prioritization-Construction continues until stopping conditions are reached. The Analysis step first computes the fitness of a current solution to identify troublesome components. The Selection step then discards these troublesome components probabilistically by using the fitness measure, and the Mutation step follows to further discard a small number of components at random. After the above steps, an input solution becomes partial and thus the resulting partial solution needs to be repaired. The repair is carried out by using the Prioritization step to first produce priorities that determine an order by which the following Construction step then schedul...

  20. Buckling optimisation of sandwich cylindrical panels

    Science.gov (United States)

    Abouhamzeh, M.; Sadighi, M.

    2016-06-01

    In this paper, the buckling load optimisation is performed on sandwich cylindrical panels. A finite element program is developed in MATLAB to solve the governing differential equations of the global buckling of the structure. In order to find the optimal solution, the genetic algorithm Toolbox in MATLAB is implemented. Verifications are made for both the buckling finite element code and also the results from the genetic algorithm by comparisons to the results available in literature. Sandwich cylindrical panels are optimised for the buckling strength with isotropic or orthotropic cores with different boundary conditions. Results are presented in terms of stacking sequence of fibers in the face sheets and core to face sheet thickness ratio.

  1. Applying the Theory of Optimising Professional Life

    Directory of Open Access Journals (Sweden)

    Lesley Margaret Piko

    2014-12-01

    Full Text Available Glaser (2014 wrote that “the application of grounded theory (GT is a relatively neglected topic” (p. 1 in the literature. Applying GT to purposely intervene and improve a situation is an important adjunct to our knowledge and understanding of GT. A recent workshop of family doctors and general practitioners provides a useful example. The theory of optimising professional life explains that doctors are concerned about sustainment in their career and, to resolve this concern, they implement solutions to optimise their personal situation. Sustainment is a new, overarching concept of three needs: the need for self-care to sustain well-being, the need for work interest to sustain motivation, and the need for income to sustain lifestyle. The objective of the workshop was to empower doctors to reinvent their careers using this theory. Working individually and in small groups, participants were able to analyse a problem and to identify potential solutions.

  2. Fermionic orbital optimisation in tensor network states

    CERN Document Server

    Krumnow, C; Eisert, J

    2015-01-01

    Tensor network states and specifically matrix-product states have proven to be a powerful tool for simulating ground states of strongly correlated spin models. Recently, they have also been applied to interacting fermionic problems, specifically in the context of quantum chemistry. A new freedom arising in such non-local fermionic systems is the choice of orbitals, it being far from clear what choice of fermionic orbitals to make. In this work, we propose a way to overcome this challenge. We suggest a method intertwining the optimisation over matrix product states with suitable fermionic Gaussian mode transformations, hence bringing the advantages of both approaches together. The described algorithm generalises basis changes in the spirit of the Hartree-Fock methods to matrix-product states, and provides a black box tool for basis optimisations in tensor network methods.

  3. Adaptive Java Optimisation using machine learning techniques

    OpenAIRE

    Long, Shun

    2004-01-01

    There is a continuing demand for higher performance, particularly in the area of scientific and engineering computation. In order to achieve high performance in the context of frequent hardware upgrading, software must be adaptable for portable performance. What is required is an optimising compiler that evolves and adapts itself to environmental change without sacrificing performance. Java has emerged as a dominant programming language widely used in a variety of application areas. Howeve...

  4. ATLAS software configuration and build tool optimisation

    Science.gov (United States)

    Rybkin, Grigory; Atlas Collaboration

    2014-06-01

    ATLAS software code base is over 6 million lines organised in about 2000 packages. It makes use of some 100 external software packages, is developed by more than 400 developers and used by more than 2500 physicists from over 200 universities and laboratories in 6 continents. To meet the challenge of configuration and building of this software, the Configuration Management Tool (CMT) is used. CMT expects each package to describe its build targets, build and environment setup parameters, dependencies on other packages in a text file called requirements, and each project (group of packages) to describe its policies and dependencies on other projects in a text project file. Based on the effective set of configuration parameters read from the requirements files of dependent packages and project files, CMT commands build the packages, generate the environment for their use, or query the packages. The main focus was on build time performance that was optimised within several approaches: reduction of the number of reads of requirements files that are now read once per package by a CMT build command that generates cached requirements files for subsequent CMT build commands; introduction of more fine-grained build parallelism at package task level, i.e., dependent applications and libraries are compiled in parallel; code optimisation of CMT commands used for build; introduction of package level build parallelism, i. e., parallelise the build of independent packages. By default, CMT launches NUMBER-OF-PROCESSORS build commands in parallel. The other focus was on CMT commands optimisation in general that made them approximately 2 times faster. CMT can generate a cached requirements file for the environment setup command, which is especially useful for deployment on distributed file systems like AFS or CERN VMFS. The use of parallelism, caching and code optimisation significantly-by several times-reduced software build time, environment setup time, increased the efficiency of

  5. Optimised polarisation measurements on Bragg peaks

    Energy Technology Data Exchange (ETDEWEB)

    Lelievre-Berna, E. [Institut Laue Langevin, 6 rue Jules Horowitz, 38042 Grenoble Cedex 9 (France)]. E-mail: lelievre@ill.fr; Brown, P.J. [Institut Laue Langevin, 6 rue Jules Horowitz, 38042 Grenoble Cedex 9 (France); Tasset, F. [Institut Laue Langevin, 6 rue Jules Horowitz, 38042 Grenoble Cedex 9 (France)

    2007-07-15

    Experimentally the asymmetry A (or the flipping ratio R) is deduced from the two count rates observed for |+> and |-> neutron spin states. Since the count rates for the two spin states may be quite different and both require to be corrected for background, the optimum strategy for the measurement is important. We present here the theory for optimisation of the accuracy of measurement of A (or R) within the constraint of a fixed total measuring time.

  6. Exploration of automatic optimisation for CUDA programming

    KAUST Repository

    Al-Mouhamed, Mayez

    2014-09-16

    © 2014 Taylor & Francis. Writing optimised compute unified device architecture (CUDA) program for graphic processing units (GPUs) is complex even for experts. We present a design methodology for a restructuring tool that converts C-loops into optimised CUDA kernels based on a three-step algorithm which are loop tiling, coalesced memory access and resource optimisation. A method for finding possible loop tiling solutions with coalesced memory access is developed and a simplified algorithm for restructuring C-loops into an efficient CUDA kernel is presented. In the evaluation, we implement matrix multiply (MM), matrix transpose (M-transpose), matrix scaling (M-scaling) and matrix vector multiply (MV) using the proposed algorithm. We present the analysis of the execution time and GPU throughput for the above applications, which favourably compare to other proposals. Evaluation is carried out while scaling the problem size and running under a variety of kernel configurations. The obtained speedup is about 28-35% for M-transpose compared to NVIDIA Software Development Kit, 33% speedup for MV compared to general purpose computation on graphics processing unit compiler, and more than 80% speedup for MM and M-scaling compared to CUDA-lite.

  7. Designing Lead Optimisation of MMP-12 Inhibitors

    Directory of Open Access Journals (Sweden)

    Matteo Borrotti

    2014-01-01

    Full Text Available The design of new molecules with desired properties is in general a very difficult problem, involving heavy experimentation with high investment of resources and possible negative impact on the environment. The standard approach consists of iteration among formulation, synthesis, and testing cycles, which is a very long and laborious process. In this paper we address the so-called lead optimisation process by developing a new strategy to design experiments and modelling data, namely, the evolutionary model-based design for optimisation (EDO. This approach is developed on a very small set of experimental points, which change in relation to the response of the experimentation according to the principle of evolution and insights gained through statistical models. This new procedure is validated on a data set provided as test environment by Pickett et al. (2011, and the results are analysed and compared to the genetic algorithm optimisation (GAO as a benchmark. The very good performance of the EDO approach is shown in its capacity to uncover the optimum value using a very limited set of experimental points, avoiding unnecessary experimentation.

  8. Procedure for Application-Oriented Optimisation of Marine Propellers

    Directory of Open Access Journals (Sweden)

    Florian Vesting

    2016-11-01

    Full Text Available The use of automated optimisation in engineering applications is emerging. In particular, nature inspired algorithms are frequently used because of their variability and robust application in constraints and multi-objective optimisation problems. The purpose of this paper is the comparison of four different algorithms and several optimisation strategies on a set of seven test propellers in realistic industrial design setting. The propellers are picked from real commercial projects and the manual final designs were delivered to customers. The different approaches are evaluated and final results of the automated optimisation toolbox are compared with designs generated in a manual design process. We identify a two-stage optimisation for marine propellers, where the geometry is first modified by parametrised geometry distribution curves to gather knowledge of the test case. Here we vary the optimisation strategy in terms of applied algorithms, constraints and objectives. A second supporting optimisation aims to improve the design by locally changing the geometry, based on the results of the first optimisation. The optimisation algorithms and strategies yield propeller designs that are comparable to the manually designed propeller blade geometries, thus being suitable as robust and advanced design support tools. The supporting optimisation, with local modification of the blade geometry and the proposed cavity shape constraints, features particular good performance in modifying cavitation on the blade and is, with the AS NSGA-II (adaptive surrogate-assisted NSGA-II, superior in lead time.

  9. Corticosteroid implants for chronic non-infectious uveitis

    Science.gov (United States)

    Brady, Christopher J; Villanti, Andrea C; Law, Hua Andrew; Rahimy, Ehsan; Reddy, Rahul; Sieving, Pamela C; Garg, Sunir J; Tang, Johnny

    2016-01-01

    Background Uveitis is a term used to describe a heterogeneous group of intraocular inflammatory diseases of the anterior, intermediate, and posterior uveal tract (iris, ciliary body, choroid). Uveitis is the fifth most common cause of vision loss in high-income countries, accounting for 5% to 20% of legal blindness, with the highest incidence of disease in the working-age population. Corticosteroids are the mainstay of acute treatment for all anatomical subtypes of non-infectious uveitis and can be administered orally, topically with drops or ointments, by periocular (around the eye) or intravitreal (inside the eye) injection, or by surgical implantation. Objectives To determine the efficacy and safety of steroid implants in people with chronic non-infectious posterior uveitis, intermediate uveitis, and panuveitis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlledtrials.com) (last searched 15 April 2013), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform(ICTRP) (www.who.int/ictrp/search/en).We did not use any date or language restrictions in the electronic search for studies. We last searched the electronic databases on 6 November 2015. We also searched reference lists of included study reports, citation databases, and abstracts and clinical study presentations from professional meetings. Selection criteria We included randomized controlled trials comparing either fluocinolone acetonide (FA) or dexamethasone intravitreal implants with standard

  10. Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort.

    Directory of Open Access Journals (Sweden)

    Akbar K Waljee

    Full Text Available Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD. Long-term use, however, is associated with significant adverse effects. To define the: (1 frequency and duration of corticosteroid use, (2 frequency of escalation to corticosteroid-sparing therapy, (3 rate of complications related to corticosteroid use, (4 rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans, and (5 factors associated with escalation and DEXA scans.Retrospective review of Veterans Health Administration (VHA data from 2002-2010.Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97, male gender (OR = 2.00,95%CI:1.16,3.46, GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95 and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90. Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3 than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9. DEXA scan utilization rates among corticosteroid users were only 7.8%.Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.

  11. Mepolizumab Injection

    Science.gov (United States)

    ... or do not go away: pain, redness, swelling, warmth, burning, or itching in the place mepolizumab was injected headache dry and itchy skin with or without red, scaly rashes back pain muscle spasms Some side ...

  12. Metoclopramide Injection

    Science.gov (United States)

    ... and feeling of fullness that lasts long after meals. Metoclopramide injection is also used to prevent nausea ... tranylcypromine (Parnate); narcotic medications for pain; sedatives; sleeping pills; tetracycline (Bristacycline, Sumycin); tranquilizers. Your doctor may need ...

  13. Ramucirumab Injection

    Science.gov (United States)

    ... dose of ramucirumab injection. Tell your doctor or nurse if you experience any of the following while you receive ramucirumab: uncontrollable shaking of a part of the body; back pain or spasms; chest pain and tightness; chills; flushing; ...

  14. Alemtuzumab Injection

    Science.gov (United States)

    Alemtuzumab injection is used to treat B-cell chronic lymphocytic leukemia (a slowly developing cancer in which ... of white blood cell accumulate in the body). Alemtuzumab is in a class of medications called monoclonal ...

  15. Ferumoxytol Injection

    Science.gov (United States)

    Ferumoxytol injection is used to treat iron-deficiency anemia (a lower than normal number of red blood ... pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or ...

  16. Fludarabine Injection

    Science.gov (United States)

    Fludarabine injection is used to treat chronic lymphocytic leukemia (CLL; a type of cancer of the white ... a reliable method of birth control to prevent pregnancy during this time. Talk to your doctor for ...

  17. Insulin Injection

    Science.gov (United States)

    ... or buttocks. Do not inject insulin into muscles, scars, or moles. Use a different site for each ... you are using insulin.Alcohol may cause a decrease in blood sugar. Ask your doctor about the ...

  18. Tigecycline Injection

    Science.gov (United States)

    ... in a person who was not in the hospital), skin infections, and infections of the abdomen (area between the ... that developed in people who were in a hospital or foot infections in people who have diabetes. Tigecycline injection is ...

  19. Golimumab Injection

    Science.gov (United States)

    Golimumab injection is used alone or with other medications to relieve the symptoms of certain autoimmune disorders ( ... did not help or could not be tolerated. Golimumab is in a class of medications called tumor ...

  20. Albiglutide Injection

    Science.gov (United States)

    ... will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer). ... symptoms or those listed in the IMPORTANT WARNING section, stop using albiglutide injection and call your doctor ...

  1. Dexamethasone Injection

    Science.gov (United States)

    ... body tissues,) gastrointestinal disease, and certain types of arthritis. Dexamethasone injection is also used for diagnostic testing. ... effects.tell your doctor if you have a fungal infection (other than on your skin or nails). ...

  2. Hydrocortisone Injection

    Science.gov (United States)

    ... own organs), gastrointestinal disease, and certain types of arthritis. Hydrocortisone injection is also used to treat certain ... effects.tell your doctor if you have a fungal infection (other than on your skin or nails). ...

  3. Methylprednisolone Injection

    Science.gov (United States)

    ... own organs), gastrointestinal disease, and certain types of arthritis. Methylprednisolone injection is also used to treat certain ... effects.tell your doctor if you have a fungal infection (other than on your skin or nails). ...

  4. Glatiramer Injection

    Science.gov (United States)

    ... To inject glatiramer, follow these steps: Remove one blister pack from the carton of glatiramer syringes and place ... paper label and remove the syringe from the blister pack. Check your prefilled syringe to be sure it ...

  5. Dexrazoxane Injection

    Science.gov (United States)

    ... that are used to treat or prevent certain side effects that may be caused by chemotherapy medications. Dexrazoxane injection (Zinecard) is used to prevent or decrease heart damage caused by doxorubicin in women who are ...

  6. Evolocumab Injection

    Science.gov (United States)

    ... autoinjector in hot water, microwave, or place in sunlight.Before you use evolocumab injection, look at the ... chills pain or burning during urination muscle or back pain dizziness stomach pain Some side effects can be ...

  7. Cidofovir Injection

    Science.gov (United States)

    Cidofovir injection is used along with another medication (probenecid) to treat cytomegaloviral retinitis (CMV retinitis) in people with acquired immunodeficiency syndrome (AIDS). Cidofovir is in a class of medications called antivirals. ...

  8. Brivaracetam Injection

    Science.gov (United States)

    ... older. Brivaracetam in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in ... older (about 1 in 500 people) who took anticonvulsants like brivaracetam injection to treat various conditions during ...

  9. Diphenhydramine Injection

    Science.gov (United States)

    ... not to use diphenhydramine injection if you are breastfeeding because of the risk of harm to infants.tell your doctor if you have or have ever had asthma or other types of lung disease; glaucoma (a ...

  10. Cefazolin Injection

    Science.gov (United States)

    ... valve, respiratory tract (including pneumonia), biliary tract, and urinary tract infections. Cefazolin injection also may be used before, during, ... to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( ...

  11. Ceftazidime Injection

    Science.gov (United States)

    ... skin, blood, bone, joint, female genital tract, and urinary tract infections. Ceftazidime injection is in a class of medications ... to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( ...

  12. Fluconazole Injection

    Science.gov (United States)

    ... and fungal infections of the eye, prostate (a male reproductive organ), skin and nails. Fluconazole injection is ... Motrin, others) and naproxen (Aleve, Anaprox, Naprelan); oral contraceptives (birth control pills); oral medication for diabetes such ...

  13. Moxifloxacin Injection

    Science.gov (United States)

    ... available.Moxifloxacin injection is in a class of antibiotics called fluoroquinolones. It works by killing the bacteria that cause ... you are allergic to moxifloxacin, other quinolone or fluoroquinolone antibiotics such as ciprofloxacin (Cipro), gatifloxacin (Tequin) (not available ...

  14. Levofloxacin Injection

    Science.gov (United States)

    ... available. Levofloxacin injection is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections. ... severe reaction to levofloxacin; any other quinolone or fluoroquinolone antibiotic such as ciprofloxacin (Cipro), gatifloxacin (Tequin) (not available ...

  15. Ciprofloxacin Injection

    Science.gov (United States)

    ... available. Ciprofloxacin injection is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections. ... reaction to ciprofloxacin or any other quinolone or fluoroquinolone antibiotic such as gatifloxacin (Tequin) (not available in the ...

  16. Alirocumab Injection

    Science.gov (United States)

    ... further decrease the amount of low-density lipoprotein (LDL) cholesterol ('bad cholesterol') in the blood. Alirocumab injection is ... antibodies. It works by blocking the production of LDL cholesterol in the body to decrease the amount of ...

  17. Chloramphenicol Injection

    Science.gov (United States)

    ... an arm or leg sudden changes in vision pain with eye movement Chloramphenicol injection may cause a condition called gray syndrome in premature and newborn infants. There have also been reports of gray ...

  18. Railway vehicle performance optimisation using virtual homologation

    Science.gov (United States)

    Magalhães, H.; Madeira, J. F. A.; Ambrósio, J.; Pombo, J.

    2016-09-01

    Unlike regular automotive vehicles, which are designed to travel in different types of roads, railway vehicles travel mostly in the same route during their life cycle. To accept the operation of a railway vehicle in a particular network, a homologation process is required according to local standard regulations. In Europe, the standards EN 14363 and UIC 518, which are used for railway vehicle acceptance, require on-track tests and/or numerical simulations. An important advantage of using virtual homologation is the reduction of the high costs associated with on-track tests by studying the railway vehicle performance in different operation conditions. This work proposes a methodology for the improvement of railway vehicle design with the objective of its operation in selected railway tracks by using optimisation. The analyses required for the vehicle improvement are performed under control of the optimisation method global and local optimisation using direct search. To quantify the performance of the vehicle, a new objective function is proposed, which includes: a Dynamic Performance Index, defined as a weighted sum of the indices obtained from the virtual homologation process; the non-compensated acceleration, which is related to the operational velocity; and a penalty associated with cases where the vehicle presents an unacceptable dynamic behaviour according to the standards. Thus, the optimisation process intends not only to improve the quality of the vehicle in terms of running safety and ride quality, but also to increase the vehicle availability via the reduction of the time for a journey while ensuring its operational acceptance under the standards. The design variables include the suspension characteristics and the operational velocity of the vehicle, which are allowed to vary in an acceptable range of variation. The results of the optimisation lead to a global minimum of the objective function in which the suspensions characteristics of the vehicle are

  19. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

    OpenAIRE

    Ang, Teck Wee Andrew

    2015-01-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient’s daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided...

  20. [Periarticular Corticosteroid Injection in the Therapeutic Approach of Musculoskeletal Disease in General Practice: A systematic Review].

    Science.gov (United States)

    Trindade, Irene

    2015-01-01

    Introdução: Internacionalmente constata-se o tratamento de patologia músculo-esquelética em cuidados de saúde primários através de técnicas de infiltração peri-articular de corticosteróides. Este artigo procede à análise da evidência existente, com o objectivo de contribuir para a discussão do desenvolvimento dessa prática, ainda diminuta, em Portugal. Material e Métodos: Análise qualitativa de estudos controlados aleatorizados, custo-efectividade, transversais e coorte restrospectivo, recorrendo ao modelo PRISMA. Fontes de dados: PubMed, Cochrane Library, Essential Evidence Plus. Critérios de elegibilidade: infiltrações de corticosteróides no tratamento de patologia músculo-esquelética e indicação de contexto em cuidados de saúde primários. Resultados: Foram incluídos nove estudos controlados aleatorizados, três estudos de custo-efectividade, três estudos transversais, três estudos descritivos e um estudo coorte retrospectivo. A maioria dos indicadores de sucesso da utilização de infiltrações de corticosteróides por médicos de medicina geral e familiar mostrou eficácia a curto prazo; a longo prazo não mostrou superioridade comparativamenteàs intervenções alternativas. O balanço entre os encargos económicos e o aumento da qualidade de vida é favorável à utilização desta técnica em cuidados de saúde primários. Todos os onze estudos que avaliaram a segurança registaram efeitos adversos ligeiros e nenhum grave. Discussão: O desempenho das técnicas de infiltração peri-articular de corticosteróides permite figurá-las como opção terapêutica no tratamento de patologia músculo-esquelética nos cuidados de saúde primários Portugueses. Importa incentivar estudos, nomeadamente a nível nacional, que suportem tanto os indicadores de eficácia, como de segurança desta técnica. Conclusão: A infiltração peri-articular de corticosteróides constitui uma opção relativamente eficaz, segura e com potencial de melhoria da prestação de cuidados de saúde primários Portugueses de uma forma economicamente sustentável.

  1. Automatic optimisation of gamma dose rate sensor networks: The DETECT Optimisation Tool

    DEFF Research Database (Denmark)

    Helle, K.B.; Müller, T.O.; Astrup, Poul;

    2014-01-01

    chosen using regular grids or according to administrative constraints. Nowadays, however, the choice can be based on more realistic risk assessment, as it is possible to simulate potential radioactive plumes. To support sensor planning, we developed the DETECT Optimisation Tool (DOT) within the scope...... monitoring network for early detection of radioactive plumes or for the creation of dose maps. The DOT is implemented as a stand-alone easy-to-use JAVA-based application with a graphical user interface and an R backend. Users can run evaluations and optimisations, and display, store and download the results...

  2. Real-time optimisation of the Hoa Binh reservoir, Vietnam

    DEFF Research Database (Denmark)

    Richaud, Bertrand; Madsen, Henrik; Rosbjerg, Dan

    2011-01-01

    -time optimisation. First, the simulation-optimisation framework is applied for optimising reservoir operating rules. Secondly, real-time and forecast information is used for on-line optimisation that focuses on short-term goals, such as flood control or hydropower generation, without compromising the deviation......Multi-purpose reservoirs often have to be managed according to conflicting objectives, which requires efficient tools for trading-off the objectives. This paper proposes a multi-objective simulation-optimisation approach that couples off-line rule curve optimisation with on-line real...... of the forecast is addressed. The results illustrate the importance of a sufficient forecast lead time to start pre-releasing water in flood situations....

  3. Methods for Optimisation of the Laser Cutting Process

    DEFF Research Database (Denmark)

    Dragsted, Birgitte

    This thesis deals with the adaptation and implementation of various optimisation methods, in the field of experimental design, for the laser cutting process. The problem in optimising the laser cutting process has been defined and a structure for at Decision Support System (DSS......) for the optimisation of the laser cutting process has been suggested. The DSS consists of a database with the currently used and old parameter settings. Also one of the optimisation methods has been implemented in the DSS in order to facilitate the optimisation procedure for the laser operator. The Simplex Method has...... been adapted in two versions. A qualitative one, that by comparing the laser cut items optimise the process and a quantitative one that uses a weighted quality response in order to achieve a satisfactory quality and after that maximises the cutting speed thus increasing the productivity of the process...

  4. Antibody induction versus corticosteroid induction for liver transplant recipients

    DEFF Research Database (Denmark)

    Penninga, Luit; Wettergren, André; Wilson, Colin H

    2014-01-01

    BACKGROUND: Liver transplantation is an established treatment option for end-stage liver failure. To date, no consensus has been reached on the use of immunosuppressive T-cell specific antibody induction compared with corticosteroid induction of immunosuppression after liver transplantation....... OBJECTIVES: To assess the benefits and harms of T-cell specific antibody induction versus corticosteroid induction for prevention of acute rejection in liver transplant recipients. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register...... of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 30 September 2013 together with reference checking, citation searching, contact with trial authors and pharmaceutical companies...

  5. System among the corticosteroids: specificity and molecular dynamics

    Science.gov (United States)

    Brookes, Jennifer C.; Galigniana, Mario D.; Harker, Anthony H.; Stoneham, A. Marshall; Vinson, Gavin P.

    2012-01-01

    Understanding how structural features determine specific biological activities has often proved elusive. With over 161 000 steroid structures described, an algorithm able to predict activity from structural attributes would provide manifest benefits. Molecular simulations of a range of 35 corticosteroids show striking correlations between conformational mobility and biological specificity. Thus steroid ring A is important for glucocorticoid action, and is rigid in the most specific (and potent) examples, such as dexamethasone. By contrast, ring C conformation is important for the mineralocorticoids, and is rigid in aldosterone. Other steroids that are less specific, or have mixed functions, or none at all, are more flexible. One unexpected example is 11-deoxycorticosterone, which the methods predict (and our activity studies confirm) is not only a specific mineralocorticoid, but also has significant glucocorticoid activity. These methods may guide the design of new corticosteroid agonists and antagonists. They will also have application in other examples of ligand–receptor interactions. PMID:21613285

  6. Intermittent inhaled corticosteroids in infants with episodic wheezing

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Hermansen, Mette Northman; Loland, Lotte

    2006-01-01

    secondary outcomes were the time to discontinuation due to persistent wheezing and safety, as evaluated by height and bone mineral density at the end of the study. RESULTS: We enrolled 411 infants and randomly assigned 294 to receive budesonide at a first episode of wheezing. The proportion of symptom...... not affected by treatment. CONCLUSIONS: Intermittent inhaled corticosteroid therapy had no effect on the progression from episodic to persistent wheezing and no short-term benefit during episodes of wheezing in the first three years of life. (ClinicalTrials.gov number, NCT00234390.).......BACKGROUND: We hypothesized that asthma is preceded by a stage of recurrent episodes of wheezing during the first years of life and that inhaled corticosteroid therapy during symptomatic episodes in this early phase may delay progression to persistent wheezing. METHODS: We assigned one...

  7. [Crusted scabies induced by topical corticosteroids: A case report].

    Science.gov (United States)

    Bilan, P; Colin-Gorski, A-M; Chapelon, E; Sigal, M-L; Mahé, E

    2015-12-01

    The frequency of scabies is increasing in France. Crusted (or Norwegian) scabies is a very contagious form of scabies because of the huge number of mites in the skin. It is observed in patients suffering from immunodepression, motor or sensory deficiency, or mental retardation. The clinical presentation, except for the classic manifestation of scabies, is characterized by crusted lesions. Treatment is not easy and requires hospitalization. Topical corticosteroids are frequently used for children's dermatological diseases. Their long-term and inappropriate application in an infested scabies child can induce crusted scabies. We report on a case of an 8-year-old boy who developed crusted scabies induced by topical corticosteroid application. We discuss the therapeutic aspects of this severe form of scabies.

  8. Minimizing side effects of systemic corticosteroids in children

    Directory of Open Access Journals (Sweden)

    Deshmukh C

    2007-01-01

    Full Text Available Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. The antiinflammatory effects of corticosteroids cannot however be separated from their metabolic effects. Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. It is essential for the treating physician to be aware of the side effects and the measures to be taken to minimize them. A side effect that is unique to children is growth suppression, which is helped by alternate day treatment. Administration of small doses of prednisolone (10-15 mg/day or < 0.5 mg/kg/day single dose on alternate days, does not slow growth velocity significantly. The potency of dexamethasone and betamethasone in suppressing growth is nearly 18 times higher than that of prednisolone. There is some evidence that the administration of growth hormone can reverse these changes.

  9. Design Optimisation and Conrol of a Pilot Operated Seat Valve

    DEFF Research Database (Denmark)

    Nielsen, Brian; Andersen, Torben Ole; Hansen, Michael Rygaard

    2004-01-01

    The paper gives an approach for optimisation of the bandwidth of a pilot operated seat valve for mobile applications. Physical dimensions as well as parameters of the implemented control loop are optimised simultaneously. The frequency response of the valve varies as a function of the pressure drop...... across the valve, and it is found to be necessary to scale the controller parameters in the optimised design as a function of pressure drop....

  10. Mechatronic System Design Based On An Optimisation Approach

    DEFF Research Database (Denmark)

    Andersen, Torben Ole; Pedersen, Henrik Clemmensen; Hansen, Michael Rygaard

    The envisaged objective of this paper project is to extend the current state of the art regarding the design of complex mechatronic systems utilizing an optimisation approach. We propose to investigate a novel framework for mechatronic system design. The novelty and originality being the use...... of optimisation techniques. The methods used to optimise/design within the classical disciplines will be identified and extended to mechatronic system design....

  11. Neurosarcoidosis associated with hypersomnolence treated with corticosteroids and brain irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rubinstein, I.; Gray, T.A.; Moldofsky, H.; Hoffstein, V.

    1988-07-01

    Narcoleptic features developed in a young man with CNS sarcoidosis. This was associated with a structural lesion in the hypothalamus as demonstrated on CT scans of the head. The diagnosis of narcolepsy was established by compatible clinical history and the Multiple Sleep Latency Test. Treatment with high-dose corticosteroids was ineffective, but when the low-dose, whole-brain irradiation was added, complete resolution of the narcoleptic features ensued.

  12. Crusted (Norwegian) Scabies Following Systemic and Topical Corticosteroid Therapy

    OpenAIRE

    Binić, Ivana; Janković, Aleksandar; Jovanović, Dragan; Ljubenović, Milanka

    2009-01-01

    It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, a...

  13. THE PARADOXICAL EFFECT ON PNEUMONIA OF CHRONIC INHALED CORTICOSTEROIDS

    OpenAIRE

    Sibila, Oriol; Anzueto, Antonio; Restrepo, Marcos I.

    2013-01-01

    Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Several studies have shown that the risk of pneumonia is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) who are receiving chronic inhaled corticosteroids (ICS). The impact of ICS On pneumonia prognosis is controversial. Recent studies have shown that COPD patients with prior ICS use have less mortality after developing CAP as compared with patients with COPD without pri...

  14. Corticosteroid refractory radiation pneumonitis that remarkably responded to cyclosporin A

    Energy Technology Data Exchange (ETDEWEB)

    Muraoka, Tomie; Bandoh, Shuji; Fujita, Jiro; Horiike, Atsushi; Ishii, Tomoya; Tojo, Yasunori; Kubo, Akihito; Ishida, Toshihiko [Kagawa Medical Univ., Miki (Japan)

    2002-09-01

    Radiation therapy is commonly used for the treatment of lung cancer. However, radiation pneumonitis frequently occurs as a complication of the radiation therapy. Although corticosteroids are widely used for the treatment of radiation pneumonitis, they are not always effective. In this report, we used cycosporin A in the treatment of a patient suffering from steroid-refractory radiation pneumonitis. To our knowledge, this is the first report in which cyclosporin A was successfully used in the treatment of radiation pneumonitis. (author)

  15. Extrafine inhaled corticosteroid therapy in the control of asthma

    Directory of Open Access Journals (Sweden)

    Ivancsó I

    2013-06-01

    Full Text Available István Ivancsó, Renáta Böcskei, Veronika Müller, Lilla Tamási Department of Pulmonology, Semmelweis University, Budapest, Hungary Abstract: Small airways disease plays an important role in the pathogenesis of asthma, but assessment of small airways impairment is not easy in everyday clinical practice. The small airways can be examined by several invasive and noninvasive methods, most of which can at present be used only in the experimental setting. Inhalers providing extrafine inhaled corticosteroid particle sizes may achieve sufficient deposition in the peripheral airways. Many studies have reported the beneficial effects of extrafine inhaled corticosteroids on inflammation, ie, on dysfunction in both the central and distal airways in asthmatics, and there are some data on asthma phenotypes in which the small airways seem to be affected more than in other phenotypes, including nocturnal asthma, severe steroid-dependent or difficult-to-treat asthma, asthma complicated by smoking, elderly asthmatic patients and/or patients with fixed airflow obstruction, and asthmatic children. The relevant randomized controlled clinical trials indicate that the efficacy of extrafine and nonextrafine inhaled corticosteroid formulations is similar in terms of primary endpoints, but there are certain clinically important endpoints for which the extrafine formulations show additional benefits. Keywords: small airways, inflammation, dysfunction, noninvasive evaluation methods, peripheral deposition

  16. Corticosteroid-related central nervous system side effects

    Directory of Open Access Journals (Sweden)

    Miriam Ciriaco

    2013-01-01

    Full Text Available Corticosteroids have been used since the 50s as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Corticosteroids have three principal mechanisms of action: 1 inhibit the synthesis of inflammatory proteins blocking NF-kB, 2 induce the expression of anti-inflammatory proteins by IkB and MAPK phosphatase I, and 3 inhibit 5-lipoxygenase and cyclooxygenase-2. The efficacy of glucocorticoids in alleviating inflammatory disorders results from the pleiotropic effects of the glucocorticoid receptors on multiple signaling pathways. However, they have adverse effects: Growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. Less is known about psychiatric or side effects on central nervous system, as catatonia, decreased concentration, agitation, insomnia, and abnormal behaviors, which are also often underestimated in clinical practice. The aim of this review is to highlight the correlation between the administration of corticosteroids and CNS adverse effects, giving a useful guide for prescribers including a more careful assessment of risk factors and encourage the use of safer doses of this class of drugs.

  17. Muscle function in rheumatic disease patients treated with corticosteroids.

    Science.gov (United States)

    Rothstein, J M; Delitto, A; Sinacore, D R; Rose, S J

    1983-02-01

    Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.

  18. Improving Vector Evaluated Particle Swarm Optimisation by incorporating nondominated solutions.

    Science.gov (United States)

    Lim, Kian Sheng; Ibrahim, Zuwairie; Buyamin, Salinda; Ahmad, Anita; Naim, Faradila; Ghazali, Kamarul Hawari; Mokhtar, Norrima

    2013-01-01

    The Vector Evaluated Particle Swarm Optimisation algorithm is widely used to solve multiobjective optimisation problems. This algorithm optimises one objective using a swarm of particles where their movements are guided by the best solution found by another swarm. However, the best solution of a swarm is only updated when a newly generated solution has better fitness than the best solution at the objective function optimised by that swarm, yielding poor solutions for the multiobjective optimisation problems. Thus, an improved Vector Evaluated Particle Swarm Optimisation algorithm is introduced by incorporating the nondominated solutions as the guidance for a swarm rather than using the best solution from another swarm. In this paper, the performance of improved Vector Evaluated Particle Swarm Optimisation algorithm is investigated using performance measures such as the number of nondominated solutions found, the generational distance, the spread, and the hypervolume. The results suggest that the improved Vector Evaluated Particle Swarm Optimisation algorithm has impressive performance compared with the conventional Vector Evaluated Particle Swarm Optimisation algorithm.

  19. Robust Optimisation Approach for Vehicle Routing Problems with Uncertainty

    Directory of Open Access Journals (Sweden)

    Liang Sun

    2015-01-01

    Full Text Available We formulated a solution procedure for vehicle routing problems with uncertainty (VRPU for short with regard to future demand and transportation cost. Unlike E-SDROA (expectation semideviation robust optimisation approach for solving the proposed problem, the formulation focuses on robust optimisation considering situations possibly related to bidding and capital budgets. Besides, numerical experiments showed significant increments in the robustness of the solutions without much loss in solution quality. The differences and similarities of the robust optimisation model and existing robust optimisation approaches were also compared.

  20. Biomarkers of alopecia areata disease activity and response to corticosteroid treatment.

    Science.gov (United States)

    Fuentes-Duculan, Judilyn; Gulati, Nicholas; Bonifacio, Kathleen M; Kunjravia, Norma; Zheng, Xiuzhong; Suárez-Fariñas, Mayte; Shemer, Avner; Guttman-Yassky, Emma; Krueger, James G

    2016-04-01

    Alopecia areata (AA) is a common inflammatory disease targeting the anagen-stage hair follicle. Different cytokines have been implicated in the disease profile, but their pathogenic role is not yet fully determined. We studied biopsies of pretreatment lesional and non-lesional (NL) scalp and post-treatment (intra-lesional steroid injection) lesional scalp of 6 patchy patients with AA using immunohistochemistry and gene expression analysis. Immunohistochemistry showed increases in CD3(+) , CD8(+) T cells, CD11c(+) dendritic cells and CD1a(+) Langerhans cells within and around hair follicles of pretreatment lesional scalp, which decreased upon treatment. qRT-PCR showed in pretreatment lesional scalp (compared to NL) significant increases (P hair keratins in lesional scalp, with significant upregulation of KRT35, KRT75 and KRT86 in post-treatment lesional scalp. This study shows concurrent activation of Th1 and Th2 immune axes as well as IL-23 and IL-32 cytokine pathways in lesional AA scalp and defined a series of response biomarkers to corticosteroid injection. Clinical trials with selective antagonists coupled with cytokine-pathway biomarkers will be necessary to further dissect pathogenic immunity.

  1. Alteration of endogenous corticosteroids and catecholamines in allergen-induced eosinophilic inflammation in Brown Norway rats

    Directory of Open Access Journals (Sweden)

    Akira Nagata

    1999-01-01

    Full Text Available Although various types of stress activate a pituitary adrenal response, the alteration of endogenous corticosteroids and catecholamines during asthma remains unclear. The aim of this study was to assess changes in endogenous corticosteroid and catecholamine levels in allergic eosinophilic inflammation in rats, using metabolic cages. Brown Norway rats (female, 6 weeks old were sensitized with intraperitoneal injections of ovalbumin on days 0 and 2 and challenged with either an aerosol of ovalbumin or saline for 30 min on day 21. Levels of urinary 11- hydroxycorticosteroid (OHCS, a primary metabolite of corticosterone; epinephrine and norepinephrine were determined in pooled samples taken 0–24 h before and 8–32 h after the challenge. Serum adrenocorticotropic hormone, corticosterone levels and cell counts in bronchoalveolar lavage fluid were assessed 32–36 h after the challenge, as well as lung eosinophil peroxidase activity, an indirect index of eosinophil infiltration. The numbers of total cells and eosinophils in bronchoalveolar lavage fluid and lung eosinophil peroxidase activity were significantly increased in the ovalbumin-challenged rats compared with the saline-challenged rats. While urinary OHCS and serum corticosterone levels were significantly increased after challenge in the ovalbumin-challenged rats, compared with the saline-challenged rats (2.1 ± 0.1 ×10−1 vs 1.7 ± 0.1 x 10−1 mg/g creatinine, P < 0.05 and 482 ± 49 vs 348 ± 19 ng/mL, P < 0.02, respectively, serum adrenocorticotropic hormone levels did not differ between the two groups. Urinary epinephrine and norepinephrine excretion also did not differ between the two groups. It is concluded that endogenous corticosterone, but not catecholamine, increases as a pathophysiologic adrenal response, possibly to protect lung during allergic eosinophilic inflammation.

  2. Simultaneous bilateral septic arthritis of the knee after intraarticular steroid injection: A clinical report.

    Science.gov (United States)

    Munigangaiah, Sudarshan; O'Sullivan, Theresa A; Lenehan, Brian

    2014-07-01

    Osteoarthritis of knee is one of the common problems in elderly population. Intraarticular corticosteroid injection is a conservative management modality in osteoarthritis of knee. Septic arthritis is an infective complication of intraarticular corticosteroid injection. Septic arthritis in rheumatoid arthritis patients have worse prognosis because of delay in diagnosis. A higher rate of infectious complications following intraarticular injection is expected in immunocompromised and rheumatoid patients. We would like to report an extremely rare case of simultaneous bilateral knee septic arthritis after bilateral knee intraarticular steroid injection in a rheumatoid arthritis patient. Patient was treated successfully with multiple bilateral knee arthroscopic washouts and long-term intravenous antibiotics. This case report emphasizes the increased risk of infection in rheumatoid arthritis patients and a risk benefit assessment on individual basis before carrying out intraarticular steroid injection. Patient should be aware of this increased risk of infection.

  3. Optics Design and Lattice Optimisation for the HL-LHC

    CERN Document Server

    Holzer, B J; Fartoukh, S; Chancé, A; Dalena, B; Payet, J; Bogomyagkov, A; Appleby, R B; Kelly, S; Thomas, M B; Thompson, L; Korostelev, M; Hock, K M; Wolski, A; Milardi, C; Faus-Golfe, A; Resta Lopez, J

    2013-01-01

    The luminosity upgrade project of the LHC collider at CERN is based on a strong focusing scheme to reach lowest values of the β function at the collision points. Depending on the magnet technology (Nb3Sn or Nb-Ti) that will be available, a number of beam optics has been developed to define the specifications for the new superconducting magnets. In the context of the optics matching new issues have been addressed and new concepts have been used that play a major role in dealing with the extremely high beta functions. Quadrupole strength flexibility and chromatic corrections have been studied, the influence of the quadrupole fringe fields has been taken into account and the lattice in the matching section had been optimised including the needs of the crab cavities that will be installed. The transition between injection and low β optics has to guarantee smooth gradient changes over a wide range of β* values and the tolerances on misalignments and power converter ripple has been re-evaluated. Finally the succ...

  4. Does the time of delivery after antenatal corticosteroids matter?

    Directory of Open Access Journals (Sweden)

    Patrícia Campos

    2016-01-01

    Full Text Available Introduction: Preterm delivery is associated with an increased risk of newborn morbidity and mortality. Respiratory distress syndrome (RDS is the most common comorbidity. It has been proven that this syndrome can be prevented with the administration of antenatal corticosteroids to women at risk of preterm delivery, before 35 weeks of gestational age.Aim: To evaluate the risk factors, severity, co-morbidities, and mortality of RDS in newborns of less than 35 weeks of gestational age, with specific emphasis on the association between the elapsed time since the administration of the last dose of a full cycle of corticosteroids and the frequency and severity of RDS.Methods: This descriptive retrospective study includes all newborns of less than 35 weeks of gestational age, who were born at our center between January 1, 2012 and December 31, 2014 and admitted to Neonatal Intensive Care Unit (NICU. Newborns with major malformations, chromosomopathies, hydrops, congenital TORCH infection or outborns were excluded. RDS was diagnosed according to the criteria of the Update on the European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants (2013 and classified with a grade of I to III, in accord with radiographic results.Results: A total of 234 newborns were studied, of which 35.5% had RDS. Antenatal corticosteroids were used for 90.1% of all newborns. When adjusted to the severity of RDS, birth weight, gestational age, and vasopressor support were all predictive factors of newborn mortality. A ROC curve identified a cut-off of at most 10.5 hours between the last dose of a full cycle of corticosteroids and the delivery as higher risk of onset of RDS and another cut-off of at most 6.5 hours as higher risk of onset of moderate to severe RDS (sensitivity of 80.0% and 83.3%, respectively.Conclusion: The last dose of a full antenatal corticosteroids cycle must be given at least 10.5 hours prior to delivery to

  5. Biorefinery plant design, engineering and process optimisation

    DEFF Research Database (Denmark)

    Holm-Nielsen, Jens Bo; Ehimen, Ehiazesebhor Augustine

    2014-01-01

    applicable for the planning and upgrading of intended biorefinery systems, and includes discussions on the operation of an existing lignocellulosic-based biorefinery platform. Furthermore, technical considerations and tools (i.e., process analytical tools) which could be applied to optimise the operations......Before new biorefinery systems can be implemented, or the modification of existing single product biomass processing units into biorefineries can be carried out, proper planning of the intended biorefinery scheme must be performed initially. This chapter outlines design and synthesis approaches...

  6. SIROCCO. Silent rotors by acoustic optimisation

    Energy Technology Data Exchange (ETDEWEB)

    Schepers, J.G.; Curvers, A. [ECN Wind Energy, Petten (Netherlands); Oerlemans, S. [National Aerospace Laboratory NLR, Amsterdam (Netherlands); Braun, K.; Lutz, T.; Herrig, A.; Wuerz, W. [University of Stuttgart, Stuttgart (Germany); Matesanz, A.; Garcillan, L. [Gamesa Eolica, Madrid (Spain); Fisher, M.; Koegler, K.; Maeder, T. [GE Wind Energy/GE Global Research (United States)

    2007-07-15

    In this paper the results from the European 5th Framework project 'SIROCCO' are described. The project started in January 2003 and will end in August 2007. The main aim of the SIROCCO project is to reduce wind-turbine aerodynamic noise significantly while maintaining the aerodynamic performance. This is achieved by designing new acoustically and aerodynamically optimised airfoils for the outer part of the blade. The project focussed primarily on reducing trailing edge noise, which was broadly believed to be the dominant noise mechanism of modern wind turbines.

  7. Sarilumab Injection

    Science.gov (United States)

    ... the needle. Do not try to warm the medication by heating it in a microwave, placing it in warm water or in direct sunlight, or through any other method.Before injecting, check the prefilled syringe to be sure that the expiration date printed on the package has not passed. Look ...

  8. Enfuvirtide Injection

    Science.gov (United States)

    ... inject enfuvirtide into any skin that has a tattoo, scar, bruise, mole, a burn site, or has ... Enfuvirtide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: itching, swelling, pain, tingling, discomfort, ...

  9. Fluorouracil Injection

    Science.gov (United States)

    ... of a doctor who is experienced in giving chemotherapy medications for cancer. Treatment with fluorouracil injection may cause serious side effects. ... this medication.If you experience a serious side effect, you or your doctor ... (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/ ...

  10. Lanreotide Injection

    Science.gov (United States)

    Lanreotide injection is used to treat people with acromegaly (condition in which the body produces too much growth hormone, causing enlargement of the hands, feet, and facial features; joint pain; and other symptoms) who have not successfully, or cannot be treated ...

  11. Paliperidone Injection

    Science.gov (United States)

    ... the body slow movements or shuffling walk painful erection of the penis that lasts for hours cough, chills and/or other signs of infection Paliperidone injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.If you experience a ...

  12. Ziprasidone Injection

    Science.gov (United States)

    ... stiffness falling confusion sweating loss of consciousness painful erection of the penis that lasts for hours Ziprasidone injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.If you experience a ...

  13. Risperidone Injection

    Science.gov (United States)

    ... control slow movements or shuffling walk falling painful erection of the penis that lasts for hours Risperidone extended-release injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.If you experience a ...

  14. Safety and efficacy of intra-articular anti-tumor necrosis factor α agents compared to corticosteroids in a treat-to-target strategy in patients with inflammatory arthritis and monoarthritis flare.

    Science.gov (United States)

    Carubbi, Francesco; Zugaro, Luigi; Cipriani, Paola; Conchiglia, Armando; Gregori, Lorenzo; Danniballe, Cristino; Letizia Pistoia, Maria; Liakouli, Vasiliki; Ruscitti, Piero; Ciccia, Francesco; Triolo, Giovanni; Masciocchi, Carlo; Giacomelli, Roberto

    2016-06-01

    The aim of this study was to assess safety and efficacy of ultrasonography (US)-guided intra-articular injections using tumor necrosis factor (TNF) blockers compared to corticosteroids in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients, experiencing refractory monoarthritis despite the current systemic therapy. Eighty-two patients were randomized to receive three intra-articular injections monthly of either corticosteroid or TNF blockers. Primary endpoints were the safety and an improvement greater than 20% for visual analogic scales of involved joint pain in patients injected with anti-TNFα. Further clinical, US, and magnetic resonance imaging (MRI) evaluations were considered secondary endpoints. Intra-articular TNF blockers are a safe strategy, determining a significant reduction of patient and physician reported clinical outcomes and US/MRI scores, in RA and PsA patients, when compared to intra-articular injections of corticosteroids. US guidance excluded the possibility to inject the drug in the wrong site, maximizing local effects, reducing systemic effects, and increasing the safety of the procedure. Patients with inflammatory monoarthritis could be successfully treated with US-guided intra-articular TNF blockers that are a safe and well tolerated procedure, to achieve a longstanding clinical and radiological good clinical response and/or disease remission.

  15. Single-Center Retrospective Evaluation of Inhaled Corticosteroid Use for Chronic Obstructive Pulmonary Disease Exacerbation Patients Receiving Systemic Corticosteroids.

    Science.gov (United States)

    Steuber, Taylor; Shiltz, Dane

    2016-11-01

    Purpose: To determine the frequency of inappropriate inhaled corticosteroid (ICS) therapy when it is prescribed concurrently with systemic corticosteroids; to identify cost-savings potential in the setting of chronic obstructive pulmonary disease (COPD) exacerbations. Methods: Patients admitted to 1 of 8 hospital locations utilizing an integrated electronic health record within the health system for COPD exacerbations treated with systemic corticosteroids (equivalent to at least 30 mg of oral prednisone) between July 1, 2013 and June 30, 2014 were included in a retrospective chart review. Endpoints assessed included number of ICS, with or without long-acting beta-2 agonists (LABA), respiratory medications potentially wasted due to overlap therapy with systemic corticosteroids, as well as overall cost attributed to drug product, administration products, and respiratory therapy labor cost from potentially inappropriate overlap therapy. Results were extrapolated based on the number of admissions within the specified time period. Length of stay data were also compared between the 2 groups (overlap therapy vs no overlap therapy) to determine whether overlap therapy results in a reduction of hospital stay. Results: A total of 10,710 admissions were identified and 74 charts were randomly identified for review. Forty-six (62%) patients received at least one dose of overlapping ICS or ICS/LABA. One hundred forty-two nebulized budesonide vials were wasted along with 43 ICS or ICS/LABA inhalers. A total cost of $8,152.75 was attributed to drug product, administration products, and labor cost. Extrapolating to the 10,710 admissions identified, there would potentially be 20,551 wasted budesonide vials and 6,223 wasted ICS or ICS/LABA inhalers, resulting in an estimated annual cost savings of $1,180,090.03 for the health system. Additionally, length of stay was shorter in the group not receiving overlap therapy compared to the group receiving overlap therapy, but it was not

  16. Optimising Antibiotic Usage to Treat Bacterial Infections

    Science.gov (United States)

    Paterson, Iona K.; Hoyle, Andy; Ochoa, Gabriela; Baker-Austin, Craig; Taylor, Nick G. H.

    2016-11-01

    The increase in antibiotic resistant bacteria poses a threat to the continued use of antibiotics to treat bacterial infections. The overuse and misuse of antibiotics has been identified as a significant driver in the emergence of resistance. Finding optimal treatment regimens is therefore critical in ensuring the prolonged effectiveness of these antibiotics. This study uses mathematical modelling to analyse the effect traditional treatment regimens have on the dynamics of a bacterial infection. Using a novel approach, a genetic algorithm, the study then identifies improved treatment regimens. Using a single antibiotic the genetic algorithm identifies regimens which minimise the amount of antibiotic used while maximising bacterial eradication. Although exact treatments are highly dependent on parameter values and initial bacterial load, a significant common trend is identified throughout the results. A treatment regimen consisting of a high initial dose followed by an extended tapering of doses is found to optimise the use of antibiotics. This consistently improves the success of eradicating infections, uses less antibiotic than traditional regimens and reduces the time to eradication. The use of genetic algorithms to optimise treatment regimens enables an extensive search of possible regimens, with previous regimens directing the search into regions of better performance.

  17. Ant Colony Optimisation for Backward Production Scheduling

    Directory of Open Access Journals (Sweden)

    Leandro Pereira dos Santos

    2012-01-01

    Full Text Available The main objective of a production scheduling system is to assign tasks (orders or jobs to resources and sequence them as efficiently and economically (optimised as possible. Achieving this goal is a difficult task in complex environment where capacity is usually limited. In these scenarios, finding an optimal solution—if possible—demands a large amount of computer time. For this reason, in many cases, a good solution that is quickly found is preferred. In such situations, the use of metaheuristics is an appropriate strategy. In these last two decades, some out-of-the-shelf systems have been developed using such techniques. This paper presents and analyses the development of a shop-floor scheduling system that uses ant colony optimisation (ACO in a backward scheduling problem in a manufacturing scenario with single-stage processing, parallel resources, and flexible routings. This scenario was found in a large food industry where the corresponding author worked as consultant for more than a year. This work demonstrates the applicability of this artificial intelligence technique. In fact, ACO proved to be as efficient as branch-and-bound, however, executing much faster.

  18. Noise aspects at aerodynamic blade optimisation projects

    Energy Technology Data Exchange (ETDEWEB)

    Schepers, J.G. [Netherlands Energy Research Foundation, Petten (Netherlands)

    1997-12-31

    This paper shows an example of an aerodynamic blade optimisation, using the program PVOPT. PVOPT calculates the optimal wind turbine blade geometry such that the maximum energy yield is obtained. Using the aerodynamic optimal blade design as a basis, the possibilities of noise reduction are investigated. The aerodynamic optimised geometry from PVOPT is the `real` optimum (up to the latest decimal). The most important conclusion from this study is, that it is worthwhile to investigate the behaviour of the objective function (in the present case the energy yield) around the optimum: If the optimum is flat, there is a possibility to apply modifications to the optimum configuration with only a limited loss in energy yield. It is obvious that the modified configurations emits a different (and possibly lower) noise level. In the BLADOPT program (the successor of PVOPT) it will be possible to quantify the noise level and hence to assess the reduced noise emission more thoroughly. At present the most promising approaches for noise reduction are believed to be a reduction of the rotor speed (if at all possible), and a reduction of the tip angle by means of low lift profiles, or decreased twist at the outboard stations. These modifications were possible without a significant loss in energy yield. (LN)

  19. The painful shoulder: when to inject and when to refer.

    Science.gov (United States)

    Codsi, Michael J

    2007-07-01

    Physicians can usually diagnose the cause of shoulder pain by performing a focused history and physical examination and ordering anteroposterior and lateral radiographs. Treatment depends on the cause and can include physical therapy, injections of corticosteroids into the joint space or bursa, and surgery. This paper reviews the diagnosis and treatment of impingement syndrome, adhesive capsulitis, rotator cuff tears, and arthritis of the glenohumeral joint and acromioclavicular (AC) joint.

  20. Optimisation for the separation of the oligosaccharide, sodium Pentosan Polysulfate by reverse polarity capillary zone electrophoresis using a central composite design.

    Science.gov (United States)

    Prochazka, S; Mulholland, M; Lloyd-Jones, A

    2003-02-01

    The separation by reverse polarity capillary zone electrophoresis of the therapeutically developed sodium salt of Pentosan Polysulfate was optimised through the analysis of response surface methodologies, modeled using a central composite design. The optimisation investigated injection pressure, injection time and voltage and the effect of the conditions on retention times, peak areas, separation efficiency and the method sensitivity. The overall goal was to develop the most sensitive results with no decrease in separation efficiency. The following results were obtained: (1) retention times generally decreased as injection pressure, injection time and voltage increased, injection time having the least effect; (2) as expected peak areas increased as injection pressure and injection time increased but decreased as voltage increased; (3) separation efficiencies generally increased as injection pressure and injection time decreased, with voltage having almost no effect. For the optimum condition, the sample was introduced at the inlet vial at the cathode hydrodynamically, at optimal setting of 44 s at 35 mbar. The optimal voltage was -20 kV. In comparison with other methods, the optimum showed increased sensitivity, resolution and separation efficiency. Repeatability studies were performed on the optimum parameter conditions. Relative standard deviation values obtained were between 0.9 and 5.4%.

  1. Multi-objective evolutionary optimisation for product design and manufacturing

    CERN Document Server

    2011-01-01

    Presents state-of-the-art research in the area of multi-objective evolutionary optimisation for integrated product design and manufacturing Provides a comprehensive review of the literature Gives in-depth descriptions of recently developed innovative and novel methodologies, algorithms and systems in the area of modelling, simulation and optimisation

  2. Optimisation of GnRH antagonist use in ART

    NARCIS (Netherlands)

    Hamdine, O.

    2014-01-01

    This thesis focuses on the optimisation of controlled ovarian stimulation for IVF using exogenous FSH and GnRH antagonist co-treatment, by studying the timing of the initiation of GnRH antagonist co-medication and the role of ovarian reserve markers in optimising ovarian response and reproductive ou

  3. Aerodynamic shape parameterisation and optimisation of novel configurations

    NARCIS (Netherlands)

    Straathof, M.H.; Van Tooren, M.J.L.; Voskuijl, M.; Koren, B.

    2008-01-01

    The Multi-Disciplinary Design Optimisation (MDO) process can be supported by partial automation of analysis and optimisation steps. Design and Engineering Engines (DEE) are useful concepts to structure this type of automation. Within the DEE, a product can be parameterically defined using Knowledge

  4. DACIA LOGAN LIVE AXLE OPTIMISATION USING COMPUTER GRAPHICS

    Directory of Open Access Journals (Sweden)

    KIRALY Andrei

    2017-05-01

    Full Text Available The paper presents some contributions to the calculus and optimisation of a live axle used at Dacia Logan using computer graphics software for creating the model and afterwards using FEA evaluation to determine the effectiveness of the optimisation. Thus using specialized computer software, a simulation is made and the results were compared to the measured real prototype.

  5. There, and Back Again Quantum Theory and Global Optimisation

    CERN Document Server

    Audenaert, K M R

    2004-01-01

    We consider a problem in quantum theory that can be formulated as an optimisation problem and present a global optimisation algorithm for solving it, the foundation of which relies in turn on a theorem from quantum theory. To wit, we consider the maximal output purity $\

  6. Kriging based robust optimisation algorithm for minimax problems in electromagnetics

    Directory of Open Access Journals (Sweden)

    Li Yinjiang

    2016-12-01

    Full Text Available The paper discusses some of the recent advances in kriging based worst-case design optimisation and proposes a new two-stage approach to solve practical problems. The efficiency of the infill points allocation is improved significantly by adding an extra layer of optimisation enhanced by a validation process.

  7. GAOS: Spatial optimisation of crop and nature within agricultural fields

    NARCIS (Netherlands)

    Bruin, de S.; Janssen, H.; Klompe, A.; Lerink, P.; Vanmeulebrouk, B.

    2010-01-01

    This paper proposes and demonstrates a spatial optimiser that allocates areas of inefficient machine manoeuvring to field margins thus improving the use of available space and supporting map-based Controlled Traffic Farming. A prototype web service (GAOS) allows farmers to optimise tracks within the

  8. Parameter Optimisation for the Behaviour of Elastic Models over Time

    DEFF Research Database (Denmark)

    Mosegaard, Jesper

    2004-01-01

    Optimisation of parameters for elastic models is essential for comparison or finding equivalent behaviour of elastic models when parameters cannot simply be transferred or converted. This is the case with a large range of commonly used elastic models. In this paper we present a general method...... that will optimise parameters based on the behaviour of the elastic models over time....

  9. Multi-criterion scantling optimisation of cruise ships

    OpenAIRE

    2010-01-01

    A numerical tool for the optimisation of the scantlings of a ship is extended by considering production cost, weight and moment of iner tia in the objective function. A multi-criteria optimisation of a passenger ship is conducted to illustrate the analysis process. Pareto frontiers are obtained and results are verified with Bureau Veritas rules.

  10. Reduced mandibular growth in experimental arthritis in the temporomandibular joint treated with intra-articular corticosteroid.

    Science.gov (United States)

    Stoustrup, Peter; Kristensen, Kasper D; Küseler, Annelise; Gelineck, John; Cattaneo, Paolo M; Pedersen, Thomas K; Herlin, Troels

    2008-04-01

    The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.

  11. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  12. Modified cuckoo search: A new gradient free optimisation algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Walton, S., E-mail: 512465@swansea.ac.uk [College of Engineering, Swansea University, Swansea SA2 8PP, Wales (United Kingdom); Hassan, O.; Morgan, K.; Brown, M.R. [College of Engineering, Swansea University, Swansea SA2 8PP, Wales (United Kingdom)

    2011-09-15

    Highlights: > Modified cuckoo search (MCS) is a new gradient free optimisation algorithm. > MCS shows a high convergence rate, able to outperform other optimisers. > MCS is particularly strong at high dimension objective functions. > MCS performs well when applied to engineering problems. - Abstract: A new robust optimisation algorithm, which can be regarded as a modification of the recently developed cuckoo search, is presented. The modification involves the addition of information exchange between the top eggs, or the best solutions. Standard optimisation benchmarking functions are used to test the effects of these modifications and it is demonstrated that, in most cases, the modified cuckoo search performs as well as, or better than, the standard cuckoo search, a particle swarm optimiser, and a differential evolution strategy. In particular the modified cuckoo search shows a high convergence rate to the true global minimum even at high numbers of dimensions.

  13. Optimisation of a Crossdocking Distribution Centre Simulation Model

    CERN Document Server

    Adewunmi, Adrian

    2010-01-01

    This paper reports on continuing research into the modelling of an order picking process within a Crossdocking distribution centre using Simulation Optimisation. The aim of this project is to optimise a discrete event simulation model and to understand factors that affect finding its optimal performance. Our initial investigation revealed that the precision of the selected simulation output performance measure and the number of replications required for the evaluation of the optimisation objective function through simulation influences the ability of the optimisation technique. We experimented with Common Random Numbers, in order to improve the precision of our simulation output performance measure, and intended to use the number of replications utilised for this purpose as the initial number of replications for the optimisation of our Crossdocking distribution centre simulation model. Our results demonstrate that we can improve the precision of our selected simulation output performance measure value using C...

  14. Open Cut resource Optimisation as applied to coal

    Institute of Scientific and Technical Information of China (English)

    Martin L.Smith

    2007-01-01

    Pit optimisation is the earliest and most established application of its kind in the minerals industry,but this has been primarily driven by metal,not coal.Coal has the same financiaI drivers for resource optimisation as does the metalliferous industry,yet pit optimisation is not common practice.Why? The following discussion presents the basics of pit optimisation as they relate to coal and illustrates how a technology developed for massive deposits is not suitable for thin.multi-seam deposits where mine planning is often driven more by product quality than by value drivers such as Net Present Value.An alternative methodology is presented that takes advantage of the data structure of bedded deposits to optimise resource recovery in terms of a production schedule that meets constraints on coal quality.

  15. Subcutaneous (SQ) injections

    Science.gov (United States)

    SQ injections; Sub-Q injections; Diabetes subcutaneous injection; Insulin subcutaneous injection ... NIH. Giving a subcutaneous injection . Rockville, MD. National ... of Health and Human Services NIH publications; 2015. Available ...

  16. Use of Inhaled and Oral Corticosteroids in Pregnancy and the Risk of Malformations or Miscarriage

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Ehrenstein, Vera; Nohr, Ellen Aagaard

    2014-01-01

    Corticosteroids are potent anti-inflammatory and immunosuppressive drugs, which sometimes must be given to pregnant women. Corticosteroids have been suspected to be teratogenic for many years; however, there is conflicting evidence regarding the association. Based on a literature review of three...... databases, this MiniReview provides an overview of inhaled and oral corticosteroid use in pregnancy with specific emphasis on the association between use of corticosteroids during pregnancy and risk of miscarriage and congenital malformations in offspring. Use of corticosteroids among pregnant women ranged...... from 0.2% to 10% and increased nearly two-fold in recent years. Taken together, the evidence suggests that use of corticosteroids in early pregnancy is not associated with an increased risk of congenital malformations overall or oral clefts in offspring; at the same time, published estimates...

  17. Benign fasciculations and Corticosteroid use: possible association? An update

    Directory of Open Access Journals (Sweden)

    Marco Orsini

    2011-09-01

    Full Text Available Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation’s, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation’s are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS.We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation’s, especially due to the changes that this causes on the ionic channels. Fasciculation’s are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation’s, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.

  18. [Antenatal corticosteroid therapy and late preterm infant morbidity and mortality].

    Science.gov (United States)

    Gázquez Serrano, I M; Arroyos Plana, A; Díaz Morales, O; Herráiz Perea, C; Holgueras Bragado, A

    2014-12-01

    Late preterm infants (34-36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure. The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids. A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared. There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P<.05) in the late preterm group that did not receive antenatal steroids. Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  19. Taenia solium tapeworms synthesize corticosteroids and sex steroids in vitro.

    Science.gov (United States)

    Valdez, R A; Jiménez, P; Fernández Presas, A M; Aguilar, L; Willms, K; Romano, M C

    2014-09-01

    Cysticercosis is a disease caused by the larval stage of Taenia solium cestodes that belongs to the family Taeniidae that affects a number of hosts including humans. Taeniids tapeworms are hermaphroditic organisms that have reproductive units called proglottids that gradually mature to develop testis and ovaries. Cysticerci, the larval stage of these parasites synthesize steroids. To our knowledge there is no information about the capacity of T. solium tapeworms to metabolize progesterone or other precursors to steroid hormones. Therefore, the aim of this paper was to investigate if T. solium tapeworms were able to transform steroid precursors to corticosteroids and sex steroids. T. solium tapeworms were recovered from the intestine of golden hamsters that had been orally infected with cysticerci. The worms were cultured in the presence of tritiated progesterone or androstenedione. At the end of the experiments the culture media were analyzed by thin layer chromatography. The experiments described here showed that small amounts of testosterone were synthesized from (3)H-progesterone by complete or segmented tapeworms whereas the incubation of segmented tapeworms with (3)H-androstenedione, instead of (3)H-progesterone, improved their capacity to synthesize testosterone. In addition, the incubation of the parasites with (3)H-progesterone yielded corticosteroids, mainly deoxicorticosterone (DOC) and 11-deoxicortisol. In summary, the results described here, demonstrate that T. solium tapeworms synthesize corticosteroid and sex steroid like metabolites. The capacity of T. solium tapeworms to synthesize steroid hormones may contribute to the physiological functions of the parasite and also to their interaction with the host.

  20. Efficacy of acupuncture versus local methylprednisolone acetate injection in De Quervain's tenosynovitis: a randomized controlled trial.

    Science.gov (United States)

    Hadianfard, Mohammadjavad; Ashraf, Alireza; Fakheri, Maryamsadat; Nasiri, Aref

    2014-06-01

    There is no consensus on the management of De Quervain's tenosynovitis, but local corticosteroid injection is considered the mainstay of treatment. However, some patients are reluctant to take steroid injections. This study was performed to compare the efficacy of acupuncture versus corticosteroid injection for the treatment of this disease. Thirty patients were consequently treated in two groups. The acupuncture group received five acupuncture sessions of 30 minutes duration on classic points of LI-5, LU-7, and LU-9 and on ahshi points. The injection group received one methylprednisolone acetate injection in the first dorsal compartment of the wrist. The degree of disability and pain was evaluated by using the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scale and the Visual Analogue Scale (VAS) at baseline and at 2 weeks and 6 weeks after the start of treatment. The baseline means of the Q-DASH and the VAS scores were 62.8 and 6.9, respectively. At the last follow-up, the mean Q-DASH scores were 9.8 versus 6.2 in the acupuncture and injection groups, respectively, and the mean VAS scores were 2 versus 1.2. We demonstrated short-term improvement of pain and function in both groups. Although the success rate was somewhat higher with corticosteroid injection, acupuncture can be considered as an alternative option for treatment of De Quervain's tenosynovitis.

  1. Corticosteroids increase superoxide anion production by rat liver microsomes.

    Science.gov (United States)

    Nelson, D H; Ruhmann-Wennhold, A

    1975-01-01

    Superoxide anion production by liver microsomes from intact, adrenalectomized, and cortisoltreated adrenalectomized rats has been determined. The amount formed was roughly proportionate to the amount of cortisol given, and a similar response was seen in the activity of NADPH-cytochrome c reductase. The amount of measurable superoxide anion was markedly reduced by the addition of superoxide dismutase. The increased production of this potent free radical with cortisol therapy suggests that its formation may contribute to some of the harmful effects of corticosteroids given in more than physiologic amounts. PMID:239969

  2. Experimental corticosteroid induction of Pneumocystis carinii pneumonia in piglets

    DEFF Research Database (Denmark)

    Nielsen, Jens; Bille-Hansen, Vivi; Settnes, O.P.

    1999-01-01

    Animal models of Pneumocystis carinii (Pc) pneumonia (PCP) play a central role in research on the Pc microorganism itself and the disease, especially the pathogenesis and the host defence. The classic rat model with corticosteroid-induced reactivation of a latent infection has been most widely used...... of the frontal lung lobes and/or atelectatic looking diaphragmatic lobes. Histopathologically, there was a focal interstitial pneumonia. Alveolar walls and interstitia had mononuclear cell infiltrations and the alveolar lumina were occluded by foamy acidophilic honeycomb material with a varying number of Pc...

  3. Corticosteroids for renal scar prevention in children with acute pyelonephritis.

    Science.gov (United States)

    Sakulchit, Teeranai; Goldman, Ran D

    2017-04-01

    Question Acute pyelonephritis in children is of great concern and I usually refer these patients to a pediatrician or send them to the emergency department owing to the risk of renal scarring. Are steroids an acceptable treatment to reduce risk of scarring? Answer Several agents have been studied in an effort to prevent renal scar formation following acute pyelonephritis in children. Use of corticosteroids, in conjunction with standard therapy for acute pyelonephritis, shows promising findings. However, evidence is very limited and steroids should not be offered on a regular basis as part of treatment. Copyright© the College of Family Physicians of Canada.

  4. Action mechanism of corticosteroids to aggravate Guillain-Barré syndrome

    OpenAIRE

    2015-01-01

    Corticosteroids have been proved to be ineffective for Guillain-Barré syndrome, but the mechanism remains unknown. In a rabbit model of axonal Guillain-Barré syndrome, treatment with corticosteroids significantly reduced macrophage infiltration in the spinal ventral roots and the survival rate as well as clinical improvement. On 30th day after onset, there was significantly higher frequency of axonal degeneration in the corticosteroids-treated rabbits than saline-treated rabbits. Corticostero...

  5. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

    OpenAIRE

    Hideki Yasui; Koshi Yokomura; Takafumi Suda

    2016-01-01

    Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days ...

  6. Osteonecrosis in a Patient with Crohn's Disease Unrelated to Corticosteroid Use

    Directory of Open Access Journals (Sweden)

    Ali Khan

    2001-01-01

    Full Text Available Osteonecrosis is a feared complication of corticosteroid use. However, a direct association between corticosteroid use and osteonecrosis has never been proven. The present report examines the case of a patient with longstanding Crohn's disease who had never been treated with corticosteroids and who developed osteonecrosis of the talus. The association of systemic inflammatory disorders with osteonecrosis and the possible association with vascular thrombosis are discussed.

  7. Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?

    Science.gov (United States)

    Forsblom, E; Nurmi, A-M; Ruotsalainen, E; Järvinen, A

    2016-03-01

    The purpose of this study was to examine the prognostic impact of corticosteroids in hemodynamically stabile Staphylococcus aureus bacteremia (SAB). There were 361 hemodynamically stabile methicillin-sensitive SAB patients with prospective follow-up and grouping according to time-point, dose and indication for corticosteroid therapy. To enable analyses without external interfering corticosteroid therapy all patients with corticosteroid therapy equivalent to prednisone >10 mg/day for ≥1 month prior to positive blood culture results were excluded. Twenty-five percent (92) of patients received corticosteroid therapy of which 11 % (40) had therapy initiated within 1 week (early initiation) and 9 % (31) had therapy initiated 2-4 weeks after (delayed initiation) positive blood culture. Twenty-one patients (6 %) had corticosteroid initiated after 4 weeks and were not included in the analyses. A total of 55 % (51/92) received a weekly prednisone dose >100 mg. Patients with early initiated corticosteroid therapy had higher mortality compared to patients treated without corticosteroid therapy at 28 days (20 % vs. 7 %) (OR, 3.11; 95%CI, 1.27-7.65; p corticosteroid therapy predicted 28-day (HR, 3.75; 95%CI, 1.60-8.79; p = 0.002) and 90-day (HR, 3.10; 95%CI, 1.50-6.39; p = 0.002) mortality in Cox proportional hazards regression analysis. When including only patients receiving early initiated corticosteroid therapy with prednisone ≥100 mg/week the negative prognostic impact on 28-day mortality was accentuated (HR 4.8, p = 0.001). Corticosteroid therapy initiation after 1 week of positive blood cultures had no independent prognostic impact. Early initiation of corticosteroid therapy may be associate to increased mortality in hemodynamically stabile SAB.

  8. Optimising bisphosphonate treatment outcomes in postmenopausal osteoporosis: review and Italian experience.

    Science.gov (United States)

    Rossini, M; Di Munno, O; Gatti, D; Giannini, S; Minisola, S; Varenna, M; Adami, S

    2011-01-01

    This review aims to investigate ways to optimise treatment outcomes with bisphosphonate therapy of osteoporosis in general, and in Italian clinical practice specifically. Overall, poor adherence to bisphosphonate therapy is a major limiting factor in the treatment of osteoporosis, and is associated to a large extent with gastrointestinal adverse events. An improved patient-doctor relationship and patient motivation are critical factors to improving adherence. However, other medical interventions also play a significant role. Intermittent dosing regimens decrease gastrointestinal adverse events and improve adherence, and demonstrate at least equivalent efficacy to daily regimens. Intravenous formulations also improve gastrointestinal tolerability, and are recommended in Italy for patients at high risk of this adverse event. Other recommendations in Italy to improve treatment outcomes include a case-finding approach to identify patients most suitable for bisphosphonate therapy, thus reducing the numbers needed to treat to avoid fractures. To facilitate this, a comprehensive assessment is advocated which incorporates bone mineral density, previous fractures, parental history of fractures, corticosteroid use and the presence of other diseases associated with secondary osteoporosis.

  9. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    Energy Technology Data Exchange (ETDEWEB)

    Sopov, V.; Groshar, D. [Dept. of Nuclear Medicine, Technion-Israel Inst. of Technology, Haifa (Israel); Fuchs, D. [Dept. of Orthopaedics, Technion-Israel Inst. of Technology, Haifa (Israel); Bar-Meir, E. [Dept. of Radiology, Technion-Israel Inst. of Technology, Haifa (Israel)

    2001-02-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  10. Self-reported osteoporosis prevention in inhaled corticosteroid users in community pharmacy setting

    Directory of Open Access Journals (Sweden)

    Valerie Chan

    2015-05-01

    Full Text Available Objectives: The use of inhaled corticosteroids is the standard maintenance therapy in asthma therapy and as adjunct therapy in moderate to severe chronic obstructive pulmonary disease. A dose-related increase in fracture risk is associated with inhaled corticosteroid use; there is an inverse relationship between bone mineral density and duration and cumulative dose of inhaled corticosteroid. Adequate intake of calcium and vitamin D are cornerstones of osteoporosis prevention. The objectives are to assess whether the proportion of patients receiving inhaled corticosteroids are taking calcium and vitamin D; the association between long-term inhaled corticosteroid use and abnormal bone mineral density or fractures; and how many qualified patients received bone mineral density scans. Methods: Patients who filled a prescription for inhaled corticosteroids at selected community pharmacies across Alberta were recruited for a survey of their osteoporosis prevention activities. Results: A total of 256 patients from 12 community pharmacies were included. The average age was 60 ± 17.4 years with 65% female. There were 21%, 51%, and 28% of patients on high, medium, and low dose inhaled corticosteroids, respectively. Only 17% of patients >50 years old received recommended calcium and vitamin D supplementation and 87 (73% of the qualified patients received bone mineral density scan. Conclusion: Osteoporosis prevention in inhaled corticosteroid users is currently poorly addressed. More promotion is needed to raise pharmacist awareness of the risks of inhaled corticosteroids.

  11. Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependent asthma

    National Research Council Canada - National Science Library

    Howarth, P H; Babu, K S; Arshad, H S; Lau, L; Buckley, M; McConnell, W; Beckett, P; Al Ali, M; Chauhan, A; Wilson, S J; Reynolds, A; Davies, D E; Holgate, S T

    2005-01-01

    .... However, as asthma becomes more severe and chronic, it adopts additional characteristics including corticosteroid refractoriness and involvement of neutrophils suggestive of an altered inflammatory...

  12. Plasma corticosteroid dynamics in channel catfish, Ictalurus punctatus (Rafinesque), during and after oxygen depletion

    Science.gov (United States)

    Tomasso J.R., Davis; Parker, N.C.

    1981-01-01

    Plasma corticosteroid concentrations in channel catfish, Ictalurus punctatus, (normally 1.0 ± 0.3 μg/100 ml) increased significantly (to 5.9 ± 1.2μg/100 ml) in response to acute oxygen depletion and then returned to control levels within 30 min after the dissolved oxygen concentration was increased; however, a secondary increase in plasma corticosteroid levels was observed 6 h after exposure. Corticosteroid levels also increased in fish exposed to dissolved oxygen concentration of blue was not effective in preventing interrenal response to low dissolved oxygen. No diurnal plasma corticosteroid rhythm was observed in fish exposed to diurnal chemical rhythms of culture ponds.

  13. Consumers attitudes and beliefs towards the receipt of antenatal corticosteroids and use of clinical practice guidelines

    National Research Council Canada - National Science Library

    McGoldrick, E L; Crawford, T; Brown, J A; Groom, K M; Crowther, C A

    2016-01-01

    ...) demonstrating scepticism towards their purpose and applicability to their needs. There is no information pertaining to consumers' views and attitudes on the receipt of antenatal corticosteroids (ACS...

  14. Study of process parameters effect on the filling phase of micro injection moulding using weld lines as flow markers

    DEFF Research Database (Denmark)

    Tosello, Guido; Gava, Alberto; Hansen, Hans Nørgaard

    2010-01-01

    Micro-injection moulding (micro-moulding) is a process which enables the mass production of polymer microproducts. In order to produce high-quality injection moulded micro-parts, a crucial aspect to be fully understood and optimised is the filling of the cavity by the molten polymer. As a result,...

  15. Hip Pain: Dry Needling Versus Cortisone Injections.

    Science.gov (United States)

    2017-04-01

    Greater trochanteric pain syndrome (GTPS) is chronic, intermittent pain and tenderness on the outside of the hip. The medical community once thought that a swollen hip bursa was the source of such pain, which led to the use of corticosteroid injections to the bursa to help decrease swelling and pain. However, researchers now believe that injuries to the muscles and tendons around the hip are the actual cause of this pain, and that inflammation is often not involved. A study published in the April 2017 issue of JOSPT explores dry needling as an alternative to cortisone injections to reduce pain and improve function in patients with GTPS. J Orthop Sports Phys Ther 2017;47(4):240. doi:10.2519/jospt.2017.0504.

  16. ATLAS software configuration and build tool optimisation

    CERN Document Server

    Rybkin, G; The ATLAS collaboration

    2014-01-01

    ATLAS software code base is over 6 million lines organised in about 2000 packages. It makes use of some 100 external software packages, is developed by more than 400 developers and used by more than 2500 physicists from over 200 universities and laboratories in 6 continents. To meet the challenge of configuration and building of this software, the Configuration Management Tool (CMT) is used. CMT expects each package to describe its build targets, build and environment setup parameters, dependencies on other packages in a text file called requirements, and each project (group of packages) to describe its policies and dependencies on other projects in a text project file. Based on the effective set of configuration parameters read from the requirements files of dependent packages and project files, CMT commands build the packages, generate the environment for their use, or query the packages. The main focus was on build time performance that was optimised within several approaches: reduction of the number of re...

  17. ATLAS software configuration and build tool optimisation

    CERN Document Server

    Rybkin, G; The ATLAS collaboration

    2013-01-01

    ATLAS software code base is over 6 million lines organised in about 2000 packages. It makes use of some 100 external software packages, is developed by more than 400 developers and used by more than 2500 physicists from over 200 universities and laboratories in 6 continents. To meet the challenge of configuration and building of this software, the Configuration Management Tool (CMT) is used. CMT expects each package to describe its build targets, build and environment setup parameters, dependencies on other packages in a text file called requirements, and each project (group of packages) to describe its policies and dependencies on other projects in a text project file. Based on the effective set of configuration parameters read from the requirements files of dependent packages and project files, CMT commands build the packages, generate the environment for their use, or query the packages. The main focus was on build time performance that was optimised within several approaches: reduction of the number of re...

  18. Specification, Verification and Optimisation of Business Processes

    DEFF Research Database (Denmark)

    Herbert, Luke Thomas

    to model checking. This allows for a rich set of both qualitative and quantitative properties of a business process to be precisely determined in an automated fashion directly from the model of the business process. A number of advanced applications of this framework are presented which allow for automated...... Model and Notation (BPMN). The automated analysis of business processes is done by means of quantitative probabilistic model checking which allows verification of validation and performance properties through use of an algorithm for the translation of business process models into a format amenable......This thesis develops a unified framework wherein to specify, verify and optimise stochastic business processes. This framework provides for the modelling of business processes via a mathematical structure which captures business processes as a series of connected activities. This structure...

  19. FEM Optimisation of Spark Plasma Sintering Furnace

    CERN Document Server

    Kellari, Demetrios Vasili

    2013-01-01

    Coupled electro-thermal FEM analysis has been carried out on a sintering furnace used to produce new materials for LHC collimators. The analysis showed there exist margins for improvement of the current process and equipment through minor changes. To optimise the design of the furnace several design changes have been proposed including: optimization of material selection using copper cooling plates, control of convection in cooling plates by lowering the water flow rate, modifying the electrode shape using unsymmetrical electrodes and upgrading the thermal shielding to make use of multilayer graphite shields. The results show that we have a significant improvement in temperature gradient on the plate, from 453 to 258 °C and a reduction in power requirement from 62 to 44 kW.

  20. Niobium Cavity Electropolishing Modelling and Optimisation

    CERN Document Server

    Ferreira, L M A; Forel, S; Shirra, J A

    2013-01-01

    It’s widely accepted that electropolishing (EP) is the most suitable surface finishing process to achieve high performance bulk Nb accelerating cavities. At CERN and in preparation for the processing of the 704 MHz high-beta Superconducting Proton Linac (SPL) cavities a new vertical electropolishing facility has been assembled and a study is on-going for the modelling of electropolishing on cavities with COMSOL® software. In a first phase, the electrochemical parameters were taken into account for a fixed process temperature and flow rate, and are presented in this poster as well as the results obtained on a real SPL single cell cavity. The procedure to acquire the data used as input for the simulation is presented. The modelling procedure adopted to optimise the cathode geometry, aimed at a uniform current density distribution in the cavity cell for the minimum working potential and total current is explained. Some preliminary results on fluid dynamics is also briefly described.

  1. Improving and optimising road pricing in Copenhagen

    DEFF Research Database (Denmark)

    Nielsen, Otto Anker; Larsen, Marie Karen

    2008-01-01

    though quite a number of proposed charging systems have been examined only a few pricing strategies have been investigated. This paper deals with the optimisation of different designs for a road pricing system in the Greater Copenhagen area with respect to temporal and spatial differentiation......The question whether to introduce toll rings or road pricing in Copenhagen has been discussed intensively during the last 10 years. The main results of previous analyses are that none of the systems would make a positive contribution at present, when considered from a socio-economic view. Even...... of the pricing levels. A detailed transport model was used to describe the demand effects. The model was based on data from a real test of road pricing on 500 car drivers. The paper compares the price systems with regard to traffic effects and generalised costs for users and society. It is shown how important...

  2. A code for optimising triplet layout

    CERN Document Server

    Van Riesen-Haupt, Leon; Abelleira, Jose; Cruz Alaniz, Emilia

    2017-01-01

    One of the main challenges when designing final focus systems of particle accelerators is maximising the beam stay clear in the strong quadrupole magnets of the inner triplet. Moreover it is desirable to keep the quadrupoles in the inner triplet as short as possible for space and costs reasons but also to reduce chromaticity and simplify corrections schemes. An algorithm that explores the triplet parameter space to optimise both these aspects was written. It uses thin lenses as a first approximation for a broad parameter scan and MADX for more precise calculations. The thin lens algorithm is significantly faster than a full scan using MADX and relatively precise at indicating the approximate area where the optimum solution lies.

  3. Optimising Signalised Intersection Using Wireless Vehicle Detectors

    DEFF Research Database (Denmark)

    Adjin, Daniel Michael Okwabi; Torkudzor, Moses; Asare, Jack

    Traffic congestion on roads wastes travel times. In this paper, we developed a vehicular traffic model to optimise a signalised intersection in Accra, using wireless vehicle detectors. Traffic volume gathered was extrapolated to cover 2011 and 2016 and were analysed to obtain the peak hour traffic...... volume causing congestion. The intersection was modelled and simulated in Synchro7 as an actuated signalised model using results from the analysed data. The model for morning peak periods gave optimal cycle lengths of 100s and 150s with corresponding intersection delay of 48.9s and 90.6s in 2011 and 2016...... respectively while that for the evening was 55s giving delay of 14.2s and 16.3s respectively. It is shown that the model will improve traffic flow at the intersection....

  4. Simulation and optimisation of turbulence in stellarators

    Energy Technology Data Exchange (ETDEWEB)

    Xanthopoulos, Pavlos; Helander, Per; Turkin, Yuriy; Plunk, Gabriel G.; Bird, Thomas; Proll, Josefine H.E. [Max-Planck-Institut fuer Plasmaphysik, EURATOM Association, Wendelsteinstr. 1, 17491 Greifswald (Germany); Mynick, Harry [Plasma Physics Laboratory, Princeton University, Princeton, New Jersey 08543 (United States); Jenko, Frank; Goerler, Tobias; Told, Daniel [Max-Planck-Institut fuer Plasmaphysik, EURATOM Association, Boltzmannstr. 2, 85748 Garching (Germany)

    2014-07-01

    In tokamaks and stellarators - two leading types of devices used in fusion research - magnetic field lines trace out toroidal surfaces on which the plasma density and temperature are constant, but turbulent fluctuations carry energy across these surfaces to the wall, thus degrading the plasma confinement. Using petaflop-scale simulations, we calculate for the first time the pattern of turbulent structures forming on stellarator magnetic surfaces, and find striking differences relative to tokamaks. The observed sensitivity of the turbulence to the magnetic geometry suggests that there is room for further confinement improvement, in addition to measures already taken to minimise the laminar transport. With an eye towards fully optimised stellarators, we present a proof-of-principle configuration with substantially reduced turbulence compared to an existing design.

  5. Optimisation of Multilayer Insulation an Engineering Approach

    CERN Document Server

    Chorowski, M; Parente, C; Riddone, G

    2001-01-01

    A mathematical model has been developed to describe the heat flux through multilayer insulation (MLI). The total heat flux between the layers is the result of three distinct heat transfer modes: radiation, residual gas conduction and solid spacer conduction. The model describes the MLI behaviour considering a layer-to-layer approach and is based on an electrical analogy, in which the three heat transfer modes are treated as parallel thermal impedances. The values of each of the transfer mode vary from layer to layer, although the total heat flux remains constant across the whole MLI blanket. The model enables the optimisation of the insulation with regard to different MLI parameters, such as residual gas pressure, number of layers and boundary temperatures. The model has been tested with experimental measurements carried out at CERN and the results revealed to be in a good agreement, especially for insulation vacuum between 10-5 Pa and 10-3 Pa.

  6. Common mode chokes and optimisation aspects

    Science.gov (United States)

    Kut, T.; Lücken, A.; Dickmann, S.; Schulz, D.

    2014-11-01

    Due to the increasing electrification of modern aircraft, as a result of the More Electric Aircraft concept, new strategies and approaches are required to fulfil the strict EMC aircraft standards (DO-160/ED-14-Sec. 20). Common mode chokes are a key component of electromagnetic filters and often oversized because of the unknown impedance of the surrounding power electronic system. This oversizing results in an increase of weight and volume. It has to be avoided as far as possible for mobile applications. In this context, an advanced method is presented to measure these impedances under operating conditions. Furthermore, the different parameters of the inductance design is explained and an optimisation for weight and volume is introduced.

  7. Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

    Directory of Open Access Journals (Sweden)

    Atanasković-Marković Marina

    2012-01-01

    Full Text Available Introduction. In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. Case Outline. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT was positive. Conclusion. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of cross-reactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.

  8. Protective effect of corticosteroids on radiation pneumonitis in mice

    Energy Technology Data Exchange (ETDEWEB)

    Gross, N.J.; Narine, K.R.; Wade, R.

    1988-01-01

    We explored the protective effect of corticosteroids on the mortality of mice that received thoracic irradiation. Methylprednisolone, 100 mg/kg/week, given from 11 weeks after gamma irradiation of the thorax resulted in an increase in the LD50 (11-26 weeks) from 14.3 +/- 0.3 (mean +/- SE) Gy to 17.6 +/- 0.4 Gy, P less than 0.001, a protection factor of 1.2. Withdrawal of steroids at various times during the period of radiation pneumonitis resulted in accelerated mortality in the next 2-4 weeks, so that the cumulative mortality caught up with that of control animals by 4 weeks after steroid withdrawal. However, after the end of the usual period of pneumonitis withdrawal of steroids did not result in accelerated mortality, suggesting that the time when steroids are protective corresponds to the duration of pneumonitis. A smaller dose of steroids, 25 mg/kg/week, was found to be as protective as the larger dose used in the above experiments. The possibility that corticosteroids reduce mortality, even when given many weeks after radiation, may have important practical and theoretical implications.

  9. Evolution of ligand specificity in vertebrate corticosteroid receptors

    Directory of Open Access Journals (Sweden)

    Deitcher David L

    2011-01-01

    Full Text Available Abstract Background Corticosteroid receptors include mineralocorticoid (MR and glucocorticoid (GR receptors. Teleost fishes have a single MR and duplicate GRs that show variable sensitivities to mineralocorticoids and glucocorticoids. How these receptors compare functionally to tetrapod MR and GR, and the evolutionary significance of maintaining two GRs, remains unclear. Results We used up to seven steroids (including aldosterone, cortisol and 11-deoxycorticosterone [DOC] to compare the ligand specificity of the ligand binding domains of corticosteroid receptors between a mammal (Mus musculus and the midshipman fish (Porichthys notatus, a teleost model for steroid regulation of neural and behavioral plasticity. Variation in mineralocorticoid sensitivity was considered in a broader phylogenetic context by examining the aldosterone sensitivity of MR and GRs from the distantly related daffodil cichlid (Neolamprologus pulcher, another teleost model for neurobehavioral plasticity. Both teleost species had a single MR and duplicate GRs. All MRs were sensitive to DOC, consistent with the hypothesis that DOC was the initial ligand of the ancestral MR. Variation in GR steroid-specificity corresponds to nine identified amino acid residue substitutions rather than phylogenetic relationships based on receptor sequences. Conclusion The mineralocorticoid sensitivity of duplicate GRs in teleosts is highly labile in the context of their evolutionary phylogeny, a property that likely led to neo-functionalization and maintenance of two GRs.

  10. Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar

    Directory of Open Access Journals (Sweden)

    F. A. Sendrasoa

    2017-01-01

    Full Text Available This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8% used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16–73 years. Two hundred and sixty-one females (68% used TC combined with handcrafted cosmetics, and 123 (32% used TC alone. “Pandalao,” which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder, and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents. Only one (0,26% had obtained the TC by physician’s prescription, 234 (61% from cosmetic retailers, 92 (23% directly from local pharmacies, 49 (12% from beauticians, and 15 (4% from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2% and cutaneous atrophy (52,1% were the most adverse effects noted.

  11. Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers.

    Science.gov (United States)

    Foye, Patrick M; Sullivan, William J; Panagos, Andre; Zuhosky, Joseph P; Sable, Aaron W; Irwin, Robert W

    2007-03-01

    This self-directed study module focuses on the use of corticosteroids and other injections in the treatment of lateral epicondylitis, de Quervain's tenosynovitis, carpal tunnel syndrome, Achilles' tendinitis, and plantar fasciitis. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. To review the medical literature to help clinicians make treatment decisions regarding corticosteroid and other injections in the upper and lower limbs in injured workers.

  12. Injection Efficiency Monitor for the Australian Synchrotron

    Directory of Open Access Journals (Sweden)

    Rassool R. P.

    2012-10-01

    Full Text Available The Australian Synchrotron AS is moving towards a continuous injection mode called top-up. During top-up the linac and booster synchrotron injection system will be in continuous operation rather than usedevery eight hours the way they are used at present. In order to monitor the performance of the injection system areal-time injection efficiency monitoring system has been developed. The system consists of several Fast CurrentTransformers [1] and matching digitisers [2] and is designed to count every beam pulse and measure the transmission efficiency through the whole accelerator complex. After calibrating the system using a properly matchedFaraday Cup at the electron gun, a transmission efficiency is then calculated at each stage of transferring the beamfrom 90 keV out of the gun to 3 GeV in the storage ring. The system is used to optimise the injection process inorder to maximise the injection efficiency and as an early warning system when equipment starts to fail and theinjection efficiency decreases.

  13. Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

    Science.gov (United States)

    Waljee, Akbar K.; Wiitala, Wyndy L.; Govani, Shail; Stidham, Ryan; Saini, Sameer; Hou, Jason; Feagins, Linda A.; Khan, Nabeel; Good, Chester B.; Vijan, Sandeep; Higgins, Peter D. R.

    2016-01-01

    Background and Aims Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Methods Retrospective review of Veterans Health Administration (VHA) data from 2002–2010. Results Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Conclusions Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken

  14. Graves眼病的糖皮质激素治疗%Corticosteroids for treatment of Graves' ophthalmopathy

    Institute of Scientific and Technical Information of China (English)

    甘世斌; 毛羽翔; 陈丹云; 陈依彤; 岳书帆

    2014-01-01

    Graves' ophthalmopathy (GO) is an inflammatory eye disease that develops in the orbit in association with autoimmune thyroid disorders.Symptoms include mainly proptosis and extraocular muscle dysfunction due to involvement of both extraocular muscle and orbital fat.Corticosteroid theraphy can relieve GO via both immunomodulation and anti-inflammation.This review focuses on issues of the efficacy,side effects,and indications of corticosteroid therapy given by orally,subconjunctival / retrobulbar injections,versus intravenously.Corticosteroid therapy,when given orally,is more effective than given subconjunctivally,and given intravenously seemed to be the most effective,whereas more side effects in the treatment of GO.GO should be treated as early as possible,especially in patients with active inflammation to prevent the development or progression of GO.Corticosteroid therapy should be made in light of the risk-benefit ratio.%Graves眼病是指自身免疫性甲状腺疾病引起的眼眶炎症,主要累及眼外肌和球后脂肪产生突眼或眼外肌功能障碍.糖皮质激素通过免疫抑制和抗炎作用可使Graves眼病得到不同程度的缓解.本综述比较了口服、局部注射和静脉注射糖皮质激素三种治疗方法的疗效、副作用及用药指征,显示口服用药效果优于局部用药,静脉给药似乎优于口服,但副作用较大.发现Graves眼病需及早治疗,尤其是活动性眼病更需要治疗,防止眼病恶化,治疗时需权衡糖皮质激素的风险与获益.

  15. Autologus Blood Injection for Recurrent Lateral Epicondylitis

    Directory of Open Access Journals (Sweden)

    M. Dehghani, M.D.

    2007-09-01

    Full Text Available Background and purpose: Tennis elbow is a common complaint. Several treatment strategies, such as corticosteroid injections and physical terapy and braces have been described with no predictable efficacy. The purpose of this study was to evaluate prospectively the result of refractory lateral epicondylitis with autologus blood injections.Materials and Methods: Twenty two patients with lateral epicondylitis were injected with 2 mL of autologous blood under the extensor carpi radialis brevis. All patients had failed the two previous non surgical treatments including all or combination of physical therapy, splintinge, non steroidal anti-inflammatory medication and prior steroid injection. The patients were evaluated with patient-rated Tennis Elbow Evaluation (PRTEE.Results: The average fallow-up period was 7.3 months (range, 4-10mo. After autologus blood injection, the average pain score decreased from 43.7 to 9.1 (P-value < 0.001. The average functional score decreased from 42.4 to 10.1 (P-value <0.001.Conclusion: On the basis of this study, this minimally invasive treatment advocates refractory Tennis elbow.

  16. Profile control studies for JET optimised shear regime

    Energy Technology Data Exchange (ETDEWEB)

    Litaudon, X.; Becoulet, A.; Eriksson, L.G.; Fuchs, V.; Huysmans, G.; How, J.; Moreau, D.; Rochard, F.; Tresset, G.; Zwingmann, W. [Association Euratom-CEA, CEA/Cadarache, Dept. de Recherches sur la Fusion Controlee, DRFC, 13 - Saint-Paul-lez-Durance (France); Bayetti, P.; Joffrin, E.; Maget, P.; Mayorat, M.L.; Mazon, D.; Sarazin, Y. [JET Abingdon, Oxfordshire (United Kingdom); Voitsekhovitch, I. [Universite de Provence, LPIIM, Aix-Marseille 1, 13 (France)

    2000-03-01

    This report summarises the profile control studies, i.e. preparation and analysis of JET Optimised Shear plasmas, carried out during the year 1999 within the framework of the Task-Agreement (RF/CEA/02) between JET and the Association Euratom-CEA/Cadarache. We report on our participation in the preparation of the JET Optimised Shear experiments together with their comprehensive analyses and the modelling. Emphasis is put on the various aspects of pressure profile control (core and edge pressure) together with detailed studies of current profile control by non-inductive means, in the prospects of achieving steady, high performance, Optimised Shear plasmas. (authors)

  17. Application of optimisation techniques in groundwater quantity and quality management

    Indian Academy of Sciences (India)

    Amlan Das; Bithin Datta

    2001-08-01

    This paper presents the state-of-the-art on application of optimisation techniques in groundwater quality and quantity management. In order to solve optimisation-based groundwater management models, researchers have used various mathematical programming techniques such as linear programming (LP), nonlinear programming (NLP), mixed-integer programming (MIP), optimal control theory-based mathematical programming, differential dynamic programming (DDP), stochastic programming (SP), combinatorial optimisation (CO), and multiple objective programming for multipurpose management. Studies reported in the literature on the application of these methods are reviewed in this paper.

  18. Genetic Algorithm Optimisation of a Ship Navigation System

    Directory of Open Access Journals (Sweden)

    E. Alfaro-Cid

    2001-01-01

    Full Text Available The optimisation of the PID controllers' gains for separate propulsion and heading control systems of CyberShip I, a scale model of an oil platform supply ship, using Genetic Algorithms is considered. During the initial design process both PID controllers have been manually tuned to improve their performance. However this tuning approach is a tedious and time consuming process. A solution to this problem is the use of optimisation techniques based on Genetic Algorithms to optimise the controllers' gain values. This investigation has been carried out through computer-generated simulations based on a non-linear hydrodynamic model of CyberShip I.

  19. Corneal endothelial rejection after penetrating keratoplasty treated with intravenous and topic corticosteroid: one year follow up

    Directory of Open Access Journals (Sweden)

    Ricardo Yuji Abe

    2013-02-01

    Full Text Available OBJECTIVE: To analyze the recovery of visual acuity (VA and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP treated with intravenous (IV and topic corticosteroid. METHODS: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. RESULTS: A total of 32 eyes from 32 patients (13 male and 19 female were included in the study. The mean VA (in number of letters before rejection was 48 (22 to 88 letters. Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001. Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047. CONCLUSION: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment.

  20. Design optimisation of a flywheel hybrid vehicle

    Energy Technology Data Exchange (ETDEWEB)

    Kok, D.B.

    1999-11-04

    This thesis describes the design optimisation of a flywheel hybrid vehicle with respect to fuel consumption and exhaust gas emissions. The driveline of this passenger car uses two power sources: a small spark ignition internal combustion engine with three-way catalyst, and a highspeed flywheel system for kinetic energy storage. A custom-made continuously variable transmission (CVT) with so-called i{sup 2} control transports energy between these power sources and the vehicle wheels. The driveline includes auxiliary systems for hydraulic, vacuum and electric purposes. In this fully mechanical driveline, parasitic energy losses determine the vehicle's fuel saving potential to a large extent. Practicable energy loss models have been derived to quantify friction losses in bearings, gearwheels, the CVT, clutches and dynamic seals. In addition, the aerodynamic drag in the flywheel system and power consumption of auxiliaries are charted. With the energy loss models available, a calculation procedure is introduced to optimise the flywheel as a subsystem in which the rotor geometry, the safety containment, and the vacuum system are designed for minimum energy use within the context of automotive applications. A first prototype of the flywheel system was tested experimentally and subsequently redesigned to improve rotordynamics and safety aspects. Coast-down experiments with the improved version show that the energy losses have been lowered significantly. The use of a kinetic energy storage device enables the uncoupling of vehicle wheel power and engine power. Therefore, the engine can be smaller and it can be chosen to operate in its region of best efficiency in start-stop mode. On a test-rig, the measured engine fuel consumption was reduced with more than 30 percent when the engine is intermittently restarted with the aid of the flywheel system. Although the start-stop mode proves to be advantageous for fuel consumption, exhaust gas emissions increase temporarily